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

In 1898 Patrick Manson gave a graphic account of beriberi. He described how medical visitors to “native hospitals in many parts of the tropical world” were likely to have “their attention arrested by the large proportion of cases of partial paraplegia, of cases of oedema of the legs, and of cases of general dropsy. These, for the most part, are cases of beriberi”.1 The visitor, Manson continued, “may be struck with the thinness of the patients’ calves, the flabby state of the gastrocnemii, and by the fact that if, whilst making the examination, he should handle these and the neighbouring muscles somewhat roughly ... the patient will call out in pain and try to drag the limb away.”2 Similar cases were to be found throughout the hospital wards: “Some are so trifling that they are up and moving about with more or less freedom; others are so severely smitten that they lie like logs in their beds, unable to move a limb or perhaps even a finger. Some are atrophied to skeletons; others are swollen out with dropsy; and some show just sufficient dropsy to conceal the atrophy the muscles have undergone.”3 Manson’s description, written on the cusp of discoveries that transformed the scientific understanding of beriberi, gave the disease, despite its apparently diverse manifestations, an embodied visibility.4 The clear corporeal presence of beriberi stood, however, in contrast with Manson’s uncertainty (and that of many of his contemporaries) about the exact nature and cause of a disease, despite its widespread distribution in the tropics among “such conglomerations of humanity as are found in Oriental jails, schools, mining camps, plantation lines, armies, ships”.5 For Manson, beriberi typified those diseases that remained part of the “tropical pathological puzzle”. Despite personally believing it to be “a disease of locality”, and in this respect “resembling malaria”, Manson felt obliged for want of evidence to include