BERIBERI 



349 



(2) The Diflferences. 



Beriberi 



(i) K. J.'s painful for 24 hours, then dis- 

 appear in 95 per cent, of cases 



(2) Anaesthesia marked and not limited 



to dropsical areas 



(3) True paralyses even when no swel- 



ling is present 



(4) HyperjEsthesia is found in muscles on 



deep pressure 



(5) Death is more sudden and more dis- 



tressing, often in cases that have 

 not been obviously bad 



(6) There is no antemia 



(7) Ihitial fever, dry skin, rashes, slight 



desquamation, not common 

 8) There is peripheral neuritis but the 

 central nervous systen) is not affec- 

 ted 



Epidemic Dropsy 

 K. J.'s seldom if ever lost 



Anaesthesia is due to pressure on the nerve 



terminals about the dropsical patches 

 Paralysis is due to the swelling and weight 



of the parts 

 Hyperoesthesia is found when the skin is 



pinched up 

 Death is the result of excessive pressure 



and the impediment of essential organs 



There is anaemia and ieucocytosis 



Initial fever, dry skin, rashes, and slight 



desquamation common 

 All nerve tissues are affected somewhat 



equally 



PROGNOSIS. 



This varies considerably and is according to the country and the 

 type of the disease. 



In Java the mortahty is 2 to 6 per cent. 



In Sumatra the mortahty is 60 to 70 per cent. 



Cardiac failure is always bad. To move much is fatal. 



Vomiting is a bad sign as it indicates that the vagus is involved. 



This latter feature is also manifested by the marked dilatation of 

 the stomach and embarrassment of the heart. 



Death may be due to dilatation of the heart and syncope, hydro- 

 thorax, pericardial effusion or paralysis of the diaphragm. 



The dropsical variety is more serious and uncertain than the 

 paralytic. 



TREATMENT. 



This is purely symptomatic. 



Absolute rest in bed is essential. 



Digitalis or strophanthus is good. 



Amyl nitrite or trini trini should be handy. 



Venesection, eight ounces to relieve the right heart when necessary. 



Oxygen during dyspnoea. 



For paralyses, strychnine, massage and electricity to prevent 

 atrophy and cramps. 



Removal from the supposed site of infection as soon as possible. 



Atropine, one 150th to one 50th grain, hvpodermicallv, or tincture 

 of belladonna for dyspnoea (Braddon). 



Plenty of good nourishment, in small quantities. 



Full diet plus one drachm of yeast and 200 grm. of beans daily 

 (Simpson). 



