In 1897, Eijkmann, a Dutch physician who was medical officer at a prison in Java, noted that a number of fowls which he was maintaining for experimental purposes had developed symptoms curiously like those of his human cases of beriberi. Careful observation showed that these symptoms were the result of an exclusive diet of polished rice, and that they disappeared on administration of rice polishings or substitution of hand-milled ("unpolished") for the machine-milled rice.14 The name polyneuritis gallinarum was given by Eijkmann to the derangement as manifested in birds, and is still used to designate the avian disease, although practically all the latter researches tend to confirm the identity of this disease with human beriberi. Fraga,15 however, dissents from this view, on the basis of an experiment in which a diet of polished rice, or polished rice plus either sterilized rice or sterilized beans was fed to nine convicts in solitary confinement, who volunteered for the experiment. The sterilized diet was distasteful to the subjects and was dropped at the thirty-sixth day on account of the onset of digestive disturbances, although no nervous disturbance developed. Another group remained on the diet for 43 days without the appearance of any symptoms.

These rations produced typical polyneuritis gallinarum in fowls. Fraga concludes that avian polyneuritis and human beriberi are distinct morbid identities, but that dietary deficiencies act as a predisposing cause for beriberi in man.

14 Eijkmann, Arch. f. path. Anat. 148, 523; 149, 197, 1897; Arch. f. Hyg. 58, 150, 1906; Arch. Schiffs. u. Tropen-Hyg. 15, 699; 17, 328, 1913; Zentr. Bioch. Biophys. 12, 505.

15 Fraga, Brazil, Med. 33, 49, 1919.

Starting with the assumption that the polished rice diet was in some way responsible for the onset of the disease in fowls, Eijkmann investigated the diets in the Javanese prisons.

Taking the prison population at nearly 300,000, there was one case of beriberi per 10,000 among those living on unpolished rice, 416 per 10,000 among those living on a mixture of polished and unpolished rice and 3900 per 10,000 among those on polished rice. Experiments showed the missing element in the rice to be found in the layer of tissue under the husk known as silver skin, in the embryo, and in the bran. From these investigations, Eijkmann concluded that the substance which was removed neutralized another factor in the whole which was harmful.

Eijkmann's observations have been repeatedly confirmed both with fowls and with human subjects. Fletcher,16 by experimenting with the diet in a lunatic asylum, demonstrated that when 28 ounces of rice was fed daily with only small amounts of other food the onset of the disease depended solely on whether the rice used was polished or unpolished. Fraser and Stanton17 showed that the disease appeared among Japanese coolies after 80 to 90 days on a diet consisting mainly of polished rice, whereas a similar ration of unpolished rice appeared to confer immunity. Grieg18 studied beriberi in India and also experimented with pigeons. He noted that those living mostly on polished rice and highly milled wheat showed much greater predisposition to the disease than those whose diet was more varied. Pigeons fed upon polished rice developed polyneuritis, while those fed on a mixture of wheat and pulses showed no symptoms of functional disturbances. Couzien19 reported cases from Tonkin, which disappeared when the white rice in the diet was replaced by fresh handmilled rice.

Cooper and Braddon20 demonstrated that the time of onset of polyneuritis in birds varied inversely with the quantity of polished rice fed to them.21

16 Quoted by Sherman, "Chemistry of Food and Nutrition/1 2nd Ed. p. 320.

17 Fraser and Stanton, Studies from Inst, for Med. Res. Fed. Malay States, Nos. 10 and 12; Lane. 1909, 1, 451.

18 Grieg, Sci. Mem. Med. San. Depts. India N. ser. 1911, No. 45.

19 Couzien, Ann. Hyg. Med. colon. 15, 445; Zentral. Bioch. Biophys. 14, 909.

The prevalence of this disease among the Philippine scouts led to interesting dietetic experiments by Chamberlain and his associates." When their investigation began the customary ration consisted of 12 ounces of fresh beef or its equivalent in bacon, canned meat or fish, 8 ounces white flour or bread, 8 ounces potatoes or onions, and 20 ounces of rice (polished). The only alteration made was the substitution of 16 ounces of unpolished rice and 1.6 ounces of dried beans for the 20 ounces of polished rice. Chamberlain states that the change to unpolished rice would have been unnecessary if they could have ensured the regular consumption of the bean ration by all the men, since even this small quantity of beans was quite sufficient to afford protection. In the course of two years after this change of diet the disease was practically eradicated.

Cox 23 reports that the Bureau of Science began to prepare extract of rice polishings in 1914, in which year 889 children under one year of age died of beriberi in Manila. Since then the amount of this extract used has steadily increased, with corresponding decrease in fatalities until now the only deaths from infantile beriberi recorded are a few cases in which illness was not reported to the health authorities until too late for treatment, as compared with the mortality of 95 per cent of all children attacked in 1914.

20 Cooper and Braddon, J. Hyg. 14, 331, 1914.

21 See also Weill and Monriquand, Bull, de la. 000. ped. 16; J. Am. Med. Abb. 62, 1510; Strong and Crowell, Phil. J. Sci. 7B, 271; Vedder, Ib„ 415; Funk, Z. phys. Chem. 89, 373; Fargier, Ann. Hyg. Med. Col. 15, 491; DeMello, Lonndro, and Rebello, Anals. Scient. da Fac. de Med. do Porto, 4, 6, 1917; McCarrison, Ind. J. Med. Res. 6, 275, 550, 1919; Riddell, Smith, and Igara-videi, J. Am. Med. Abb. Feb. 22, 1919.

22 Chamberlain, Phil. J. Sci. 63, 133, 1911; J. Am. Med. Abb. 64, 1215, 1915; Chamberlain and Vedder, Phil. J. Sci. 6B, 25, 395; Chamberlain, Bloom-bergh, and Kilbonrne, lb. 6, 177; Chamberlain, Vedder and Williams, lb. 7B, 39, 1911-12.

23 Cox, AnnL Rep. Phil. Bur. Sci. 1918.