DIETETJC DEFICIENCY. 299 



beri in the Ininian siiliject and " experimental beriberi," or poly- 

 neuritis galliiiantjii, in birds. 



In the hnnian, four main forms of the disease are usually 

 distinguished, althouo^li coml)inations of the type forms may 

 occm-. 



(i) The mild sciisory-niofor or ambulatory form is said to 

 be the most frequent, and to be commoniy precipitated from the 

 dormant state by over-exertion. The ])atient shows signs of 

 weakness and uncertainty in the legs, and the calf nniscles are 

 sensitive to pressure. Sometimes oedema in the lower limbs is 

 observed, and palpitation of the heart after exertion is common. 

 The knee reflex is at first intensified and subsequently weakened. 

 Temperature is normal. 



This form, if free fron^. comjilications. is easily ciu'ed by 

 rest and simple change of diet. 



(2) The dry atropJiic form involves nmscular atro]>hy and 

 gradual paralysis, usually afifecting first the legs, then tlie arms 

 and hands, and finally the trunk nuiscles. This form is also cur- 

 able, and complete recovery is possible within a few months. Re- 

 lapses, however, frequently occur, and often the cure is not com- 

 plete. Chronic cases, involving ])ermanent contractures of the 

 feet, and sometimes of the fingers and biceps, may also occur. 

 These api)ear to be no lotiger cm-able, and the ])atient is reduced 

 to crutches. 



(3) The dropsical atrophic form, sometimes diagnosed under 

 the name " epidemic dropsy," is said to be characterised by dis- 

 turbance of the circulatory system in addition to showing symp- 

 toms analogous to those just mentioned. Tachycardia, dys|)noea, 

 oliguria and indicanuria, < edema, hydropericard, and pleuro- 

 hydrops, appear to belong to the symptoms of this form. [Para- 

 lysis of the larynx, diaphragm, intercostal muscles, and less com- 

 monly of the brain nerves, may f)ccur. Death is usually attri- 

 buted immediately to vagus ])aralysis. This dropsical form is 

 common in ])tierperal beriberi. In cases not too far advanced 

 ciux may be efifected. and if so. is accoiupanied by diuresis and 

 rapid disappearance of the ( edema. A\hereu])on the true nuiscular 

 atrophy becomes apparent. 



(4) The acute or cardin-vascular form. This variety arises, 

 either primarily, or from one or other of the already-mentioned 

 forms — either spontaneousl}- or following over-exertion. It may 

 appear quite suddenly, and even within a few hours very serious 

 symptoms may develo]) — |)recordial distress, epigastric pain, 

 dyspnoea, tachycardia, nausea, vonu'ting. 'fhe tem]:)eratm-e remains 

 nonual and consciousness clear. The heart becomes enlarged, 

 particularly the right A'entricle, and the whole heart region pul- 

 sates in consequence of increased heart labour and paresis of the 

 intercostal nuisculatiu-e. The pulse is increased to uo, and even 

 to 140 in severe cases. Respiration is asthmatic. The voice is 

 often hoarse or altogether lost. The urine gives a marked indican 

 reaction, weak albumen reaction, and sometimes the diazo reac- 



