MYCOTOXIC ORIGIN OF CARDIAC BERIBERI

Acute cardiac beriberi ('Shoshin-kakke') is the most violent and malignant type, causing numerous victims among people in Japan and Asia in the past three centuries. It appeared first among the higher circles in Edo (now Tokyo) and increased as the polished rice-eating habit spread into the middle class. After the Meiji Restoration in 1868, the morbidity was seemingly higher, with an increased mortality rate among lower social strata. This indicates its characteristics as an urban disease derived from a changing dietary life with technological improvement of rice preparation, storage and transportation in towns. Tokyo used to be the focus of epidemy, blessed with opportunities for observation and investigation, but the pathogenesis of Shoshin-kakke has never been clarified and the patients were left to take their destined fatal course of a few days. The high incidence of Shoshin-kakke showed an abrupt drop in 1910-one year before the discovery of vitamins and nearly ten years before their adoption into practical medicine. In the year 1910 rice inspection was extensively accelerated and widespread enough to cover the major part of the rice-producing prefectures, and as a result mouldy rice and unqualified rice were practically excluded from co mercial dealings in Japan. By revealing these phenomena occurring coincidently, it became apparent to the author that a toxic substance other than avitaminosis must be considered to be the etiologic factor. Since 1940 the author has conducted experimental studies on Penicillium toxicarium Miyake (later identified as P. citreo-viride Biourge) growing on rice; acute mycotoxicosis in mammals and other vertebrates shows a close resemblance to Shoshin-kakke reported in man. The mycotoxin is citreo-viridin. Consequently, such a mycotoxicosis as acute beriberi can be presumed to still occur in some of the rice-producing areas of the world. © 1969.