SARAIVA, which I mentioned, I do not think 
any medical man ever noticed a rise in tem- 
perature.’ ALMEIDA COUTO says that he 
does not consider beriberi a malarial disease, 
as it was at that time supposed to be, 
amongst other reasons as it is an apyretic 
disease. EDWARD B. VEDDER (Beriberi, 
1913) says that fever in cases of beriberi is 
not a characteristic of the disease, and may 
possibly be caused by a chill, a slight attack 
of gastro-enteritis or other like complication. 
. MIRANDA AZEVEDO in 1874, basing 
himself on his own observations and on the 
opinions of RIBEIRO da CUNHA and COS- 
TA ALVARENGA, declares that beriberi is 
an essentially apyretic disease. 
It has now beem demonstrated that the 
majority of brazilian observers deny the exis- 
tence of a special febrile phase in beriberi. 
This I had the opportunity of confirming 
even in hyper-acute cases, in contradiction to 
the observations of SARAIVA in the Para- 
guyan war and also those of Prof. SODRE. 
Weakness of the legs. These symptoms 
of the prodomatic period are followed, sooner 
or later, by more typical indications of 
the disease. Weakness of the legs, which at 
first only shows itself when going upstairs, 
is followed by the sensation of wheight. When 
walking the patient feels as if he were 
traversing a river with a strong current. 
Then after some days, his legs feel altoge- 
ther too weak to bear the weight of his body. 
Numbness. Numbness or torpor of cuta- 
neous sensibility is a relatively precocious 
symptom. It begins at the legs, extending sy- 
metrically to the feet, and then to the thighs. 
Thence it reaches to the soles. The patient 
feels as if he were treading on an india-rub- 
ber floor, or On layers of cotton. The numb- 
ness now goes upwards and affects the skia 
of the abdomen. PEKELHARING says that 
it always spares the groinand the neighbour- 
ing parts. SODRE speaks of anesthesia 
round the mouth. 
Sometimes, instead of numbness, the 
patients feel formication or prickliness, so 
that some complain of a sensation of walking 
84 —— 
on needles. This perturbation may also af- 
fect the mucous membranes. COSTA ALVA- 
RENGA describes a very curious and quite 
unique phenomenon. The patient, when he 
passed his tongue over the roof of his mouth, 
felt as if it were covered with threads or 
hairs. 
The painful sensibility gradually disap- 
pears. In the beginning transmission of pain- 
ful feeling is slow; it diminishes gradually 
until there is complete anaesthesia.“ SODRÉ 
also noticed that heat was less perceived. 
WERNICH describes as a constant pheno- 
menon the existence of an anaesthetic area 
round the ankles; in this region. slight im- 
pressions were not felt. PEKELHARING 
and WINKLER describe, amongst the earlier 
symptoms, an increase in the tactile zones, 
specially in the lower extremities. SODRE, 
who had the opportunity of verifying and 
confirming these assertions, claims that this 
is one of the first symptoms of beriberi. The 
latter, as well as PEKELHARING and WIN- 
KLER, say that in the initial stage of the 
disease, its presence is revealed by the elec- 
trical examination of the muscles and of the 
nerves. “Faraday”s current shows a diminu- 
tion of the irritability of the muscles, either 
direct or indirect, and at the same time a re- 
markable diminution of the indirect irritability 
by galvanic currents, as also a somewhat len- 
gthy contraction when anode and cathode are 
shut. 
Locomotory perturbations. In nearly all 
the forms of beriberi the symptoms follow one 
after the other and gradually increase. To 
the initial phenomena, all of which affect the 
sensibility, succeed others influencing motility. 
We not only observed this phenomenon 
constantly, but also found it described in all 
the classics. 
The feeling of tiredness is followed by 
more or less accentuated phenomena of pa- 
resis. 
The course of the disease then assumes 
its characteristic appearance. The patient 
finds great difficulty in getting up when lying 
or sitting down, and only succeeds by reite- 
rated effoits. When beginning to walk, he 
