755 
INFANTILE BERIBERI. 
Hirota ** first called attention to beriberi occurring among infants 
suckled by mothers suffering from kakke. He gives a summary of 52 
eases which he observed and enumerates the following as the most 
important symptoms of the condition: 
The heart’s action is accelerated; the second pulmonic sound accentuated ; 
heart’s area of dullness generally increased toward the right side; sound at the 
apex sometimes dull; pulse rapid, soft, having the character of pulsus celer ; 
diastolic arterial sound sometimes heard over the crural artery, dyspnoea and 
aphonia almost without exception present; vomiting, cyanosis, and edema occur 
very frequently; urine generally diminished; indican test sometimes positive, 
no albumen; general condition characterized by depression, constant erying and 
groaning; sensorium, clear; no fever. The sensory and motor disturbances 
of the patients could not be tested on account of their age. 
Hirota first medicinally treated a number of cases of this type of beri- 
beri in children, who had been suckled by mothers sick with kakke, but 
without success. However, he soon found that such patients rapidly 
improved when taken away from their mothers and either given to a 
healthy wet nurse or fed on artificial food. He therefore recommended 
this procedure as the only rational therapy. However, it was successful 
only when the disease had not progressed too far. 
The author has made inquiries among a number of practitioners in 
Manila to ascertain whether beriberi in infants occurs in the Philippine 
Islands under the same circumstances under which Hirota has observed 
it in Japan. He has been repeatedly assured, for instance by Dr. Albert, 
that such cases are not very infrequent. However, the suggested proper 
therapy—i. e., of taking the child away from a mother (who frequently 
only shows mild symptoms of beriberi)—is very difficult to carry out 
in practice, since the people do not understand the necessity for such 
a measure. 
COMPLICATIONS AND SEQUEL. 
The most common complications of beriberi are tuberculosis and 
dysentery, and in some localities, malaria. When these conditions coexist 
the prognosis is usually very grave. Whereas most cases of beriberi end 
in rapid recovery, some assume a protracted course and in the latter, 
general weakness with or without anemia, difficulty in the use of the 
lower extremities, contraction and induration of the muscles of the calf, 
and also disturbances of motility in the upper extremities, diminution 
and disturbance in the quality of the sensation, palpitation of the heart, 
and rapid pulse may remain present for a long time. As a rule, these 
symptoms all disappear under proper treatment and diet. It has been 
“ Hirota: Ueber die durch die Mileh der Kakke (Beriberi) leidended Frauen 
Verursachte Krankheit der Siiuglinge. Centralbl. f. Innere Medizin (1898), 19, 
385; also Zeitschr. d. Mediz. Ges. zu Tokyo (1891), 5. 
