This disease is seen rarely in the United States but has been prevalent in the Philippines and in most Oriental countries. It is not only common there but very fatal. Foods have long been blamed for its production. That it occurred oftener among those who ate almost exclusively polished rice than others has been observed in many places and first lead to the suspicion that rice was its cause. When in the Japanese navy meat was added to the sailors diet the disease which had been very prevalent lessened and almost disappeared. Elsewhere it was observed that if other vegetables rich in phosphorus were eaten with rice the frequency of beri-beri lessened.

John M. Little has described Beri Beri in Newfoundland - He sees cases of it frequently of late years, especially at certain seasons, when the inhabitants live exclusively on bread and tea. Formerly when they used whole wheat bread the disease did not exist but since fine wheat flour has been used the disease has appeared. It is curable by a mixed diet and good hygienic surroundings. {Jul. Am. Med. Ass. June 29, 1912, p. 2029.)

Frasar, Stanton and others have shown that a disease similar clinically and anatomically to beri-beri can be produced in fowls by feeding them on polished rice. It has also been shown that in its early stages this experimentally produced disease can be cured by feeding the birds meat with rice or by adding the polishings or bran to the rice.

Drs. Chamberlain and Vedder, members of the United States Army studying tropical diseases as they exist in the Philippine Islands, state that the pathology and symptom-complex of the two diseases, polyneuritis gallinarum and human beri-beri, are practically the same with the exception that edema is commonly observed in beri-beri and only rarely found in the multiple neuritis of fowls. The similarity, they remark, is so striking that it is hard to avoid the conclusion that the two conditions are due to the same pathologic process causing, as might quite naturally be expected, slightly different manifestations in diverse species. The surprising thing is not that there are minor differences in symptomatology, but rather that the similarity is as great as it is. This lends great importance to the use of fowls in the experimental study of the etiology of beri-beri.

More recently men afflicted with the malady have been cured by a change from a diet of polished rice to meat and other vegetables. It has also been observed that in groups of men some fed on polished rice and others upon unpolished rice the disease did not appear among the latter but did among the former. All these facts leave no doubt of the causative relationship of polished rice to the disease. 26

Polished rice is made by modern milling machinery which removes the husk and leaves only the white starch of the center of the grain. With the husk, fat and phosphorus compounds are also removed. Although the relative proportion of phosphorus compounds in rice is a good criterion of its whole-someness as a food, experiment does not warrant the belief that the lack of phosphorus is the cause of beri-beri. For the administration of phosphorus, phosphates and other mineral salts does not cure or prevent the disease.

During the last year it has been shown that the substance which prevents beri-beri when unpolished rice is eaten is soluble in water, in alcohol and in 0.3 per cent, of hydrochloric acid. Moreover, it has been shown to be a substance which will not pass through a dialyzer. Funk believes that it is an organic base which is completely precipitated by phosphotungstic acid, by silver nitrate and baryta. It occurs in very minute quantities, there being not more than 0. 1 grams per kilo of rice.1 These are important facts and throw light on the nature of the cause of the disease.

Although until recently beri-beri has been regarded as a most fatal malady it is now shown to be curable, if treated early, and quite preventable. For its cure a mixed and varied diet, generous in meat and phosphorus-bearing foods, is needed and the exclusion of polished rice. Rice polishings when fed to birds in whom this form of polyneuritis has been produced will cure the disease, as will a more varied diet; especially one containing meat. The dose of the material in rice polishings which will cure pigeons is minute, according to Funk not more than .004 gram.

It is significant that according to Hulshoff-Pol and Chamberlain and Vedder, decoctions of white beans cure polyneuritis in fowls. The same substance which is present in the rice millings, or a similar substance, is present in a decoction of ordinary white beans; in fact, bodies corresponding to them are found among the decomposition products of the proteins. These facts are of importance, since they suggest that beans can be used as a preventive of beri-beri, in the rations of the

1 Funk: "The Chemical Nature of the Substance which cures Polyneuritis in Birds induced by a Diet of Polished Rice." Journal Physiology, 1911, XLIII, 395.

native Philipine troops, native prisoners and others whose diet by preference consists largely of rice. This is a useful discovery because if the natives do not care for mongos, or the other articles introduced into the ration for the purpose of preventing beri-beri, they will not eat them, but will live on an almost exclusive diet of rice; however, the man, native or white, who does not relish well-cooked beans is hard to find." W. H. Jefferys has {Jul. Am. Med. Ass. July 12, 1912, p. 201) called attention to the fact that H. W. Boone, of the staff of St. Lukes Hospital, Shanghai, and others have relied upon beans for ten years to effect a cure in this disease.

V. G. Heiser in "Medical Observations in Islands of South Pacific Ocean" describes symptoms of an infantile disease which is probably beri-beri of infancy.

"The mothers have all had symptoms of incipient or marked beri-beri. A number of these mothers have previously had infants die with symptoms similar to those presented by the children which were studied. In every case the diet of the mother had been chiefly highly milled rice with a little fish and occasionally a bit of meat. The children have all been breast fed. With one exception all have been under three months of age. The disease usually has been ushered in with vomiting, which after a few days was followed by great restlessness, sleeplessness, continual whining and later by dyspnea, increased cardiac action and edema of the face and legs. Later still, oliguria and aphonia developed in many of the patients. About one-half of those treated had aphonia, and some appeared to be at the point of death. On the other hand, several cases were milder.

"The infants were all given twenty drops of the extract of rice polishings every two hours while awake, and the results have been truly marvelous. Improvement is immediate. The vomiting stops in twenty-four or thirty-six hours. The child, who has not passed any urine for several days, urinates five or six times freely. The edema disappears in the course of a few days. Usually on the first night after treatment is begun the infant falls into a deep sleep, although it may have been practically sleepless for several weeks. The dyspnea and palpitation cease after two or three days. At the end of a week, or in less time, the patients are completely cured with the exception of the aphonia. The mother is positive that the baby is well and she would be completely satisfied if only it would recover its voice. The aphonia, however, does not disappear until after about two months of treatment, when the voice usually returns quite suddenly. This is probably due to the fact that the aphonia is caused by degeneration of the pneumo-gastric nerve, which only slowly regenerates." These results have been confirmed by Chamberlain and Vedder.

To prevent beri-beri the use of polished rice (and probably the use of finely milled wheat) as an exclusive diet must be forbidden or better still its manufacture and sale prevented.

It seems probable that beri-beri which has been so common and so fatal in the Orient may be made as rare as it was common and possibly may be exterminated by dietetic management and by the correct manufacture of rice as a food.