751 
and contracted. Together with the disturbances of locomotion, those of 
sensation simultaneously develop. Hypesthesia of the lower extremi- 
ties is the most common form of disturbance of sensation in beriberi. 
It generally begins on the anterior, or external, surface of the legs and 
frequently extends to the dorsum of the feet and toes. In other words, 
it is found in the regions supplied by the peroneal and saphenous nerves. 
Accompanying hypeesthesia, there is a subjective paresthesia. If the 
skin of the patient is touched with a soft, camel’s-hair brush, he has 
the sensation of paper intervening between the skin and the brush. The 
intensity and the extent of such sensations not only vary in different 
individuals but also at different periods of time in the same one. These 
disturbances have a tendency to extend upward from the feet and legs. 
In the severer cases, the upper extremities are similary affected. The 
face is rarely involved, but occasionally disturbances in sensation are 
found around the mouth. True anesthesia is rare, as is also hyperes- 
thesia. The interferences with motility generally begin as a sensation 
of weakness in the legs, which is first noticed in the calves and later 
on in the thighs. After these changes have endured for some time, 
atrophy generally manifests itself, or it may appear even before distinct 
paralysis becomes obvious. Usually, the anterior, sharp edge of. the 
tibia becomes more prominent, the calf thin and flabby, and the thigh 
gradually emaciated. When more or less contraction is associated with 
the atrophy, the foot assumes an equinovarus position. In severe cases, 
similar changes occur in the upper extremities. Paralysis of the lower 
extremities is much more common than it is of the upper ones; but in 
the severest cases both feet and hands, including the toes and 
fingers, may be paralyzed. In such instances the hands and fingers may 
occasionally be more affected than the feet. In the gravest types neither 
the hands nor the fingers can be flexed toward the dorsum, and we 
have complete wrist drop, as is the case in lead poisoning. 
The electrical excitability shows various degrees of change, from a 
simple diminution to complete degeneration reaction. According to 
K. Miura,*® one can predict the result of the electrical reaction from the 
position and movements of the foot and toes. If the foot can easily be 
moved on the ankle joint, one finds only a diminution of electrical 
excitability. If the toes, but not the foot, can be flexed dorsally, we 
encounter only a partial degeneration reaction, but if neither the foot nor 
the toes can be moved voluntarily, then it is complete. Paralysis of 
the diaphragm and of the intercostal muscles occurs only in the severest 
cases. Other nerves, besides those of the extremities which are so 
profoundly affected in beriberi, are also more or less frequently involved. 
Paresis of the muscles of the larynx is by no means rare; in fact, it is a 
® KK. Miura: Notizen zur Symptomatologie der Beriberi. Centralb. fiir Neu- 
rologic, etc., Tokyo, April (1905), 6. 
