BERIBERI 345 



not correspond with tlie segmental or nerve areas. It is very 

 patchy. 



Diffuse apex beat, dilated right heart, loud systolic murmur, 

 reduplication of the pulmonary second sound, palpitation and 

 epigastric pulsation. 



The pulse rate is increased and the tension diminished. 

 With increasing oedema the urine is diminished, when the 

 oedema is clearing up the urine is increased. Urea and 

 chlorides are diminished, phosphates and indican increased. 

 There is cutaneous oedema ,of the legs, scrotum, abdominal 

 wall, face and arms, with exudation into the abdominal cavity, 

 pleural sacs and pericardium. 



Digestion is fair but a good meal increases the epigastric dis- 

 tress. The bowels are often constipated. 

 The temperature is normal or sub-normal. 

 The patient may remain like this for weeks or montiis, some- 

 times better, sometimes worse; he mav recover with or without 

 paralytic deformities or he may die suddenly. 

 If fever occurs it is a complication, usually T. B., malaria or 

 dysentery. 



One attack predisposes to another. The patient may die at 

 any time during the attack. 

 There is lymphocytosis 30 to 68 per cent. 



(2) The Hypertrophic, Wet or (Edematous Variety. 



This variety is usually somewhat acute. 



There is nausea, epigastric pain, clean tongue, throat con- 

 gested, cardiac oppression, epigastric pulsation, palpitation, 

 dyspnoea, pulse rate much increased by the slightest exertion, 

 hcemic murmurs, right heart dilates, urine diminishes, there is 

 effusion in'o the cavities of the pericardium, pleural and peri- 

 toneum. 



The oedema is somewhat localized and fugitive. It is firmer 

 than in Bright's disease. 



There are patches of anaesthesia and In-perassthesia in the 

 course of the anterior tibial and musculo-cutaneous nerves. 

 The paralysis may be slight or extensive. 



The heart becomes more embarrassed, the lungs engorged, the 

 nostrils dilate, the mouth opens in the struggle for breath, the 

 pupils dilate, the face becomes cyanosed, the extremities cold, 

 the patient becomes unconscious and dies. This may take 

 place in a few hours. 

 Some account for ihe uxlema b\- suggesting that the patho- 



