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to say, but observations of a number of patients showed that, given the increase, 
it may remain and never disappear before the patient’s apparent recovery, or 
it may slowly decrease to absolute loss, or it may disappear rapidly in a few 
days, giving way to complete absence. Recovery of the knee jerk after loss 
seems to be a very slow process, but that it is eventually regained there can be 
no doubt, if the history of having had the disease in several prisoners and others 
is to be believed. Increased response to a blow of the muscles seems to obtain 
generally after the diminution of knee jerk has occurred. 
It has already been mentioned that the muscles of the calves of the 
leg are frequently painful and very tender to pressure. The skin, partic- 
ularly of the lower extremities, shows disturbances of sensation. There 
is general hypesthesia or paresthesia and less frequently complete 
anesthesia. In mild cases the urine is somewhat decreased in amount, 
and in severe ones considerably so. The diminution is sometimes very 
great and the daily amount passed may fall below 100 cubic centimeters. 
The specific gravity in such cases is increased, but not proportionately 
to the great diminution in amount. Albumen is generally not present. 
However, when it is observed, only traces occur. Sometimes, though 
rarely, a complicating nephritis develops in the later stages of beriberi 
and then albumen is constantly found in the urine. Indican is very 
frequently observed in the urine in the acute and cedematous varieties 
of the disease. ~ 
According to most authors, the temperature in uncomplicated cases 
of beriberi is either normal or very slightly elevated. Whenever we 
have met with a fatal case of this disease, in which there was, inter vitam, 
a marked rise in temperature, on post-mortem examination we have 
found some complication, generally either amoebic dysentery or malaria. 
In cases of the cedematous or of the atrophic form, which progress un- 
favorably, the dyspnoea and the difficulty in respiration increase and the 
resulting, grave circulatory disturbances find their expression in a 
superficial venous congestion, with visible, throbbing veins. While con- 
sciousness is preserved, the dyspncea and the suffering, progress, and the 
face of the patient sometimes presents a picture of grave anxiety, such as 
may be seen in true angina pectoris (arteriosclerosis of the coronary 
arteries), and death frequently occurs quickly in consequence of heart 
failure. 
Stanley * has drawn attention to the frequency of sudden heart failure 
in diphtheria and in beriberi. His analysis of 341 cases of the latter 
disease shows 72 fatal ones, of which 31 died of rapid heart failure. The 
pulse tension was lowered in 254 cases, and dilatation of the heart 
existed in 98. The second sound was reduplicated in 245 and the first 
* Arthur Stanley: On Sudden Heart Failure in Toxsemice Conditions with a 
Special Reference to Diphtheria and Beriberi. Brit. Med. Jowrnal, (1903), 2 
1636. 
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