Almost without exception the portions of the body supplied by affected nerves grew (edematous.
The chief and earliest symptom of heart-implication is rapidity of action, with weakness. This begins about or shortly after the time the nerves of the body and arms become attacked.
The rapidity of heart-action in these eases will average about 130. but may show a higher rate. In one extreme ease the pulse for three weeks ranged between 180 and 210, the patient suffering sur prisingly little dyspncea. E. D. Bondu rant (N. Y. Med. Jour., Nov. 20, '97).
Diagnosis.—Beriberi prevails en demically in tropical and subtropical countries, especially in Brazil, the West Indies, India, and Ceylon. That it also occurs occasionally in temperate climates has recently been shown by the out breaks at the Richmond Asylum, in Dublin, and the Insane Hospital at Tus caloosa, Alabama. Its peculiar charac ters readily cause it to be recognized, and the diseases with which it can be con founded are few.
Malignant Dropsy.—This affection is less infectious and attacks exclusively the insane. Paralysis is never observed. The digestive tract is unaffected. The progress is slow, and in an epidemic very few persons are affected, differing in these respects from beriberi. (3Ielen dez.) Ceylon Anceinia.—This affection, due to the presence in the intestines of the Anchylostonta duodenale, is also charac terized by weakness and numbness; but there are no true motor symptoms, and intestinal haemorrhage is frequent (Kyn sey). The anchylostomum is sometimes found in beriberi, and the two affections are considered as similar by some authors.
Ancliylostorniasis is common in coun tries (such as Italy) where beriberi is not found. A uchylostomum fliaria saa gainis or q'richocephalus diaper may be present in beriberi; but they are co incidents, and not a cause. Anchylos tomiasis has symptoms not at all like beriberi. Giles (Indian Med. Rec., July, '90).
Anchylostomum duodenale, a human parasite found in tropical countries, and especially in Ceylon, gives rise to grave antemia, often ending in death. This affection, the kala-azar, or beriberi, of Ceylon, bears no resemblance to the true beriberi, except a cachexia, often accom panied by muscular weakness and dropsy. Giles (Indian Med. Record,
July, '90).
Two eases of beriberi associated with Distoma crassum, A nchylostoma duode mile, and other parasites. James Walker (Brit. Med. Jour., Dee. 5, '91).
Beriberi a peripheral neuritis, inde pendent of the presence of anchylostoma; the affection produced by the latter is absolutely distinct from beriberi. Leslie (Brit. Med. Jour., Feb. 27, '92).
Beriberi and the kala-azar of Assam are identical; the latter an anchylosto miasis caused by the Dochntitts duode nulls. Giles (N. Y. Med. Jour., Mar. 2G, '92).
In beriberi (endemic neuritis) we must look for the characteristic cardiac and nerve symptoms and the reaction of de generation.
In anchylostomiasis (parasitic amentia) we must search for the worm after the exhibition of thymol, or by microscopical examination of a portion of the excreta for the ova of the parasite.
In kala-azar (epidemic malarial fever), which is confined to Assam, we have the history of the sure and slow spread and evidence of its infectiveness.
The co-existence of malarial cachexia with either beriberi or anchylostomiasis, as very frequently happens in tropical countries, renders an exact diagnosis sometimes difficult, and it is this fact which, in countries where malaria is very common, has stood so much in the way of clear ideas on the above diseases. W. J. Buchanan (Dublin Jour. Med. Sci ences, Dec., '97).
An epidemic of peripheral neuritis is probably one of beriberi. When, in the beginning, the symptoms are indistinct, the subsequent rapid development of oedema and paresis, in the absence of any other cause—e.g., nephritis—points to that disease.
Malarial neuritis of a character simu lating beriberi is exceedingly rare. It is generally confined to one nerve; besides, paresis, muscular atrophy, and cardiac disturbances are absent. If the plasmo dium of Laveran is found and the disease responds to quinine, the diagnosis is cleared up; both diseases may co-exist.