JETIOLOGY 1677 



The deficiency theor}^ in some form is at the present time accepted 

 ali over the world, but there are still some observers who think 

 that there may be more than one form of disease concealed under the 

 name beri-beri. 



The following objections have been raised against the food theory: — 



(1) Beri-beri may occur in people who do not feed on rice. We have 



seen an epidemic among officers on a man-of-war. 



(2) The geographical distribution. In populations eating the same kind 



of rice some suffer from beri-beri and others do not. 



(3) Tamil coolies in Ceylon do not get beri-beri, though they suffer 



from this disease in the Straits Settlements, In both countries 

 they are mostly supplied with the same kind of rice {Rangoon rice). 



(4) People recovered from beri-beri go back to their usual rice diet without 



again suffering from the disease. Thus in the Malay States the 

 mortality is only 20 per cent.; therefore 80 per cent, of sufferers 

 recover. Do these people change their diet ? 



Fraga, having failed to produce beri-beri in prisoners fed on polished rice, 

 believes that dietary deficiency acts merely as a predisposing cause. 



(&) Deficient Nitrogen. — Previous to 1884, 33 per cent, of the sailors in the 

 Japanese Navy were disabled owing to beri-beri. 



In 1883 the Ryujo, a Japanese warship, went on a voyage of 271 days to 

 New Zealand and South America, and developed 160 cases of the disease 

 out of a crew of 350 men. Takaki investigated this outbreak, and came 

 to the conclusion that there was too little nitrogen in the diet, the nutritive 

 value of which was: Proteids, i09'29 grammes; fats, 15-8 grammes; carbo- 

 hydrates, 622'32 grammes. He therefore changed the diet to: proteids, 

 196 grammes; fats, 43 grammes; and carbohydrates, 775 grammes; and on 

 this dietary the warship Taukuba was sent the same cruise, taking 287 days, 

 and only suffered from sixteen cases of the disease. Takaki attributed 

 the success to the increased nitrogen, a portion of the rice being replaced 

 by corn or bread; but Fales has pointed out that fresh vegetables were in- 

 creased from 215 grammes to 450 grammes, and that therefore nitrogen 

 alone may not have been the cause of the decrease of the disease. This 

 dietary was applied to the Japanese Army and Navy, and beri-beri decreased 

 enormously. But Baelz has pointed out that this decrease was associated 

 with a great improvement in general hygiene, and that it also took place 

 in barracks in which the food had not been changed. A similar decrease in 

 the Dutch-Indian Navy, associated with a better diet, was attributed by some 

 to the improved hygiene rather than to the diet. 



(c) Deficient Fat. — Bremaud and Laurent believe that the disease is due to 

 too little fat in the food, and consider that an epidemic at Chaudabum, in 

 Siam, was stopped by causing fat to be more freely consumed by the healthy. 

 This theory, however, has found but little support. 



{d) Deficient Vegetables, together with an Infection. — Fales, from a study of 

 an outbreak of an epidemic of beri-beri in the Bilibid Prison, in Manila, came 

 to the conclusion that the lack of fresh vegetables conduced powerfully to 

 both beri-beri and scurvy. 



In November, 1901, there were two cases of the disease, and no deaths, 

 in that gaol. The food was then changed to a ration consisting of 97*17 

 grammes of proteids, i7'24 grammes of fats, 491*04 grammes of carbo- 

 hydrates, and 26*52 grammes of salts. In this diet there were 85*05 grammes 

 of potatoes, and 453*60 grammes of rice. Put into other figures, this diet 

 consisted of: Nitrogen, 172*1 grammes; carbon, 4,1 66*5 grammes; hydrogen, 

 61 '9 grammes; sulphur, 13*2 grammes; salts, 140-2 grammes — the propor- 

 tion of nitrogen to carbon being as i to 24*2. Whereas, calculating the 

 weight of Filipinos at 125 pounds, it was estimated that proteids ought, 

 according to Voigt's diet, to have been at least 94 grammes, fats 45 grammes, 

 and carbohydrates 400 grammes ; or, according to Moleschott's diet, nitrogen 

 256 grammes; carbon, 3,789 grammes; hydrogen, 143 grammes; sulphur, 

 23 grammes; salts, 172 grammes — i.e., N: C :: i : 0*15. 



