894 CARL VOEGTLIN 



absence of colic and the blue line on the gums. Heart disease is elim- 

 inated by the absence of the signs of valvular disease, and the presence of 

 paralysis. The differential diagnosis should furthermore take into con- 

 sideration myelitis, locomotor ataxia, pellagra, kidney disease, and 

 lathyrism. 



The opinion generally prevails that beriberi is very rarely found in 

 this country, and while this is undoubtedly true, it should be remembered 

 that the diagnosis of mild cases is exceedingly difficult on account of 

 the vague symptoms which are not at all specific of this disease. Some 

 time ago the writer called attention to the possibility that in the United 

 States incipient cases of beriberi may escape recognition, a view which 

 now seems to be confirmed by the marked improvement noted by Eddy 

 and others following the administration of antineuritic vitamin to infants 

 suffering from "malnutrition." 



Treatment. It is obviously far more important to prevent beriberi 

 by means of a proper diet than to cure it. This can be accomplished by 

 including in the diet a sufficient quantity of foods rich in antineuritic 

 vitamin (see table in chapter on vitamins). The treatment in the early 

 stages of the disease has some chance of immediate success, but the chronic 

 cases require prolonged treatment, and even then some of the anatomical 

 injuries resulting from the disease may never completely disappear. A 

 case of this kind was seen by the writer in a discharged soldier, who had 

 contracted beriberi while on duty in the Philippines. He was discharged 

 from the army and returned to this country, but still suffered from neu- 

 ritis, which in spite of a mixed nutritious diet had not receded after 

 four years. 



Symptomatic treatment is undoubtedly of some value, but since the 

 disease has been shown to be due to a dietary deficiency the main effort 

 should be directed, as will be pointed out later, towards correcting the 

 dietary defect. Acute, cardiac cases should be kept in bed so as to avoid 

 any unnecessary strain on the weakened circulation. This is particularly 

 important, as the fatalities from this type are due to sudden heart failure, 

 which often occurs without a preliminary warning. The heart action may 

 be supported by the use of digitalis and venesection. Hypodermic injec- 

 tions of atropin are advocated by Braddon. Edema and constipation are 

 favorably influenced by the administration of saline cathartics. Bromids 

 tend to relieve the hyperesthesia, and strychnin is used as a general tonic 

 in the treatment of the paralytic symptoms in chronic cases. 



The milder cases respond rapidly to a proper change in diet. In 

 adult patients the diet should include green vegetables, legumes, milk and 

 fresh meat, as it has been shown that green vegetables, especially beans 

 and peas, are fairly rich in the antineuritic vitamin. 



Specific treatment with vitamin preparations is based on the results 

 obtained in animal experimentation. Soon after the discovery of poly- 



