758 
sent from the front to the military reserve hospitals of Hiroshima, 'Tokyo, 
ete., 50,340 Japanese soldiers sick with beriberi. Of these 1,024, or less 
than 2 per cent, died. During the same period of time, among the troops 
in Japan there developed 3,337 cases, of which only 44 died. So on the 
whole, taking a very large material as a basis, the prognosis quoad vitam 
is quite favorable in beriberi. However, nothing definite can be stated 
in an individual case of beriberi, because a fatal termination in conse- 
quence of heart failure may occur at almost any time during the course 
of the disease. Unfavorable symptoms are: marked dilatation of heart, 
great weakness and irregularity of the pulse and other grave disturbances 
of circulation, circumscribed cedemas on the trunk of the body, oedema 
of the lungs, and particularly, persistent vomiting. The last symptom 
is almost invariably the precursor of a rapid fatal termination, in conse- 
quence of heart failure. The mortality in the acute, pernicious form 
is always very high; in the subacute or chronic, edematous type it is 
lower than in the former, but higher than in the dry, atrophic variety. A 
favorable prognostic omen is the appearance of a copious renal secretion 
after a partial or complete suppression of urine. Acute, pernicious cases, 
when fatal, always terminate by heart failure or asphyxia; in chronic 
cases death results from paralysis of the respiratory muscles, but occasion- 
ally from aspiration pneumonia or from general debility. The latter 
event is particularly liable to take place when tuberculosis or amcebic 
dysentery is present as a complication. The average duration of the 
cases of acute, pernicious beriberi is very short, while that of those of 
moderate intensity and of a moderately chronic character is perhaps 
between three and six weeks. Besides the above there are a large number 
of protracted cases, which extend over a period of months or even more 
than a year. These are characterized by muscular atrophies and joint 
fixations. However, generally even these cases, if properly treated and 
if placed under proper hygienic conditions and given proper nutrition, 
finally completely recover. 
It has frequently been noticed in Japan, the Malay Peninsula, and 
the Philippine Islands that if a patient who has had one attack of this 
disease, and has completely recovered, is exposed to the same conditions 
which brought on the first one, he suffers a second or even a third attack. 
In this respect beriberi may perhaps be likened to pneumonia and some 
of the other infectious diseases, which, in certain individuals after the 
first attack, leave a predisposition to subsequent ones. 
PROPHYLAXIS. 
Our ideas on prophylaxis, in relation to beriberi, are still in a decidedly 
“unsatisfactory state. The observance of the ordinary rules of hygiene 
and sanitation has frequently shown a. favorable influence in restricting 
the spread of the disease. However, in other instances, beriberi will 
prevail in certain localities and under certain conditions, in spite of all 
