Ae / PERITO 
Oedema in beriberi may attain all the 
organs. The subcutaneous cellular tissue may 
assume enormous proportions, asin anasarca. 
Diffusion in the serous cavities coincides 
with cutaneous infiltration. A very frequent 
phenomenon is hydropericardium. 
In 256 cases, VEDDER found pericar- 
diac effusion in making autopsies, in the pro- 
portion of 66 0/0. Hydro-thorax and ascites 
are rarer. The diagnosis of hydro-pericardium 
is very difficult, it is generally only revealed 
at the autopsy. 
Oedema of the lungsis very rare in the 
initial stages of beriberi, and is generally 
one of the final symptoms. Beriberi cough, 
slight and tiring, accompanied by sanguino- 
lent expectoration, according to some of our 
classical authors, has nerver come under my 
notice, even in the most acute forms of the 
disease. Dyspnoca comes from the weakness 
of the myocardium because percussion and 
auscultation do not reveal anything wrong in 
the lungs, except in the final stages of the 
disease. PEDRO DE MAGALHÃES attribu- 
tes the cardiacal affections of beriberi to a 
constriction in the pulmonary network, caused 
by the excitation of the thoracical ganglia 
and of the sympathetic gangiion on which 
depend the vasomotors of the lungs. 
In the acute forms of beriberi I have 
met with real states of orthopnoea. Breathing 
is only effected with indescribable anguish. 
Paralysis of the diaphragm and the muscles 
of the thorax help to aggravate the situation 
of the patient. Sitting with his arms as if he 
were nailed to the bed, with distended neck 
and cyanotic lips, the sufferer tries to aid his 
inbreathing with his lips. Profuse cold sweat 
covers his face on which is imprinted the 
most anguished image of dispair. SAMPAIO 
VIANNA counted from 50 to 60 respirations 
a minute in the acute stage of beriberi. 
Beriberi girdle, This is a frequent symp- 
tom. The patient feels squeezed, constricted, 
the sensation beginning in the epigastrium 
and reaching round the sides. SILVA LIMA 
describes the girdle as “a feeling of being 
tied in, with a feeling of fulness and hard- 
ness, as if you were weighed upon by a plane : 
or an iron bar”. I think that this is because 
the phrenic nerve is attacked, and thus causes 
paralysis of the diaphragm. As we are told by 
SILVA LIMA, TORRES HOMEM and AZE- 
VEDO SODRÉ this sensation may extend 
to the armpit when the intercostal muscles 
are paralysed. In the north I found that this 
makes the prognosis serious. The sensation 
of the girdle is always accompanied by 
dyspnoea and precardiac anguish. 
Vomiting. Is often found in the begin- 
ning stages of the disease and ensues 
from gastric perturbations. Out of 61 pati- 
ents, SAMPAIO VIANNA noticed vomiting 
in 13. In severe cases it is a very bad sign. 
VEDDER considers it as an indication that 
the disease is entering on an acute phase. 
SILVA LIMA tells us that the patients vomit 
eftener when their liver is very much con- 
gested. He is of opinion that the liver is al- 
ways congested in oedematous cases, as the 
circulation in the veins is embarassed. In 
this case the liver is very sensitive to the 
touch. 
According to carefully taken measures by 
SAMPAIO VIANNA and PEDRO A. DE 
MAGALHÃES, the size of the liver is al- 
ways increased (100 0/0). The spleen is also 
swollen according to SAMPAIO VIANNA 
and SCHEUBE. 
It is very rare for the sense organs to 
be affected by beriberi, but Brazilian litera- 
ture on the disease is fu'l of notes on this 
subject. SILVA LIMA quotes cases of stra- 
bism and diplopia and even a case of blind- 
ness which appeared in 24 hours, eight days 
before the death of the patient. 
Cases of amblyopia, diplopia and amau- 
rosis sine materia of one eye, while the other 
one was not affected, were diagnosed and exa- 
mined opthalmoscopically by HILARIO DE 
GOUVEA, and observed by MIRANDA 
AZEVEDO in 1874. Touch seems to be most 
frequently affected. The patients are even 
often unable to hold anything in their hands, 
button their clothes, or even to put on a 
slipper, unless guided by their sight. (SILVA 
LIMA). 
