BERIBERI 347 



The K. J.'s are diminished. Heart as before. The general 



heaUh is unaffected. 



Some appear almost normal, others lie like logs. 



Some appear to be dying one day and seem well the next. 



Some are like skeletons while others are bloated with dropsy^ 



and again others have just enough dropsy to hide the muscular 



wasting. 



The laryngeal muscles are more often affected so that coughing 



is difficult. A profound diuresis converts a bloated victim into 



a skeleton in one day. 



(4) Infantile Variety. 



This is seen in the Philippines in the infants of beriberi 

 mothers. 



They have a defective diet and suffer from oedema, dyspepsia 

 and cyanosis. They often die suddenly. 



It causes 56 per cent, of the infantile mortality in the Philip- 

 pines 



P.M. shows degeneration of peripheral nerves. 

 Children seem to improve when weaned, suggesting that the 

 cause may be due to cessation of absorption of milk. 



DIAGNOSIS. 



Look for : — 



Increase followed by loss of K. J.'s. 

 Patches of anaesthesia or hypersesthesia on the legs. 

 Pain on handling the calf muscles. 

 Subcutaneous oedema, usually of the leg first. 

 There is no albumin in the urine and no fever. 

 In alcoholic neuritis, there is a history of habit and general 

 trembling. 



In arsenical neuritis, there is abdominal pain and diarrhoea. 

 In lead neuritis, there is colic and blue line on the gums. 

 In dropsies due to heart there is history of rheumatism or other 



fevers. 

 ,, ,, kidneys there is albumin in the urine and casts. 



,, ankylostomiasis there are ova in the fasces. 

 ,, epidemic dropsy there is fever and no anass- 

 thesia or paralysis. 

 ,, ,, mvelitis one finds relaxation of sphincters. 



,, ,, pellagra there are skin eruptions and mental 



changes. 

 Scurvy should be excluded by the spongy and bleeding gums. 





