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British India and the “Beriberi Problem”, 1798–1942

Published online by Cambridge University Press:  17 May 2012

David Arnold
David Arnold
Affiliation:
David Arnold, BA, DPhil, Department of History, University of Warwick, Coventry CV4 7AL, UK; e-mail: d.arnold@warwick.ac.uk
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Information
Medical History , Volume 54 , Issue 3 , July 2010 , pp. 295 - 314
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Copyright © The Author(s) 2010. Published by Cambridge University Press

References

1 Patrick Manson, Tropical diseases: a manual of the diseases of warm climates, London, Cassell, 1898, p. 223.

2 Ibid., p. 223.

3 Ibid., pp. 228–9.

4 McCarrison cited this passage in his own attempt, thirty years later, to describe the defining physical characteristics of beriberi: Robert McCarrison, Beri-beri columbarum, Calcutta, Thacker, Spink, 1928, p. 1.

5 Manson, op. cit., note 1 above, p. 233.

6 Ibid., pp. 233, 235, 238.

7 Report on the medical topography and statistics of the Northern, Hyderabad and Nagpore Divisions, the Tenasserim Provinces, and the Eastern Settlements, Madras, Vepery Mission Press, 1844, p. 89. Morehead cautioned against the “unnecessary introduction” of the word “beriberi” into Indian nosology as tending to “retard and obscure” the knowledge of what he regarded as a form of “general dropsy”: Charles Morehead, Clinical researches on disease in India, 2 vols, London, Longman, Brown, Green and Longmans, 1856, vol. 2, p. 685.

8 Robert R Williams, Towards the conquest of beriberi, Cambridge, MA, Harvard University Press, 1961; K Codell Carter, ‘The germ theory, beriberi, and the deficiency theory of disease’, Med. Hist., 1977, 21: 119–36; Kenneth J Carpenter, Beriberi, white rice, and vitamin B: a disease, a cause, and a cure, Berkeley, University of California Press, 2000; Ken De Bevoise, Agents of the apocalypse: epidemic disease in the colonial Philippines, Princeton University Press, ch. 5; Lenore Manderson, Sickness and the state: health and illness in colonial Malaya, 1870–1940, Cambridge University Press, 1996, pp. 90–2; Julyan G Peard, Race, place, and medicine: the idea of the tropics in nineteenth-century Brazilian medicine, Durham, NC, Duke University Press, 1999, pp. 51–63; Anne Hardy, ‘Beriberi, vitamin B1 and world food policy, 1925–1970’, Med. Hist., 1995, 39: 61–77.

9 Williams, op. cit., note 8 above, p. 13.

10 On “monsoon Asia”, see Robert Orr Whyte, Rural nutrition in monsoon Asia, Kuala Lumpur, Oxford University Press, 1974; V D Wickizer and M K Bennett, The rice economy of monsoon Asia, Stanford University Press, 1941, pp. 1–4.

11 Edward B Vedder, Beriberi, London, John Bale, Sons and Danielsson, 1913, pp. 1–9; Harold J Cook, Matters of exchange: commerce, medicine, and science in the Dutch golden age, New Haven, Yale University Press, 2007, pp. 195–6.

12 George M Giles, A report of an investigation into the causes of the diseases known in Assam as kála-azár and beri-beri, Shillong, Assam Secretariat Press, 1890, p. 1.

13 William Hunter, An essay on the diseases incident to Indian seamen, or lascars, on long voyages, Calcutta, The Honourable Company's Press, 1804, pp. 77–141.

14 Ibid., pp. 86, 128.

15 Ibid., pp. 77–80.

16 Ibid., pp. 79, 128.

17 Ibid., pp. 82, 86. The idea of beriberi as a scurvy-like complaint was a recurrent one: Morehead, op. cit., note 7 above, vol. 2, pp. 685–99; E D W Greig, Epidemic dropsy in Calcutta, Calcutta, Superintendent of Government Printing, India, 1911, pp. 6–8. That scurvy resulted from “a defect of nourishment”, and might be found on land as well as sea, was well established in early nineteenth-century medical literature in India: B Burt, ‘On land scurvy among the natives’, Transactions of the Medical and Physical Society of Calcutta, 1829, 4: 14–20.

18 But see James Johnson and James Ranald Martin, The influence of tropical climates on European constitutions, New York, Samuel and William Wood, 1846, p. 385, where Christie's views on “debauchery” as predisposing to beriberi are cited.

19 Including an anonymous essay cited in Report on the medical topography, op. cit., note 7 above, pp. 89–96; P W Wright, ‘Remarks on beriberi’, Edin. Med. Surg. J., 1834, 41: 323–9. Wright's essay was one of the four submitted to the Madras Medical Board in 1833.

20 Madras Consultations, 11 May 1832, Board's Collections F/4/1454: 57130, India Office Records (hereafter IOR), British Library, London.

21 John Grant Malcolmson, A practical essay on the history and treatment of beriberi, Madras, Vepery Mission Press, 1835, pp. i, 2–6, 296–311.

22 Mark Harrison, ‘Differences of degree: representations of India in British medical topography, 1820–c.1870’, in Nicolaas A Rupke (ed.), Medical geography in historical perspective, London, Wellcome Trust Centre for the History of Medicine at UCL, 2000, pp. 51–69.

23 Malcolmson, op. cit., note 21 above, p. 27.

24 Ibid., p. 16. For the seasonality of acute thiamine deficiency, see Whyte, op. cit., note 10 above, pp. 33–6.

25 Malcolmson, op. cit., note 21 above, pp. 21–5. On “seasoning”, see Mark Harrison, Climates and constitutions: health, race, environment and British imperialism in India, 1600–1850, New Delhi, Oxford University Press, 1999, pp. 88–92.

26 Other writers blamed the “low, damp and more or less swampy” conditions of the Northern Circars: Wright, op. cit., note 19 above, p. 323; Report on the medical topography, op. cit., note 7 above, p. 89.

27 Malcolmson, op. cit., note 21 above, pp. 42, 46.

28 William Campbell Maclean, Diseases of tropical climates, London, Macmillan, 1886, p. 311; Giles, op. cit., note 12 above, p. 1; C M E Dubruel, Le béribéri, Paris, J-B Baillière, 1906, p. 7.

29 James Bankier, Essay on the origin, progress and treatment of cholera, with remarks on berriberri and diet, Madras, J B Pharoah, 1835, pp. 409–10. The idea of beriberi as a contagious disease had a long history, and not just in South Asia: e.g., B Scheube, The diseases of warm countries: a handbook for medical men, 2nd ed., London, John Bale, Sons and Danielsson, 1903, p. 191.

30 In India beriberi occurred almost entirely among Madrasi troops, who formed a declining proportion of the Indian Army. In 1905 there were 15 hospital admissions for beriberi among Indian troops with two deaths: Annual report of the sanitary commissioner with the Government of India, 1905, p. 126.

31 Malcolmson, op. cit., note 21 above, pp. 9, 13–14; Morehead, op. cit., note 7 above, 2: 684–90.

32 Report on the medical topography, op. cit., note 7 above.

33 Report on the medical topography and statistics of the Ceded Districts, Madras, Vepery Mission Press, 1844, pp. 24, 27, 58.

34 Alexander Porter, The diseases of the Madras famine of 1877–78, Madras, Superintendent, Government Press, 1889.

35 David Arnold, ‘The “discovery” of malnutrition and diet in colonial India’, Indian Econ. Soc. Hist. Rev., 1994, 31: 1–26.

36 W F Thomas, ‘Beri-beri’, Indian Med. Gaz., 1889, 24: 107–10.

37 J Smyth, ‘Beri-beri’, Br. Med. J., 1889, i: 193.

38 Mark Harrison, ‘A question of locality: the identity of cholera in British India, 1860–1890’, in David Arnold (ed.), Warm climates and western medicine: the emergence of tropical medicine, 1500–1900, Amsterdam, Rodopi, 1996, pp. 133–59.

39 Maclean, op. cit., note 28 above, pp. 308–20.

40 C Barry, ‘Notes on beri-beri in Rangoon’, Indian Med. Gaz., 1900, 35: 343–5; T K Munro, ‘A case of ship beri-beri’, Lancet, 1909, i: 529–30.

41 Maclean, op. cit., note 28 above, p. 308.

42 Giles, op. cit., note 12 above, pp. 1–3; C P Costello, ‘Remarks on the anaemia of coolies, or the beriberi of Ceylon as found in Assam’, Annual sanitary report of the province of Assam, 1888, p. 20.

43 W J Buchanan, ‘Beri-beri and rice’, Lancet, 1898, ii: 577–8.

44 Norman Chevers, A commentary on the diseases of India, London, J and A Churchill, 1886, p. 60.

45 Ibid., pp. 61–2.

46 Kenneth Macleod, ‘Beri-beri and epidemic dropsy’, in William Ernest Jennings (ed.), Transactions of the Bombay Medical Congress, 1909, Bombay, Bennett, Coleman, 1909, pp. 273–5.

47 Greig, op. cit., note 17 above; Hugh W Acton and R N Chopra, ‘The problem of epidemic dropsy and beriberi’, Indian Med. Gaz., 1925, 60: 1–18.

48 R B Lal and A C Gupta, ‘Investigations into epidemic dropsy’, Indian J. Med. Res., 1941, 29: 157–65.

49 For example, Vedder, op. cit., note 11 above, p. 296.

50 In 1894 Scheube listed 363 works on beriberi: B Scheube, Die Beriberi-krankheit: eine geographisch-medicinische Studie, Jena, Gustav Fischer, 1894, pp. 207–18. In 1903 he revised this list to include many recent publications: Scheube, op. cit., note 29 above, pp. 222–6.

51 Carpenter, op. cit., note 8 above, chs 3–6.

52 W R Aykroyd, ‘The Nutrition Research Laboratories, Coonoor’, in H M Sinclair (ed.), The work of Sir Robert McCarrison, London, Faber and Faber, 1953, pp. xi–xxix, on p. xiii.

53 On the development of the Indian medical services and their outlook, see David Arnold, Colonizing the body: state medicine and epidemic disease in nineteenth-century India, Berkeley, University of California Press, 1993; Mark Harrison, Public health in British India: Anglo-Indian preventive medicine, 1859–1914, Cambridge University Press, 1994; Anil Kumar, Medicine and the Raj: British medical policy in India, 1835–1911, New Delhi, Sage, 1998.

54 In the 1930s Vietnam exported more than a billion francs’ worth of rice, equivalent to nearly half its export trade: Charles Robequain, The economic development of French Indo-China, London, Oxford University Press, 1944, pp. 276, 310.

55 But see Annual report of the Public Health Commissioner with the Government of India, 1930, vol. 1, map facing p. 134; J W D Megaw, S P Bhattacharji and B K Paul, ‘Further observations on the epidemic dropsy form of beri-beri’, Indian Med. Gaz., 1928, 63: 417–39, p. 419.

56 W Leonard Braddon, The cause and prevention of beri-beri, London, Rebman, 1907, p. 1.

57 Report of the Philippines, Geneva, League of Nations, 1937, pp. 20–1.

58 Vedder, op. cit., note 11 above, p. 15.

59 Victor G Heiser, ‘Beri-beri’, Far Eastern Association of Tropical Medicine: comptes rendus des travaux du troisième congrès biennal, Saigon, A Portail, 1914, pp. 369–73, on p. 371.

60 W A Sawyer, ‘Advantages of nation-wide and inter-national organization for disease control, with special reference to hookworm disease and beriberi’, in A L Hoops and J W Scharff (eds), Far Eastern Association of Tropical Medicine: transactions of the fifth biennial congress, London, John Bale, Sons and Danielsson, 1924, pp. 183–92, on p. 192.

61 Kenta Omori, ‘Studies on the cause and treatment of beri-beri in Japan’, Far Eastern Association of Tropical Medicine: transactions of the sixth biennial congress, Tokyo, Kyorinsha, 2 vols, 1925, vol. 1, pp. 183–204, on p. 203.

62 H Fraser and A T Stanton, ‘The etiology of beri-beri’, Transactions of the Society of Tropical Medicine and Hygiene, 1910, 3: 257–69, pp. 266–7.

63 Henry Fraser, in ‘Discussions on the papers’, Philippine J. Sci., 1910, 5: 137–44, p. 141.

64 Carpenter, op. cit., note 8 above, chs 7, 8.

65 For the FEATM's aims and composition, see J W Scharff (ed.), A report of the fifth congress of the Far Eastern Association of Tropical Medicine, Singapore, Government Printing Office, 1923, p. 24. The FEATM and its engagement with the beriberi issue are discussed more fully in David Arnold, Tropical governance: managing health in monsoon Asia, 1908–1938, Asia Research Institute, Singapore, Working Papers Series 116, http://www.ari.nus.edu.sg/publications/ ariwps.htm.

66 Victor G Heiser, ‘Practical experiences with beriberi and unpolished rice in the Philippines’, Philippine J. Sci., 1911, 6: 229–33, p. 229. Vedder echoed this view: “We are now in a position to prevent the disease in any country that can and will follow our advice just as surely as we can prevent smallpox and yellow fever”: Vedder, op. cit., note 11 above, p. iii.

67 Francis Clark, ‘Discussions on the papers’, Philippine J. Sci., 1910, 5:144.

68 Richard P Strong and B C Cowell, ‘The aetiology of beriberi’, Philippine J. Sci., 1912, 7: 271–414, pp. 289–90.

69 Scharff (ed.), op. cit., note 65 above, p. 13.

70 Warwick Anderson, Colonial pathologies: American tropical medicine, race, and hygiene in the Philippines, Durham, Duke University Press, 2006; Victor Heiser, ‘Unsolved health problems peculiar to the Philippines’, Philippine J. Sci., 1910, 5: 171–8.

71 Heiser, op. cit., note 59 above, p. 372.

72 A Hooton (ed.), Report on the first biennial meeting of the Far Eastern Association of Tropical Medicine, Bombay, Government Central Press, 1910.

73 M Yeatts, Education, Health and Lands, 23 June 1938, Education Health and Lands (Health), 34–3, 1938, National Archives of India, New Delhi.

74 L/E/7/1504, IOR; RG 1.1, series 600A, box 3, file 15, Rockefeller Archives, Tarrytown, New York; Seventh congress of the Far Eastern Association of Tropical Medicine souvenir: the Indian Empire, Calcutta, Thacker, 1927.

75 N Gangulee, Health and nutrition in India, London, Faber and Faber, 1939, p. 136.

76 Madras Government Order 639, Local Self-Government (Public Health), 14 Apr. 1923, Tamil Nadu Archives, Chennai. For local discussion of the FEATM resolutions, see GO 1034, LSG (PH), 26 June 1923, TNA.

77 Henry Knight, Food administration in India, 1939–47, Stanford University Press, 1954, chs 12, 14; Williams, op. cit., note 8 above, pp. 247–8.

78 In 1912 there were 68 registered rice-mills in Madras and 245 in Burma, rising by 1938 to 342 in Madras, 411 in Bengal and 683 in Burma. Rice-milling was one of India's leading industries, employing 72,000 workers by the late 1930s. Reports on the working of the Indian Factories Act for the relevant years and provinces.

79 Annual Report, op. cit., note 55 above, p. 135; Annual report of the Public Health Commissioner with the Government of India, 1933, vol. 1, p. 83. The incidence of beriberi in Burma was in fact rather different from that in British India: see Judith L Richell, Disease and demography in colonial Burma, Singapore, NUS Press, 2006, ch. 6. Mortality from beriberi in the Philippines was far higher than in the Northern Circars despite similar population numbers: Williams, op. cit., note 8 above, p. 250.

80 Buchanan, op. cit., note 43 above, p. 578.

81 “There is hardly a place or district where Chinese are found in which beri-beri does not occur”: C W Daniels, Observations in the Federated Malay States on beri-beri, London, E G Berryman, 1906, p. 46. See also William Fletcher, ‘Rice and beri-beri’, J. Trop. Med. Hygiene, 1909, 12: 127–35, photographs following p. 134.

82 Aldo Castellani and Albert J Chambers, Manual of tropical medicine, 3rd ed., New York, William Ward, 1920, p. 1680; Dubruel, op. cit., note 28 above, p. 59; Scheube, op. cit., note 29 above, pp. 196–7.

83 Buchanan, op. cit., note 43 above, p. 577; Greig, op. cit., note 17 above, p. 5.

84 Braddon, op. cit., note 56 above, pp. 150–98.

85 W R Aykroyd and B G Krishnan, ‘Rice diets and beriberi’, Indian J. Med. Res., 1941, 29: 551–5, p. 551.

86 Williams, op. cit., note 8 above, pp. 113–14.

87 Robert McCarrison and Roland V Norris, ‘The relationship of rice to beri-beri in India’, Indian Medical Research Memoirs, no. 2, 1924, pp. 3–4; Aykroyd and Krishnan, op. cit., note 85 above, pp. 553–5.

88 Scharff (ed.), op. cit., note 65 above, pp. 33–43.

89 For example, Williams, op. cit, note 8, pp. 48–9.

90 MM. Bréaudat, Le Dautec, Jeanselme, Kermorgant, Marchoux and Potterin, ‘Rapport sur le béribéri’, Bulletin de la Société de Pathologie Exotique, 1911, 4: 575–604. For the French investigation of both the “toxi-infection” and “alimentary” theories, see P-Noël Bernard, Les Instituts Pasteur d'Indochine, Saigon, A Portail, 1922, pp. 154–8.

91 Akira Fujinami, ‘Historical review of research on kakke in Japan’, FEATM, op. cit., note 61 above, vol. 1, pp. 11–17, on p. 17.

92 Scharff (ed.), op. cit, note 65 above, p. 43.

93 C D de Langen, ‘The international control of beri-beri’, FEATM, op. cit., note 61 above, vol. 1, pp. 61–85, on p. 85.

94 O Deggeller, 18 Nov. 1927, L/E/7/1504, IOR.

95 Megaw had strongly held views on other matters too, including population control: David Arnold, ‘Official attitudes to population, birth control and reproductive health in India, 1921–1946’, in Sarah Hodges (ed.), Reproductive health in India: history, politics, controversies, Hyderabad, Orient Longman, 2006, pp. 22–50.

96 J W D Megaw, ‘Notes on cases of the “epidemic dropsy” type of beri-beri at the Presidency General Hospital, Calcutta’, Indian Med. Gaz., 1910, 45, offprint, p. 8, Megaw Collected Papers, Wellcome Library, London; see also Megaw, ‘The beriberi and epidemic dropsy problem’, Indian Med. Gaz., 1923, Megaw Collected Papers.

97 In Calcutta alone in 1909–10 there were 1,581 reported cases of epidemic dropsy with 368 deaths: E D W Greig, Epidemic dropsy in Calcutta (final report), Calcutta, Superintendent of Government Printing, India, 1912, p. 9.

98 J W D Megaw, ‘Epidemic dropsy: its bearing on the beri-beri problem’, in J Cunningham (ed.), Far Eastern Association of Tropical Medicine: transactions of the seventh congress, 3 vols, Calcutta, Thacker, 1928, vol. 3, pp. 349–60, on p. 349.

99 Megaw, ‘Presidential Address’, Medical Research Section, Eighth Indian Science Congress, Transactions of the Asiatic Society of Bengal, 1921, Megaw Collected Papers, p. ccviii.

100 J W D Megaw, ‘The beriberi problem’, in FEATM, Transactions of the fifth biennial congress, Megaw Collected Papers, p. 14.

101 Megaw, op. cit., note 99 above, pp. ccviii–ccix. This was a longstanding view in Calcutta, where the city's health officer claimed that the “arguments against the food theory are very strong”: T Frederick Pearse, ‘Report of the Health Officer on the outbreak of beri-beri or epidemic dropsy’, Report of the municipal administration of Calcutta, 1909–10, p. 101.

102 At Tokyo in 1925, where he attacked the “dogma that beriberi could and would be controlled by the prohibition of over-milled rice”, Megaw claimed that there “seemed to be just as many who were dissatisfied with the orthodox vitamine [sic] deficiency view as those who declared their adherence to that view”: J W D Megaw, ‘The sixth congress of the Far Eastern Association of Tropical Medicine’, Indian Med. Gaz., 1926, 41: 349–56, p. 349.

103 Megaw, op. cit., note 99, above, p. ccix.

104 Megaw, op. cit., note 100 above, p. 11.

105 Ibid., p. 11; Megaw in Annual report of the Calcutta School of Tropical Medicine, 1926, p. 31.

106 Victor Heiser's Diary, Tokyo, 16 Oct. 1925, RG 12.1, RAC.

107 Megaw, op. cit., note 100 above, p. 3. As late as 1930 Megaw held that beriberi was the name given to “a disease group”, not a single disease: Leonard Rogers and John W D Megaw, Tropical Medicine, Philadelphia, P Blakiston's Son, 1930, pp. 438–9.

108 Annual Report, op. cit., note 55 above, pp. 136–7. There are clear echoes here of the anti-contagionist opposition by IMS officers to a bacteriological explanation for cholera and insistence upon the effects of soil, climate and other “local conditions”: Harrison, op. cit., note 53 above, pp. 112–15.

109 Sinclair (ed.), op. cit, note 52 above.

110 D McCay, Investigations into the jail dietaries of the United Provinces, Calcutta, Superintendent of Government Printing, 1912.

111 R McCarrison, ‘The nutritive value of wheat, paddy, and certain other food-grains’, Indian J. Med. Res., 1927, 14: 631–9, pp. 631–2.

112 McCay, op. cit, note 110 above, ch. 9.

113 Chevers, op. cit., note 44 above, pp. 568–9. Although Chevers’ account of deficient rice diets was separate from his account of epidemic beriberi, later authors tended to conflate the two: e.g., Greig, op. cit., note 17 above, pp. 6–8.

114 N Gangulee, The Indian peasant and his environment, London, Oxford University Press, 1935, p. 116. See also R McCarrison, ‘A good diet and a bad one: an experimental contrast’, Indian J. Med. Res., 1927, 14: 649–54; idem, ‘Problems of nutrition in India’, in Sinclair (ed.), op. cit., note 52 above, pp. 265–78.

115 For the national concern for nutrition, see, Gangulee, op. cit., note 75 above; U N Brahmachari, ‘The role of science in the recent progress of medicine’, Presidential Address, Twenty-third Indian Science Congress, Indore, 1936 (n.p.d.), p. 3; editorial, ‘Nutritional research in India’, Calcutta Med. J., 1942, 39: 67–9. For all its local referents, McCarrison's research formed part of the wider recognition in the 1920s and 1930s of the inadequacy of diets across the British empire: Michael Worboys, ‘The discovery of colonial malnutrition between the wars’, in David Arnold (ed.), Imperial medicine and indigenous societies, Manchester University Press, 1988, pp. 208–25.

116 Speaking at the FEATM congress at Singapore in 1923, S R Christophers, on behalf of the Government of India, cited McCarrison's research as indicating that, since a correlation between rice milling and beriberi was still unproven, “it is not thought that legislation to prevent the over-milling of rice would effect the purpose for which it is intended”: Scharff (ed.), op. cit., note 65 above, p. 37.

117 McCarrison and Norris, op. cit., note 87 above, p. 33.

118 Ibid., p. 4.

119 Aykroyd and Krishnan, op. cit, note 85 above, p. 551.

120 Annual report, op. cit., note 55 above, p. 136.

121 W R Aykroyd and B G Krishnan, ‘Infantile mortality in the beriberi area of the Madras Presidency’, Indian J. Med. Res., 1941, 29: 703–8. On infantile beriberi, see Vedder, op. cit., note 11 above, pp. 240–64; Williams, op. cit., note 8 above, pp. 81–94.

122 For two early Indian works on the subject, see Sarat Chandra Ghose, Beri-beri: its causation, prevention and homoeopathic treatment, Calcutta, A C Dutt, 1910; S M Varis, A study of malaria and beri-beri, Allahabad, Pioneer Press, 1912.

123 Pioneer Mail, 16 Dec. 1927, p. 11.

124 Alembic Chemical Works, Baroda, advertised the “Alembic Elixir Haemoglobin” for “deficiency diseases like sprue, rickets [and] beri-beri”: Calcutta Med. J., 1942, 39: xviii; Glaxo marketed “Berin” for the treatment of beriberi, anorexia and neuritis: Calcutta Med. J., 1943, 40: xii.

125 For example, B C Guha, ‘Editorial: Better nutrition’, Indian Med. J., 1938, 32: 593–6, p. 593.

126 P K Shukla, Nutritional problems of India, New Delhi, Prentice-Hall, 1982, pp. 133, 136.