probably, with the tropical and sub-tropical belts; doubtless it exists in many places where its presence is not generally suspected. It is the scourge of many of the mines and plantations of the Malay and Eastern Archipelago. It is apt to break out among the coolie gangs engaged on extensive engineering works in the tropics, such as the Panama Canal or the Congo Railway. It haunts the Dutch army in Sumatra, and used to be common enough in the British armies in India. It is at home in many parts of Japan, particularly in her large, low-lying, damp, overcrowded cities. It occurs in China, the Philippines, the Eastern Peninsula, India, and Africa. It is prone to break out in gaols, in schools, in ships. Some- times, as an epidemic wave, it passes over a tropical country, as was the case in the early 'sixties in Brazil, where it still lingers. Sometimes sporadic cases crop up here and there. Generally, when it appears in a community, it attacks large numbers, picking out particular houses and districts. Lately we had an account of a small epidemic among a group of Western Australian natives, and also among Chinese on the eastern seaboard of Australia, a continent where beriberi was formerly supposed not to exist. Similarly it appeared, apparently for the first time, in Japanese immigrants in Fiji. Some time ago I saw a case having the history and clinical features of beriberi from Lake Nyasa, another from the Upper Congo, another from Hayti. We hear of it also from Havana, from New Caledonia, from the Sandwich Islands, from Uganda all of them places not before known to be liable to this disease so that the area of distribution is an extensive one. Indeed, within the last few years it would seem that it includes the temperate as well as the tropical zones. Not long ago beriberi showed itself in a lunatic asylum in Ireland Richmond Asylum, Dublin; and apparently the same disease has been seen lately in lunatic asylums in the United States and in France, and also among the fishermen on the North American coast.
Symptoms.— Medical visitors to the native hospitals in many parts of the tropical world are
