Prognosis.—The mortality of beriberi varies considerably in different epidemics, and may range from S to 44 per cent. On shipboard the number of deaths may surpass that proportion.
Beriberi may cause death in three ways, these being, in the order of fre quency, by failure of the heart from pe ripheral paralysis of its special nerves; by suffocation from congestion and (edema of the lungs; by effusion into the pericardium. (Max Simon.) A peculiarity of this disease is its tendency to relapse, and the fact that with each relapse the prognosis becomes much more unfavorable.
Treatment. — The first step should naturally be to remove the patient from the unhygienic surroundings in which he may find himself, and especially from germ-infected abode. Out-of-door life and suitable diet are the primary ele ments of cure.
As to remedial measures, the symp toms should be treated as they occur, there being no specific remedy at our dis posal. The oedema should be met with acetate of potassium, squill, and digitalis. Cathartics may be administered to an tagonize the constipation, opium to ar rest the pain, and camphor, digitalis, and strophanthus be given when cardiac symptoms appear. Diaphoretics and hot vapor-baths are useful in the oedematous form, unless they debilitate the patient. When there is marked dyspncea ether, hypodermically, is of great service. Methylene-blue, 3 grains two or three times a day, was found very valuable by Thin., and salicylate of soda by Berry, of Boston. When the case is beginning to improve, electricity, judiciously em ployed, may prove of great benefit to stimulate the vasomotor system and increase the nutrition of the muscles.
Massage also is valuable.
Strychnine, in gradually increasing doses until slight toxic phenomena are produced, is capable of bringing about a cure even when the paralysis is com plete. The treatment is begun with grain, and the same quantity is added every third day until 1/6 grain is taken. If the disease should return, the initial dose grain should again begin the course of treatment. (Domingos Freire.) The berry of the Phaseolus radialas, a common plant, has proved effectual in the treatment of beriberi. It was thoroughly tested on the two hundred and fifty to three hundred inmates of the asylum, and displayed a marked prophylactic action when an average of 150 grammes of the peas were eaten regularly every day. No injurious effects of any kind were noted even after prolonged use. It also proved a good remedy against the infection it self, but had no influence on the se quelm. The (Edema rapidly subsided under its influence, and likewise the paresis in the acute cases, which is liable to persist for months. Its in fluence was particularly beneficial in the severer forms of the disease. The asy lum has long been affected with beri beri, but not a single ease has occurred in the pavilion in which the inmates take regularly 150 grammes of the peas in their daily ration. The natives make great use of these peas both in their own food and for poultry. Burg (Janus, Oct.. 1902).