892 CARL VOEGTLIN 



the addition of vitamin to the diet. The blood sugar of beriberi patients 

 was found increased (Suga, 1919, and Suzuki(a), 1916) in severe, acute 

 cases. Yoshikawa, Jano and Nemota (1917) observed an increase in 

 urea in the blood in severe but not in mild cases of beriberi, and the re- 

 fractive index of the blood serum was found normal. Nursing infants, 

 suffering from beriberi, were shown by Suzuki(fe) (1917) to secrete an 

 increased amount of amino-acid nitrogen in the urine, an observation 

 which this author attributes to abnormalities in the intermediate protein 

 metabolism resulting from impaired liver function. Aron and Hocson 

 (1910) studied the metabolism of a beriberi patient in a fairly advanced 

 stage of the disease and observed that the utilization of nitrogen and 

 phosphorus is reduced. Kamoino (1916) studied the respiratory metab- 

 olism in pigeons on a polished rice diet and noted that the respiratory 

 quotient is lowered. The quantity of oxygen consumed does not follow a 

 descending curve parallel to that of the carbon dioxid excreted. The 

 addition of rice polishings to the diet is followed by a prompt return of 

 the respiratory quotient to normal. Drummond(&) (1918) found a 

 marked creatinuria in rats fed on a diet deficient in antineuritic vitamin, 

 a fact which is probably explained by the marked wasting of muscle tissue 

 under these conditions. Dutcher and Collatz (1918) found the catalase 

 activity of the blood and tissues reduced in polyneuritis. 



Symptomatology. Clinically the disease has been divided into various 

 types. It should be remembered, however, that these various types are 

 manifestations of one and the same morbid process, and that one form 

 may suddenly pass over into another form. Perhaps the most useful 

 classification is that which recognizes the so-called "wet" and "dry" beri- 

 beri, these two types being distinguished chiefly by the presence or absence 

 of edema. The period of development of beriberi has been estimated by 

 Fraser and Stanton (1908) as at least 80-90 days. The onset is usually 

 gradual, the patient complaining for some time of malaise, heaviness, 

 numbness and weakness of the legs. Other complaints are loss of appe- 

 tite, constipation, palpitation and dyspnea after moderate exertion, pain 

 caused by deep pressure on the muscles of the legs. As the disease pro- 

 gresses, certain objective symptoms can be made out, such as edema over 

 the tibia, slight hyperesthesia over the internal surface of the lower ex- 

 tremities, increase or decrease of the knee reflexes, increased pulse rate 

 and heart action. Kato and Yamada (1918) examined two cases of 

 beriberi and found no evidence of cardiac irregularity until the patients 

 were convalescing, when a slowing of the pulse was noted, and the electro- 

 cardiagram showed a condition of sinusarythemia. This they attribute 

 to vagotonia, as atropin relieved the arythemia. Enlargement of the 

 heart can be readily demonstrated by percussion, and the downward and 

 outward displacement of the apex-beat. Systolic heart murmurs may be 

 present and the second heart sound over the pulmonic area is particularly 



