BERIBERI 343 



The subcutaneous tissues are usually oedematous. 

 The veins are filled with dark fluid blood. 

 There is serous fluid in the abdomen, chest and pericardium. 

 The mucous membrane of the trachea and larynx may be oedem- 

 atous with the lumen full of fluid. 



The lungs are congested and oedematous. 

 The right heart is dilated and fatty degeneration is present. 

 The muscles show atrophied and normal fibres side by side. 

 There is nerve degeneration of the bulbar nuclei, thoracic ganglia, 

 vagal nerve endings and peripheral nerves. 



The congested liver sometimes shows h^emorrhagic patches. 

 The kidneys show cloudy swelling and sometimes hjemorrhages. 

 Tile meninges are hyper^emic with an increase of fluid in the 

 ventricles. There is marked degeneration in the bulb. 

 Thus summing up one finds : — 



Degeneration of nerves. 



Secondary degeneration of muscles including the heart. Excess 



of blood in the right heart and veins. 



Serous effusions into the cavities and cellular tissue. 



Oedema of the lungs. 



VARIETIES. 



Atrophic, Dry or Paralytic. 



Hypertrophic, Wet or Dropsical. 



Mixed. 



Infantile. 



The incubation is unknown. 



(1) The Atrophic, Dry or Paralytic Variety. 



Insidious onset, malaise, dull pain in epigastrium, tenderness 

 on pressure, headache, palpitation, dyspnoea, subcutaneous 

 oedema, K. J.'s slightly increased, sense of heaviness in the 

 legs, difficulty in walking, K. J.'s disappear gradually. After 

 the first week there is usually a peculiar high stepping gait, 

 tender calves, "pins and needles," anaesthesia and paraes- 

 thesia. 



The anterior tibial and peroneal muscles are chiefly affected. 

 Sometimes the forearms are aft'ected with diminished grip and 

 wrist drop. There is no tremor but the patient is often too 

 weak to hold a bowl of rice. The sphincters are normal. 

 There is wasting of muscles, the paralysis ascends from the 

 calf to the thigh, gluteal region, arms, abdomen, diaphragm, 

 intercostals and larynx. 

 There is loss of sense of heat, pain and cold, but the areas do 



