Beriberi - Kakke

Japanese: 脚気 - かっけ

This disease is caused by a deficiency of vitamin _B1 (thiamine), and is one of the diseases that led to the discovery of vitamins. Possible causes of its onset include insufficient intake of vitamin _B1 , impaired absorption, impaired utilization, and increased requirement. Insufficient intake can be due to an absolute deficiency, or because vitamin _B1 is necessary for the metabolism of sugars (carbohydrates), excessive intake of sugars can result in a relative deficiency due to the consumption of large amounts of vitamin _B1 . In addition, there can be impaired absorption due to digestive diseases and impaired utilization due to cirrhosis of the liver, and excessive alcohol consumption impairs both absorption and utilization. Furthermore, hyperthyroidism, febrile diseases, and strenuous exercise and physical labor can increase the requirement, making deficiency more likely.

It is common in the summer, and in the early stages symptoms include general fatigue and loss of appetite in the legs, followed by numbness and abnormal sensations in the legs, and symptoms of polyneuritis. As the condition progresses, motor paralysis occurs, tendon reflexes are lost, the arms and legs become weak, and the patient becomes bedridden. Circulatory system symptoms include a rapid pulse, which worsens with movement. As the blood vessels relax, diastolic blood pressure drops. As the condition progresses, heart failure develops, and if left untreated, the patient goes into shock and dies, a condition known as beriberi shock heart. In addition, swelling occurs throughout the body, but is particularly prevalent in the legs, which remain indented when pressed with the fingers and do not return to normal immediately.

As for treatment, if the condition is mild, it can be improved by diet alone, but if it is severe, 5 to 10 milligrams of vitamin _B1 are first injected, and if the condition improves, switch to oral administration of 1.0 milligram. To prevent this, avoid unbalanced diet and overwork, pay attention to nutritional balance, and add foods high in vitamin _B1 (pork, chicken giblets, beans, eggs, etc.) to your menu.

[Naotaka Hashizume]

Beriberi and Vitamins

Beriberi was common among people who regularly ate polished rice. It is called beriberi in English, which comes from a local language in Southeast Asia and is a combination of two words meaning "weakness" in Sinhala, a language spoken in Sri Lanka. In Japan, it was prevalent in Edo during the Kyoho era (1716-1736) during the Edo period, and was called "Edo-wazarai" (Edo trouble) at the time and considered a rare disease. Even in the Meiji era, the death toll from beriberi reached 20,000 people per year, and in December 1877 (Meiji 10), the government ordered each prefecture to investigate the cause and treatment of beriberi, and the army and navy authorities also began investigations. There were various theories about the cause of beriberi, including bacterial infection, fungal infection, fish poisoning, and a lack of protein or fat. Takagi Kanehiro, Director of the Navy Ministry's Medical Bureau, succeeded in preventing beriberi by improving the diet during the Navy's long-distance voyage training in 1882-84 (Meiji 15-17), and Eijkman, Director of the Pathological Institute in Batavia (Jakarta), also discovered avian rice disease. In other words, it was suggested that beriberi was closely related to the consumption of white rice and may have been a symptom of a deficiency of a specific substance, and efforts continued to be made to discover an effective substance. In 1910 (Meiji 43), Suzuki Umetaro succeeded in extracting a specific substance, which he named aberic acid, later oryzanin. The following year, Funk at the Lister Laboratory in London succeeded in extracting the same substance in a pure form, naming it vitamin, which was recognized worldwide and became the first vitamin to be discovered. Thus, the cause of beriberi was discovered and a treatment method was established. However, in 1923 (Taisho 12), there were many cases of typical beriberi in Japan, with as many as 27,000 deaths, and it was feared as one of the two major national diseases along with tuberculosis. In recent years, the incidence of beriberi has dropped dramatically due to improvements in nutrition, but sporadic reports are still heard today.

[Naotaka Hashizume]

Source: Shogakukan Encyclopedia Nipponica About Encyclopedia Nipponica Information | Legend

Japanese:

ビタミンB₁（チアミン）の欠乏による疾患で、ビタミン発見の端緒となった疾患の一つ。発症の誘因としては、ビタミンB₁の摂取量不足、吸収障害、利用障害、所要量の増大が考えられる。摂取量不足には、絶対量の不足と、糖質（炭水化物）の代謝にビタミンB₁が必要であり、糖質の過剰摂取のためにビタミンB₁が大量に消費され、相対的に不足する場合もある。また、消化器疾患による吸収障害、肝硬変による利用障害もあり、アルコールの過飲は吸収と利用の両面とも障害する。さらに、甲状腺機能亢進(こうしん)症や熱性疾患のほか、激しい運動や肉体労働によっても所要量が増大し、不足をきたしやすくなる。

　夏季に多く、初期には全身や下肢の倦怠感(けんたいかん)、食欲不振などがあり、しだいに下肢のしびれ感や知覚異常がおこり、多発性神経炎の症状が現れる。さらに進行すると、運動麻痺(まひ)が加わり、腱(けん)反射が消失して手足に力が入らず、寝たきりとなる。循環器系の症状として脈が速くなり、体を動かすとひどくなる。血管は弛緩(しかん)するので、拡張期血圧は低下する。進行すると心不全となり、放置すれば脚気衝心とよばれ、ショック状態となって死亡する。そのほか、むくみが全身にくるが、とくに下肢に多く、指で圧すとへこんだままで元にすぐ戻らない。

　治療としては、軽症なら食事療法だけでも改善するが、重症の場合は、まずビタミンB₁を5～10ミリグラム注射し、症状が好転すれば1.0ミリグラムの内服に切り替える。予防には、偏食や過労を避け、栄養のバランスを心がけ、ビタミンB₁の含有量の多い食品（豚肉、鳥もつ、豆類、卵など）を献立に加える。

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脚気とビタミン

脚気は精白米を常食とする民族に多く発症していた。英語ではベリベリberiberiというが、これは東南アジアの原地語に由来し、スリランカのシンハラ語で「虚弱」の意味をもつ語を二つ重ねたものである。日本では江戸時代の享保(きょうほう)年間（1716～36）に江戸で大流行し、当時は「江戸煩(わずらい)」とよばれ、奇病とされていた。明治になっても脚気による死亡者は年間2万人にも達し、政府は1877年（明治10）12月各府県に脚気の原因究明と療法の調査を命じ、陸海軍当局も調査を始めた。脚気の原因には細菌感染説、真菌説、魚毒説、タンパク質や脂肪の欠乏説などの諸説があった。海軍省医務局長の高木兼寛は1882～84年（明治15～17）に海軍の遠洋航海訓練中の食事改善で脚気の予防に成功し、またバタビア（ジャカルタ）の病理研究所長エイクマンも鳥類白米病を発見した。つまり、脚気は白米摂取との関係が深く、特定物質の欠乏症状である可能性が唱えられ、有効物質の発見に努力が続けられた。1910年（明治43）鈴木梅太郎は特定物質の抽出に成功し、アベリ酸のちにオリザニンと名づけた。翌年、ロンドンのリスター研究所でフンクが同じく特定物質を純粋な形で抽出することに成功し、ビタミンと命名、これが世界的に認められ、ビタミン発見の第一号となった。かくて脚気の原因が判明し、治療法が確立した。しかし、1923年（大正12）には2万7000人もの死者を出したほど日本には典型的な脚気が多発し、結核と並び二大国民病として恐れられた。近年は栄養改善に伴い脚気の発症は激減したが、今日でもなお散発的に報告がある。

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