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at first as identical with wet beriberi. It is likely now, however, that 

 epidemic dropsy, sometimes accompanied by fever, is related not to 

 beriberi but to hunger edema. Greig (880) later investigated the 

 mode of development of the disease somewhat more closely, and 

 found that some natives feed on wheat from which the husk and bran 

 are carefully removed. Addition of meat in these cases exercised a 

 beneficial influence. The question of the etiology of this disease will 

 be taken up again later. 



4- The acute pernicious or cardio-vascular form 



This variety can occur either primarily or secondarily from the 

 above described forms by over-exertion, after an operation, and also 

 without apparent causes. Quite suddenly, often in but a few hours, 

 a severe picture develops : precordial pains, pain in the epigastrium, 

 dyspnea, tachycardia, nausea, vomiting, diarrhea and staggering. 

 The temperature remains normal and the mind clear. The heart is 

 markedly enlarged, especially the right ventricle; the whole heart 

 region pulsates, due to paresis of the intercostal muscle and the 

 increased heart labor. The visible pulsation in the epigastrium 

 belongs to the early symptoms of the disease. Frequently, there 

 develops a systolic murmur at the apex, and also in the second or 

 third intercostal space; the second heart sound is strengthened. In 

 the arteria cruralis, we hear an arterial-diastolic murmur; in severe 

 cases, even a tone. The pulse is accelerated, 120; in severe cases, 

 130 and 140, full and soft. The breathing is wild and wheezing, 

 the whole thorax is raised spasmodically. Hoarseness or aphonia 

 frequently develops. The quantity of urine is greatly diminished, 

 100 to 200 cc. per day, and even less. The urine gives a marked 

 indican reaction; in some cases it contains some albumin, and occa- 

 sionally it gives a diazo reaction. Death occurs with a small frequent 

 pulse, cyanosis and edema of the lungs, sometimes in but a few days 

 or weeks, but sometimes very suddenly in a few hours. 



The mortality in beriberi varies within wide limits. In some out- 

 breaks in Sumatra, Java and Manila, the death rate was frightful 

 up to 60 to 70 per cent and even higher, while among the Dutch 

 troops in Insulinda 2 to 6 per cent, and among the Japanese troops 

 2 to 4 per cent. The death rate in the wet form is greater than in 

 the dry, and highest in the acute pernicious form. Formerly, the 

 average death rate was calculated to be 37 per cent, but in recent 



