Distribution and Incidence

Within recent centuries, beriberi has occurred among institutionalized populations and military forces all over the world. Although the disease has afflicted poor Americans subsisting mainly on white bread and poor Europeans consuming a monotonous diet of potatoes without meat or vegetables, beriberi is and has been most prevalent among the large Asian populations who consume white rice. In the first decade of the twentieth century, mortality from beriberi in Japan averaged 20 per 100,000, and in 1920 reached 70 per 100,000 among the urban population (Shimazono and Katsura 1965). In that same first decade, an estimated 120 per 1,000 people in the Straits Settlements (what is now Malaysia and Singapore) had beriberi, and in the Philippines, 120 per 1,000 of Filipino military scouts were admitted to a hospital for the disease (Williams 1961). Jacques May (1977) reported that in recent times beriberi still occurred in southern China, Vietnam, the Philippines, Indonesia, parts of Burma, southern India, Sri Lanka, Madagasgar, central Africa, local areas in west Africa, and Venezuela, northwestern Argentina, and Brazil.

The true contemporary incidence of beriberi cannot be determined. Since it is so easily treated upon detection by the administration of thiamine, it has almost ceased to be fatal. As a nutritional deficiency, it is rarely reportable at any governmental statistical level. At the subclinical level, however, it probably still occurs widely. In a study in Australia, one in five healthy blood donors and one in three alcoholics at a hospital were found by biochemical assay to be deficient in thiamine (Wood and Breen 1980).

There was an epidemic of beriberi in the decades following World War II. Before the war, hand milling of rice was universal except for the largest cities. With independence and economic development, power milling spread along the railroads and, via new highways, to the rural hinterland and eventually even to the remote hill country. In the late 1950s, beriberi was thought to be responsible for a quarter or more of the infant mortality in parts of Burma and the Philippines (Postumus 1958) and to be the tenth highest cause of overall mortality in Thailand (May 1961). Enrichment of rice at the mills has greatly reduced clinical beriberi, but even in southern China it still occurs (Chen, Ge, and Liu 1984).

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