BERIBERI 287 



legs. The knee reflex is increased at first, and later usually entirely 

 absent; the temperature remains normal. In this stage a cure may 

 result but it may go over into the dry atrophic or the wet atrophic 

 form. 



2. The dry atrophic form (figs. 55-56) 



In this stage, there is general paralysis and muscle atrophy; at 

 first the legs, then the thighs, hands, arms, and finally the back muscles 

 are involved. The patients then show a skeleton-like emaciation. 

 In this stage, too, improvement may take place under certain con- 

 ditions, and in the end, after many months, a complete cure may 

 result. The motility, electrical reaction, the original musculature, 

 the patellar reflex all gradually return. In other cases, reoccur- 

 rences appear, the paralysis and atrophy increase, the foot remains 

 in the position of pes equinovarus (Fig. 57) ; the hands hang weakly 

 with half-closed fingers, as in any radial paralysis. After long 

 prevalence of the disease, permanent contractions of the foot de- 

 velop, less frequently of the fingers and biceps. The patient can 

 only walk on tip-toes with the help of crutches. These severe chronic 

 conditions are incurable. 



8. The wet atrophic Jorm 



In this condition, besides the above symptoms, the disturbance of 

 circulation is more sharply prominent. There is palpitation of the 

 heart, tachycardia, dyspnea, oliguria, pain in the calf muscle and 

 edema. Over the ankle there is a pale edema and in severe forms 

 also in the thighs and in the back, especially in the shoulder and 

 neck region; often also in the arms and on the face. Hydropic 

 condition of the serous cavities, namely, the pericardial and the 

 pleural, belongs to the most important symptoms. The elimina- 

 tion of urine is greatly decreased, often to 200 to 300 cc. or even less. 

 The urine has a high specific gravity, is protein free, urates are 

 precipitated out, and it shows a marked indican reaction. If a cure 

 is initiated, the edema disappears with marked diuresis, whereupon 

 the great emaciation and muscle atrophy become apparent. In nu- 

 merous cases, death follows, partly because of the severe hydroperi- 

 cardium, partly through paralysis of the heart muscle, or, finally, 

 through a merging into the acute pernicious form. In puerperal 

 beriberi, the wet form is noted, as a rule. In severe cases, there is 



