THE COURSE OF BERIBERI HEART DISEASE IN AMERICAN PRISONERS-OF-WAR IN JAPAN

Abstract

Two cases are presented from a group of patients who suffered from advanced and protracted beriberi. The first patient made a temporary recovery after liberation but 7 mo. later, following poor diet, excessive physical exertion and alcoholic bouts, developed a sudden relapse of acute "wet" beriberi with heart failure and anasarca. He responded dramatically to treatment, but four months later, following similar indiscretions, had a second relapse from which he responded very slowly, reaching only borderline cardiac compensation. One year later he died in a final episode of acute decompensation after being ambulatory four months. Autopsy showed a dilated, flabby heart with a non-specific subacute myocarditis considered compatible with chronic beriberi heart. The 2d case made a complete clinical recovery following prolonged and enforced bed rest, excellent diet and restricted activity for two years necessitated by extensive orthopedic procedures for a compound fracture of the tibia. The course of these cases illustrates the importance of prolonged care, observation, intensive therapy and enforced rest in management of this disease, and corroborates similar conclusions from experimental data on beriberi in laboratory animals. The course of the first case also illustrates that beriberi heart disease in its advanced stages may be clinically similar to other types of myocardial insufficiency, the history of dietary insufficiency being of paramount importance in the diagnosis.