History.—While modern knowledge of beriberi may be said to date from the writings of Bontius, in 1642, yet the disease is distinctly described by Chinese writers of the seventh century and treated in writings of the second century and possibly referred to in writings as ancient as B. C. 2697. It is probable that the disease described by Strabo as occurring in a Roman army while invading Arabia, in 24 B. C., was beriberi. While mention of the disease may be found in Japanese writings of the ninth century it is thought by Scheube that this relates to the disease in China and that beriberi first appeared in Japan about the eighteenth century. Bontius described the atrophic form of the disease, Rogers, in 1808, the serous effusions, and Marshall, in 1812, noted two types, barbiers, when the paralysis predominated, and beriberi, when the dyspnoea and oedema were leading features.
In 1835 Malcolmson noted that cases of beriberi assumed the type of barbiers and vice versa, from this time the view has obtained that the two affections belong to one disease.
The disease seems to have first made its appearance in Brazil in 1866.
Fig. 82.—Geographical distribution of Beriberi.
Geographical Distribution.—Reference to the chart will show 3 markedly endemic centers for beriberi, one embracing Japan, a second the Dutch East Indies (Java, Borneo, Sumatra), and a third, involving the Eastern coast of Brazil. In somewhat less degree the disease prevails in India, Indo-China, Malay Peninsula, Eastern China, and the Philippine Islands. It is also found in the regions of the East and West Coasts of Africa, and was devastating to the laborers on the Congo railway. It has been reported from many parts of the world among coolies from Asiatic countries. A disease of similar nature has been noted in asylums in England and America. Beriberi occurred among the British soldiers in Mesopotamia during the recent war—more than 300 cases in 1915. It is interesting to note that scurvy, and not beriberi, occurred among the Indian troops in Mesopotamia at this time. There was no scurvy in the British troops.
Etiology and Epidemiology
Etiology.—There is probably no disease about which there exist so many views as to etiology as with beriberi. Many of those formerly advanced are so negatived by recent investigations that it would seem hardly worth while to mention them. While the cause is still unsolved attention is at present almost exclusively directed to some deficiency of a neuritis-preventing substance in the dietary and such studies have in large part centered about the question of such deficiencies in certain kinds of rice.
Reserving until the last the discussion of the rice theories we may briefly dismiss such views as those assigning bacterial or protozoal causes with the exception of those of Manson and Hamilton Wright.
Manson’s Theory.—Under conditions of overcrowding, filth, warmth, moisture and lack of ventilation, as would obtain in the forecastle of a ship carrying a native crew, the development of a hypothetical germ is favored. This germ in its growth gives off emanations which like alcohol act as toxins upon the peripheral nerves. The germ itself does not infect the patient.