B VITAMIN DEFICIENCY STATES 401 



in many cases are more pronounced on one side of the body. Motor 

 disturbances may vary from a general sense of weakness to absolute 

 paralysis. In severe cases there is extensive edema which is present only 

 to an incipient degree in the milder ones. Fever and vomiting also occur 

 in the advanced stages; there is no respiratory pulsation of the diaphragm, 

 and severe pulmonary edema aggravates the generally terminal cardiac 

 failure. While the disease may run a protracted course throughout most 

 of which dietotherapy provides rapid recovery, a much feared variation 

 which occasionally develops — Shoshin — brings about rapid aggravation 

 of the symptoms and death within a few days. Findings on autopsy are 

 generally in line with those to be expected from the symptoms: edematous 

 effusions, typical cardiac changes, and frequent peripheral nervous degen- 

 eration. Histologically demonstrable nerve degeneration has never, how- 

 ever, been proved to be the result of thiamine deficiency. 39 



In the less severe deficiencies more frequently encountered in the West- 

 ern world, loss of appetite is one of the first symptoms. 40 In many cases 

 there is an accompanying disturbance in gastric motility and in experi- 

 mental animals, at least, a more severe gastric disturbance frequently 

 occurs. It has been shown that in thiamine-deficient rats there is a much 

 greater volume of gastric secretion, but there is no change in acidity, 

 peptic power, or total chloride concentration. 41 There is a high incidence 

 of gastric ulcer in protein-deficient rats on a restricted calorific intake 

 which is independent of thiamine intake; but thiamine-deficient rats 

 have a greater incidence, number, and severity of lesions than rats having 

 adequate thiamine. 41, 42 



In the type of deficiency manifest largely by cardiac symptoms, the 

 most frequent disturbances are dyspnea, tachycardia (increased heart 

 rate), and palpitation, and the general picture with its less frequently 

 occurring auxiliary symptoms of edema, pulmonary congestion, and 

 systolic and diastolic murmurs is such as to show little difference from the 

 similar phase in beriberi itself. Weiss and Wilkins state that thiamine 

 deficiency in their experience is a more frequent cause of heart disease 

 than either subacute bacterial endocarditis or congenital heart disease. 43 

 In the neuritic type of disturbance, mild cases frequently manifest only 

 absence of knee jerks, plantar dysesthesia (impaired sensitivity of the 

 sole of the foot), and a tenderness of the calf muscles; prompt recovery 

 generally results from thiamine administration. In more severe cases these 

 symptoms become progressively worse, resembling those of beriberi, 

 although in this case there may be a more frequent involvement of mental 

 difficulties (Korsakoff's syndrome?). The course of the disease may be as 

 short as a few weeks, but is frequently much longer, and when acute, 

 seldom responds completely to thiamine therapy. 



