eS Gp 
the greatest praciical results would have been 
obtained, and beriberi would already be no 
more in our Navy. 
In 1914, Professor AUSTREGESILO 
published a most important monograph on 
an epidemic of beriberi in the National 
Lunatic Asylum, which he called scorbutic 
polyneuritis, in the REVUE de NEVROLO- 
GIE. Analysed by the light of the new doc- 
trines, this work enlightens the etiology of the 
other epidemics of beriberi which have been 
noticed there. Studying all his magnificent ob- 
servations indetail, we see that beriberi and 
scurvy broke out at the same time, and were 
most likely both caused by defficient alimen- 
tation! The polyneuritis described by Professor 
AUSTREGESILO had all the characteristic 
symptoms of beriberi. 
Let us take for instance one of his obser- 
vations: ”D. Igl I do not know when the 
illness began, as the patient is insane 
but on the 24th. of February he was 
shown to me, had attacks of dyspnoea tachy- 
cardia, difficulty in walking, oedema of the 
lower limbs; he looked like a very weak 
person, with ptyriasis versicolor on his 
neck, acne on the back, petechias on the 
lower limbs, scorbutic signs, echimoses in 
the popliteal space and also purpura 
spots on his legs; the general oedema 
was more accentuated in the lower limbs 
The patient stepped high; the rotular reflexes 
were exaggerated aud lasted a fortnight. 
Afterwards the reflexes diminished without 
disappearing. He had anaesthesia in his lower 
limbs, aud hyperaes thesia of the trunk. Exa- 
mination of the faeces revealed eggs of anky- 
lostomum. There was reduplication of the first 
and second sounds of the heart. The mur- 
mur of the pulmonary artery vibrated more 
than in health. 
This patient was put in the infirmary o¢ 
the Asylum, but his family removed him 
so as to nurse him. He then escaped 
from the vigilance of the family after he 
was cured of the intercurrent disease. 
We see that this was a classic form of 
beriberi, where there were symptoms of 
scurvy caused by of defficient food, which 
were almost cured by a change of diet. 
2nd. Observation. L. M. years old, Bra- 
zilian etc. 16th. of May 1916. During the sli- 
ght epidemic of scurvy this year, he had clas- 
sic symptoms of the disease. After treatment, 
cleansing the blood, rigorous disinfection of 
the mouth with ferruginous injections, change 
of diet etc. there appeared classic phenomena 
of polyneuritis; walking was impossible; 
there was high-stepping, pes equino varus, 
great weakness of the lower limbs, with 
muscular atrophy and pain in the gastroc- 
nemius on being touched. Rotular and plantar 
reflexes were absent; there was pro- 
gressive anaesthesia of the roots of the lower 
hinbs and paraesthesia of the upper limbs. 
Tongue dirty and trembling. Hyperphonesis 
of the pulmonary sound and some times of 
the second murmur. Pulse weak, 74 times 
a minute. Microscopical examination of the 
excrementa revealed eggs of ankylostoma ; 
they are commum amongst the insane in 
Brazil. The patient had a tendonous rectrac- 
tion of the right leg, on account of a scor- 
butic ecchimosis on the popliteal region. 
The muscles and nerves, especially those of 
the inferior hinbs, did not answer to fara- 
disation, and only irregularly to the galvanic 
current, mostly showing Erb’s reaction of 
degeneration (D. R. incomplete). Extreme 
weakness and cachexy were noticeable: the 
patient weighed 22 kilos and 900 grs. He 
was transferred to another ward. After fara- 
disation, galvanisation, massage, strychnine 
and change of diet the patient, put on weight 
till he weighed 43 kilos; the morbid pheno- 
mena disappeared in 6 months, leaving him 
almost cured. 
Although the author thought of the 
possibility of a new affection (scorbutic po- 
lyneuritis), his observations form a valuable 
document in favor of modern doctrines. From 
his observations we may conclude that scurvy 
and beriberi are two different diseases caused 
by defficient nourishment; they were found 
in the same individual, mingling their symp- 
toms, so that they seemed to be anew di- 
sease. And as their principal symptons come 
from the want of certain vitamines, being at 
