Rice.  One of the most prominent and relied-upon staples, cooked in any variety of dishes the world over, and a vital source of nutrition for millions of people on our planet.  I love it; one of my favorite foods that, at times, it seems I just cannot get enough of.  However, this seemingly innocuous ellipsoid was, at one point, the source of an illness that ravaged a large portion of the Royal Fleet in the 18th and 19th centuries.  One arguably more virulent and more mysterious than that of even the famous scurvy.  The disease I speak of is called beriberi; an illness which killed many sailors in the age of sail, and perplexed physicians and surgeons for around a century.

You may ask: what kind of a name is “beriberi” anyway?  If so, you would be joining the masses who, for more than two centuries, have asked that very same question and received the same ambiguous, imprecise answer, “We’re not sure.”  How can this be??  Almost every characterized disease has its roots in the foundations of modern medicine, forged through the use of Latin, and a carefully sculpted (though I can assure you it does not always seem so) and beautifully convoluted (think Rube Goldberg here) terminology.  We have a meticulously documented name, differential description, set of symptoms, and so on, for just about every ailment under the sun, so how is it possible that for this one we “just don’t know?”  I must admit that the enigmatic origins of the disease’s name piqued my interests.  Zachary Friedenberg, author of the book I am now reading (and also enjoying immensely) titled, Medicine Under Sail, describes the proposed origins for the title of beriberi.  It is thought that it might originate from Sri Lanka, where beri beri literally means, “I can’t, I can’t.”  This was in reference to the fact that the affected were so sick that they could not rise to greet the doctor when he arrived to treat them.  Another postulated source for the name comes from the Arabic words, bhur (which means shortness of breath - or asthma) and bhari (which means marine).  Regardless of the number of conjectures, the definitive source of the name is lost to history.

As for the symptoms of beriberi, they were anything but ambiguous, and followed a definitive course to certain death during the age of sail.  They began with anesthesia (loss of sensation) and tingling in the lower extremities, which was followed by edema and swelling in the same region.  The edema spread to include the entirety of the legs, as did the numbness and weakness of the muscles, eventually leading to paralysis.  In the thorax, the edema was just as prominent and significantly more dangerous.  As it affected the lungs, breathing became labored and difficult.  The heart followed with searing pain developing, and leading, both eventually and imminently, to sudden death.  This was, of course, a terrible and hopeless situation for the affected because as soon as it was contracted, they were given a death sentence; the people they looked to for treatment and guidance not only being powerless to help them, but also at a loss to even tell them what it was that was killing them.  Autopsies were performed on the patients who died of beriberi, and some startling findings were made.  The entirety of the chest cavity was filled with fluid, and it was obvious that the peripheral nerves (apart from the central nervous system - brain and spinal cord) had been greatly affected by the disease course.

The strangest factor, at least to the surgeons of the time, was the pattern of who contracted this disease.  The lascars, or Indian crew members serving aboard British naval vessels, contracted beriberi in droves.  Their living condition were poor and unsanitary; a factor that many pointed to as the source of the disease.  However, the other crew members living in direct proximity to them did not contract the illness.  It was also noticed that the Japanese, and far-Eastern cultures, were diagnosed far more often than those of the West.  This aspect was despite socioeconomic status.  Therefore, many concluded and wrongly so, that diet had nothing to do with it.  If a poor person with a poor diet in the Britain did not get it, but a similar person in Japan did, then the diet was obviously not the cause.  As an aside, this sort of egocentric rationalization speaks volumes to the view that the “superior” powers of the world had.  To me, it is almost unbelievable that one could even come to such conclusions since any person could easily recognize that a diet in one country is different than the diet in another.  Many did notice this, the age of sail was not devoid of great thinkers, but it is the huge amount of people who did not see this that leaves one befuddled.  The miasma theory (previous post) showed its face as well, with many surgeons pointing to the poor quality of the air aboard ships as the cause of beriberi.  However, the more astute and creative thinkers of the time did begin to notice patterns in the diets of those affected with the disease versus those who less likely to contract it.  There was one staple that all of their cultures shared, and this was, of course, rice.

What was it about the rice that caused beriberi?  It was the vitamins, or rather, the lack thereof.  Rice is an excellent source of one of the most important vitamins, thiamine (also called vitamin B1).  Thiamine is an essential factor in our body’s ability to metabolize carbohydrates, proteins, and fats.  As one might imagine, if we become deficient, this spells trouble for many bodily processes as these building blocks are absolutely necessary for our body to function correctly.  The milling and refining process of the time, used in the harvesting and preparation of rice for consumption by the masses, effectively cleansed the rice of any measurable amount of this vitamin.  Therefore, people eating this milled rice as a large, or the sole, staple in their diet, would almost certainly come down with beriberi.  It took nearly a century for this very simple relationship between deficiency and disease to be brought to light.  This was in part due to the lack of creative thinking, but even more so, due to the lack of proper means of elucidation.  In modern times, we can easily measure the amount of thiamine in a food source, however, such methods were obviously not in existence during this period.  Many were aware of this, even then, yet they persevered despite their frustrating lack of resources.  Thomas Christie, Inspector General of Hospitals in Colombo, Ceylon in the early 19th century recorded the following in his characterization of beriberi: “I can suppose the difference to depend on some nice chemical combination which I have not sufficient confidence in my knowledge to explain.” (Friedenberg 2002)  The cause was eventually clarified, yet many crew members suffered grievously and died agonizing deaths in the interim.