750 
In the acute, pernicious form, the onset of the symptoms is generally 
rapid. The patient becomes ill, apparently without premonitory symp- 
toms. <A feeling of oppression develops in the chest, dyspnea, forced 
respiration, evidences of great venous congestion, frequent vomiting, and 
the signs of rapid heart failure appear and death finally supervenes. 
The different types of beriberi have been described by observers from 
all localities where the disease is prevalent, but they vary in their 
predominance, . 
A. Plehn*® recently observed a number of cases of beriberi in German West 
Africa (Kamerun); they were all of the acute, pernicious type, ending fatally 
within from twelve to forty-eight hours. However, he states that Lichtenberg 
previously had seen subacute and chronic cases in the same territory. Plehn’s 
cases, with one exception which was complicated by malaria, never showed any 
elevation of temperature; they were characterized by dyspnea, forced, frequent 
respiration, violent action of the heart, small, easily compressible, rapid pulse, 
muscular weakness, and violent vomiting. Death occurred from paralysis of 
the heart after the pulse had become imperceptible. 
Both the cedematous and the atrophic types generally develop in the 
same manner. Preceding the actual outbreak of the disease there is a 
period of malaise, during which a dull pain in the stomach, lack of 
appetite, and a. heaviness in the lower extremities and occasionally in 
the upper ones are complained of. 
Wright believes that the incubation period of beriberi is between ten: 
and fifteen days, although extreme paralysis and the other more marked 
effects of the virus may not manifest themselves until some days after 
the first demonstrable symptoms of nerve lesions have occurred. One 
of the earliest symptoms usually referred to by the patient, is palpitation 
of the heart on slight exertion; next, pain in the legs is frequently 
noticed, particularly in the calves, which soon become tender on pressure. 
Later, the gait becomes unsteady; the patient walks as if it were difficult 
for him to lift his feet from the ground, as indeed it is, the effect being 
such that this gait has not improperly been compared to that of a man 
walking in soft and very sticky clay, or to that of a man heavily dressed, 
who has been in the water and whose clothes are weighted by the 
amount of fluid absorbed. At this stage, in wet beriberi, an cedema of 
the lower extremities is generally noticeable. It is particularly well- 
marked over the anterior tibial region, over the dorsum of the feet, and 
around the ankles. In these places the skin pits on pressure. In the 
dry form there may be slight cedema at an early period in the disease, 
but this is not well marked and is only transitory in character. The 
lower extremities in this variety, instead of being swollen, become more 
and more emaciated, the muscles become atrophic, and often indurated 
*Plehn: Die acuten Infektionskrankheiten bei den Negern der iiquatorialen 
Kiisten »Westafrikas. Virehow'’s Archiv. (1903), 174, Supplement  (Beriberi, 
DOF. 
eee) eee 
