temperature, and, it has been said, by its most often attacking those who sleep on or near the ground. As with malaria, though its explosion in any given individual residing in the endemic area may be solicited by fatigue, chill, privation, and other causes of physiological depression, it is not actually caused by such circumstances. Unlike malaria, it is common enough in the midst of large cities, as well as in villages and jungle lands.
Influence of overcrowding.— Overcrowding and unhygienic conditions generally seem to favour the outbreak, or, possibly, the spread, of beriberi. This has, perhaps, a good deal to do with its frequency and virulence in oriental gaols, schools, mining camps, plantation lines, armies, ships.
Ship beriberi.— Unlike malaria, beriberi is common in the native crews, more rarely, though occasionally, among the European officers and sailors, of ships on the high seas and far away from any recent telluric influence. The crowding in the damp forecastle and the exposure incident to a sailor's life seem to be among the reasons, though not the only ones, for ship beriberi. Thus, this form of the disease is often seen at the Seamen's Hospitals at the Albert Docks and Greenwich among the lascars and sidi-boys of steamers trading to India, the disease appearing perhaps months after the ships have left the East, sometimes even months after they have been lying in the London Docks. Some years ago a number of these cases were admitted to the Seamen's Hospital at the Albert Docks. I had the curiosity to visit one of the ships from which several of the patients had been brought. I went into the forecastle. Although the weather was mild for Englishmen, it was evidently very cold for the half-clothed lascars. They had a tire blazing in their quarters, every door, scuttle, window, and ventilator of which they had carefully closed. The place was suffocatingly hot, damp, and redolent of steaming humanity. I do not know how many men had stowed themselves away with their dirty rags in this place, but there was a crowd of them. Several had symptoms of beriberi, and were in their bunks.
