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anesthesia, without pain in the muscles of the calf; no electric degeneration 
reaction; no symptoms on the part of the heart and kidneys. In Landry’s 
paralysis there is fever at the onset, and pain in the head, with much perspira- 
tion at the back and extremities. A study of the sensation and circulation 
reveals nothing abnormal. Tabes usually should not be confounded with beriberi 
or vice versa. In anesthetic leprosy a thickening of the peripheral nerves and 
true anesthesia is found and not hypasthesia which is generally encountered in 
beriberi. In addition, in leprosy spots or nodules or diffuse thickenings of the 
skin are usually encountered. Obviously, a careful search will reveal the presence 
of the leprosy bacillus. 
Certain cases of peripheral nephritis, depending upon chronic alcohol 
or arsenic intoxication, may at times be exceedingly difficult to dif- 
ferentiate from beriberi. Alcoholic neuritis should first be definitely 
excluded before a diagnosis of beriberi is made in Europeans and Ameri- 
cans living in tropical countries, where beriberi is prevalent, and who 
present symptoms suggesting the possibility of an attack of this disease. 
In Japan and the Philippine Islands, where beriberi is so frequent and 
so well known, patients often consult the physician with the simple 
statement that they are suffering with this disease. But, of course, 
such a statement can not be accepted without verifying its correctness by 
_a proper examination. 
PROGNOSIS. 
The prognosis of beriberi varies greatly in different epidemics and in 
different localities. The disease is generally most fatal, like other infec- 
tions, when it first invades an entirely new territory in which it has not 
before been prevalent, or at least not been present for several genera- 
tions. Scheube emphasizes the great uncertainty of the prognosis in 
beriberi because, even in apparently very mild cases, a profound cardiac 
disturbance may suddenly supervene. If this condition appears, then 
the prognosis always becomes grave. On the other hand paralyses 
per se are not indicative of a fatal issue. The mortality in beriberi also 
varies very much in different epidemics, localities, and races. Among 
the Chinese prisoners at Shanghai, according to Stanley, the mortality 
is 20 per cent, but it has been 50 per cent among the Chinese patients 
of the Hongkong Government hospitals during the last ten years.*4 The 
death rate in cases developing in Bilibid Prison at Manila is likewise 
quite high. However, in these instances the conditions are somewhat 
exceptional and particularly unfavorable. With better surroundings 
the mortality from beriberi is usually low. Among the troops in Dutch 
India the death rate in this disease is given as between 2 and 6 per cent; 
with the English East Indian troops the figures are somewhat higher. 
According to Scheube the average mortality in Japan is 3.5 per cent. 
During the first year (1904) of the late Russo-Japanese war, there were 
“ According to a personal communication from Dr. M. V. Koch, physician in 
charge of the Government Civil Hospital for Infectious Diseases, Hongkong. 
44510 4 
