ina ype 
Convulsions. SILVA LIMA made obser- 
vations on several patients who had slight con- 
vulsions, or choreic movements of the hands 
and arms. VEDDER thinks that convulsions 
are rare, but may be provoked by cerebral 
oedema. In experimental beriberi, however, 
convulsions are of common occurence as 
will be seen later on in the account of my 
experiments. The rareness of convulsions is 
used as an argument by many scientists to 
prove that beriberi in man is not an illness 
“of the same nature as that of birds. 
The blood. WERNICH found constant 
hyperglcbulia. From the studies of MARTINS 
COSTA, P.S. MAGALHÃES and WOL- 
FERSTAN THOMAS a general rule may be 
established, that there is no considerable di- 
minution in the red corpuscles nor increase 
of white globules in beriberi, especially in 
the early stages of the disease. As ankylos- 
tomiasis is a very common disease in Brazil, 
some beriberi patients may have been anae- 
mic from the beginning of their illness, the 
anaemia being considered as proceeding froin 
ankylostomiasis. 
The urine does not show anything ab- 
normal in its chemical constitution. SAM- 
PAIO VIANNA found traces of albumen in 
some of his patients, and in others glucose. 
Albumen is not found as a rule. The urinary 
secretion is diminished. In some of the most 
oedematous cases the quantity of urine passed 
is very much less, in some cases only 200 to 
300 grammes and even as little as 75 gram- 
mes in 24 hours. 
The urine may stop altogether. FRAN- 
CISCO DE CASTRO was the first to call 
attention to beriberi uremia, without albu- 
minuria. SAMPAIO VIANNA met two 
patients with frank symptoms of uremia. The 
diminution of the urinary secretion is due to 
vaso-motor oedema of the cortical part of the 
kidney, and as the tissues of this part are 
inextensible, the pressure applied to the affe- 
rent vessels explains everything (NINA RO- 
DRIGUES). The density of tue urine always 
increases. 
Pulse. The pulse is characterized by its 
frequency, irregularity and lowered tension. 
In the acute cases it attains 150 a minute, 
and sometimes is to rapid to be counted. 
Heart. The examination of the heart is 
of the greatest interest, as the alterations 
observed are almost sufficient to distinguish 
this polyneuritis from all others. In the be- 
ginning ofthe disease palpation indicates the 
increase of cardiacal impulse, zaturally due 
to the resistance in the network of pulmonary 
circulation. In the later stages, when the 
heart is dilated, the cardiacal impulse is of 
counse always dimished. 
Percussion always gives an increase of 
precardiac dullness especially on the right 
side, which is increassed in size and re- 
veals a larger zone of dullness of 2 or 3 cen- 
timeters to the right and deviation of the 
point to the left (a few centimeters). This 
increased dullness was observed by SAM- 
PAIO VIANNA in 70 0/o of his patients, and 
is not only due to the swelling of the organ, 
by dilatation or hypertrophy, but may also 
be attributed to hydro-pericardium, always 
met with in the final stages of the disease. 
The dilatation, is in the beginning confined to 
the right ventricle, then 1t spreads over all 
the right half of the heart. SAMPAIO VIAN- 
NA says that a very certain sign of beriberi 
cardiopathy is the coinciding of epigastric pul- 
sation with the absence. of precardiac shock 
which is an immediate consequence of the 
dilatation of the right side of the heart. Un- 
fortunately, this modification of the shock of 
the apex is not absolutely constant; in the 
majority of cases it is only weakened, as is 
ascertained on touch. SAMPAIO VIANNA 
affirms that in all the patients observed 
in the hospital at Copacabana, he found the 
diastolic pulsation was greatly diminished 
or almost absent 
Palpitations. These constitute a symptom 
from the very beginning; at first, they are 
brought on by the least exercise or effort, 
even by a moral impression. Later on, tachy- 
cardia is a permanent phenomenon. The 
- acceleration is accompanied by palpitations 
and is, according to PEKELHARING and 
WINKLER, simultaneous with the first ma- 
nifestations of the disease. The slowing down 
