In addition to bad ventilation and overcrowding, it is also recognized that insufficient diet encourages the develop ment of the disease. But it should be borne in mind that these conditions foster, but do not generate, beriberi. The morbid entity which causes it must be imported into the locality in which the vicious environment, prevails: an en vironment which is eminently favorable to the development of many other epi demic diseases. Editorial (Lancet, Aug. 14, '97).
In the seventy-one cases which oc curred in the Insane Hospital at Tusca loosa, Ala., the first case developed in February, 1S95. The disease was not again seen until November. 1S95, when almost simultaneously seven cases de veloped among the white female patients.
During the succeeding six weeks five eases made their appearance, all of simi lar type. After a period of immunity the disease reappeared in the late sum mer of 1S90, when, following a season of unusual dryness and distressing heat, fifty-eight patients were attacked. State ment giving the average population of the hospital during the period covered by the outbreak:— Peculiar distribution among the sev eral classes of insane patients: every one of the seventy-one patients attacked was the subject of a psychical degenera tive form of mental disorder. E. D. Bondurant (N. Y. Med. Jour., Nov. 20, 97).
The nature of the food, as shown in the results obtained by a change of diet in the Japanese navy, has an important bearing upon the development of the disease. The influence is but an indi rect one, however, operating also by pre paring the field for microbic infection, the latter only taking place when the person enters an infected abode.
Rapid spread in Brazil; rice the cause. Azevedo (Deutsche med. Zeit., Aug. 25, '90).
The aboriginal Aino, a great fish-eater, is very rarely attacked. Grimm (Deut sche med. Koch., Oct. 23, '90).
Rice-eating has weight in the etiology. Takaki (Sci-I-Kwai INfed. Jour., Oct. 25, '90).
The disease due to abnormal fermenta tion in the intestines under certain cir cumstances, the ferment being, perhaps, a micro-organism. Owi (Sei-I-Kwai Med. ,Tour., Jan. 23, '92).
Success in controlling a considerable number of cases of beriberi in the Japan ese navy, by adopting a food-regimen in which rice is, for the greater part, re placed by beef, pork, eggs, etc. Of 3063
cases per million in I883, in 1889 there were only 3SS. Takaki (Brit. Med. Jour., Sept. 24, '92).
Three eases in which the cause of the disease seemed to be the use of old pre serves, in which, however, the pathog enic agent was not to be found. Kirch berg (Gaz. Med. de Nantes, Dec. 12, '93).
Ascribed to eating diseased tunny-fish. It was common in the Japanese navy until fish was abolished from the diet; vegetable-eating prisoners are also ex empt. Miura. (Virehow's Archly, vol. cxix).
Cases in which microscopical and bac teriological examination showed blood to be free from any parasites. Disease prob ably due to toxemia caused by pto maines derived from special kinds of food. Judson Daland (N. Y. Med. Jour.. Mar. 9, '95).
A toxemia of alimentary origin (rice, fish) ; for cure, European rations indi cated. Grail, Porce, and Vincent (Revue Inter. de Med. et de Chin, July 10, '95).
In stamping out the disease in the Japanese navy, however, besides the im proved dietary, very important hygienic improvements were introduced at the same time. D. C. Rees (Brit. Sled. Jour.. Sept. 18, '97).
The seventy-one cases at Tuscaloosa seemingly due to use of water contami nated by decaying vegetable matter. E. D. Bondurant (N. Y. Sled. Jour., Nov. 20, '97).
Attention drawn to spread of this dis ease to suckling infants through the milk of nursing mothers suffering from it. Of 52 eases in such infants, 42 re covered and 5 died, the result in the re maining 5 eases being unknown. Cows' milk or condensed milk was mostly sub stituted for human milk. Improvement occurred almost at once. It is personally maintained that the disease is really due to an intoxication brought about by the milk, and that the only sure cure is to withhold the milk, and this before the disease is too advanced. Hirota (Cen tralb. f. innere Sled., Apr. 23, '98).
Cold and damp have been regarded as etiological factors, the disease occurring most frequently on board of ships during the winter, probably owing to the fact that those exposed are more likely to remain huddled together in close quar ters than during other seasons. The re cent epidemics at the Richmond Asylum and at Tuscaloosa, Ala., however, oc curred during the warm months, and the latter during a period of excessive dryness.