The motor symptoms are usually well marked, and the gait of the patient is characterized by wobbly, incoordinate, and jerky movements, due to dropping and inversion of the foot. In advanced cases the power of locomotion may be entirely lost. In cases in which the Special attention has been given in the Richmond Asylum to the condition of the joints. The relaxation of the ankle- and knee- joints is extreme in some eases, and is present probably in all. In many this condition permits the legs and feet to be placed in postures re sembling those occurring in subluxations of the knee or ankle. This condition gives rise to a characteristic wobbling at the knee in walking, which the Japanese designate, according to Professor Ander morbid changes have an extensive dis tribution, the patient may be unable to move. The upper extremities are always involved in severe cases.
Muscular atrophy may be a more or less prominent late feature of the case, that of the inferior extremities being the most pronounced. The joints are greatly relaxed, and foot-drop and wrist-drop are typically shown in the annexed cuts. in severe cases there may be son. by the term gaku-gokit. Editorial (Brit. Med. Jour., Aug. 14, '97).
Electrical examination shows the re action of degeneration, even in acute cases.
In the acute form, the symptoms out lined follow in quick succession, and death is exceedingly frequent. This is frequently mentioned as the "pernicious" form of beriberi.
Disease divided into three forms: I.
Acute, with pyrexia, anemia, anasarca, serous effusions, paralysis, and dyspncea. 2. Subacute, with pain, atrophic paral ysis, anesthesia, loss of knee-jerk, mental debility, and (edema. 3. Chronic, with prostration. ana•ia, (edema, and cardiac dilatation. Thomas (Edinburgh Med. Jour., Jan., '90).
Two characteristics not yet noticed: patients are subject to attacks of per spiration, ordinarily limited to the head, but sometimes general. In addition, two exceedingly sensitive points are to be found on the feet: one toward the middle of the dorsal face of the first intermeta tarsal space, corresponding to the bifur cation of the internal branch of the anterior tibial nerve; the other at the cuhoid protuberance, corresponding to the external saphenous nerve. Previous to any treatment the patient should be withdrawn from the endemic surround ings. C. E. Corlette (Brit. Med. Jour., Sept. 28, '94).
Case of suddenly developing beriberi: (edematous paralysis with blindness. The
patient suffered from optic neuritis with central scotoma and consequent blind ness. The urine exhibited a sensible diminution of urea and an almost par allel decrease of other constituents. There was a decrease of the red blood corpuscles and an increase of the leuco cytes. In several muscles a partial reac tion of degeneration was obtained, not withstanding the return of voluntary motion. Mosse (Med. Bull., Jan., '95).
Series of seventy-one cases which, dur ing 1895-'96, occurred among the patients in the State Insane Hospital, at Tusca loosa, Ala. A striking feature of the disease was its variability in mode of onset. Some cases began suddenly with fever and gastrointestinal irritation, as is commonly seen in the acute infectious, the local neuritic symptoms appearing either simultaneously or after a few days. In other instances the onset was insidious, the initial vague aches, pains, and discomfort gradually crystallizing into the clinical picture of neuritis with out fever or general systemic disorder, it being in many of these cases impos sible to elate the commencement of the attack. In still other cases the initial symptom was suddenly occurring dysp ncea, with tachycardia and violent pul sation of the vessels of the neck; oedema of feet and ankles was, in others, the first indication.
The temperature was, in about half of the cases, elevated in the beginning, but usually subsided to normal within a week or less.
The clinical manifestations of inflam mation of the peripheral nerves varied in intensity, distribution, and character, but always consisted in weakness, per version, or abolition of function of the affected nerve-trunk. In all cases the disease began in the nerves of the legs.
The sensory symptoms were frequently those to first attract attention: pain and tenderness in the area of distribution of the affected nerve, at first aching and not very severe, but becoming progress ively more intense, and at its height very distressing.
The motor symptoms, appearing with or shortly after the sensory disorders, were: stiffness in muscles supplied by affected nerves, progtesing through simple weakness and disinclination to exertion to some degree of paralysis, this, in severe cases, becoming complete.
Vasomotor and trophic disorders. other than the oedema in affected parts, which is referred to below, were not frequent.