Another epidemic

In 1882, two decades before the USA invaded the Philippines and crushed the First Republic, a German expat, Dr. M. Koeniger, observed that “…an illness appeared among the natives that was new to them and at the beginning carried off its victims without exception in a few days or weeks.” The mortality rate of that yet unidentified disease was higher than previous cholera epidemics. Dr. Koeniger recognized the symptoms of “kakke,” as it was called in Japan.  He convinced the Spanish colonial authorities to inform the public that “kakke” was not a mutation of the bubonic plaque, which had depopulated Europe; it was also called beriberi.

A Filipino doctor in Iloilo made the baffling declaration that the beriberi epidemic was unassailable proof of the dire effects on public health of the “commercialization” of world economy.  He must have sounded like a prophet of doom, but he was right. This doctor (whose name I can’t remember) pointed out that since 1880, there were detectable signs of new maladies, among them beriberi, which were related to crop specialization in Southeast Asia.  Rarely did doctors connect world economic trends to public health, wars were the most obvious culprits; but this doctor in Iloilo believed that malnutrition which is vitamin B1 deficiency made Filipinos susceptible to beriberi.

When the Suez Canal opened in November, 1869, travel time between the Philippines and Europe was cut to 30 days, so bulk trading of commodities became extremely profitable. As the principal source of rice, the Southeast Asian region became inextricably linked with world trade. However, in the Philippines, the Spanish colonial administration seemed more interested in crops other than rice. Tobacco, abaca and other fibers, indigo, coffee, coconuts, and sugar promised bigger profit margins. Frederic H. Sawyer, an English businessman living in Manila observed that it was a sign of progress for former rice producers to discontinue cultivation, in favor of importing rice from neighboring countries.

As a result, the Philippines became a net importer of rice as early as 1873. Unlike the locally grown and milled rice, the imported varieties were/are nice-looking because these were/are very white, but little did consumers know that these severely bleached, over-husked imported rice varieties were completely shorn of precious thiamin, the vitamin B1 that makes one resilient to beriberi.

Meanwhile in Japan and Indonesia, scientists like Drs. Kanehiro Takaki and Christian Eijkman were already conducting experiments by feeding polished rice, rice bran, and rice germ to different kinds of fowl. Those fed with polished rice immediately showed signs of polyneuritis (paralysis), similar to symptoms detected in humans afflicted with beriberi.

The cure for the dreaded disease was severely controversial; the two Filipino doctors who recommended it were almost lynched by angry mothers. However, Drs. Manuel Guerrero and Joaquin Quintos were emphatic and uncompromising: Mothers with newborn babies were not allowed to breast-feed because beriberi was/is transmitted through mothers’ milk.

In those pre-infant formula days, the alternative to maternal milk was tinned condensed milk, or the milk of a wet nurse, which was not only expensive but also just as risky because the wet nurse herself could, unknowingly, be a beriberi carrier.  Once, Dr. Guerrero was baffled because one of his bottle-fed patients suddenly died of beriberi!  He soon found out that the mother had left the baby  in the care of a neighbor who was a lactating mother. Too lazy (or too ignorant?) to prepare a bottle of condensed milk, she breastfed her neighbor’s child and infected it with beriberi.

Infant mortality in the Philippines was so alarming, it made world news.  Malnutrition caused by a diet of over-polished rice (imported from Saigon since 1873) had become a chronic scourge, which was later aggravated by food shortages due to the ravages of the Filipino-American war (1899-1907).

Filipino doctors, scientists, and philanthropists addressed the daunting challenge of infantile beriberi by establishing La Gota de Leche, a health center that  distributed pasteurized milk and took care of infants with beriberi. The demand for uncontaminated milk was so great that Gota de Leche opened its own dairy farm with pasturelands somewhere in Pasay.   Drs. Guerrero and Quintos held office in the elegant, Italian-inspired villa of La Gota on Lepanto (now Sergio Loyola) street.  Among the patrons were Felipe Calderon (author of the Malolos Constitution), the Kalaws, Yangcos, Ongpins, Paternos, and other venerables of the First Philippine Republic.

Dr. Manuel Guerrero recommended preventive measures – a liquid diet consisting of watery mongo, barley soup, “am” or “lugaw” of unpolished rice with vegetables (preferably malunggay), and, for dessert, a puree of fruits.  Consequently, Dr. Guerrero made the formulation of a wonder cure, the famous  “tikitiki.”

At this writing, the public is waiting for the National Food Authority and the Department of Agriculture to tell us whether or not there is a rice shortage, and if there is one, will they purchase the staple grain from Filipino farmers, or import tons of over-bleached and over-milled rice shorn of the essential vitamin B1. Now that breastfeeding has become so popular, wouldn’t another beriberi epidemic be catastrophic?

(Source: Guerrero, Manuel S. y Quintos, Joaquin, “El beri-beri en los niños de pecho,” Imprenta de Lorenzo Cribe, Manila 1910)