INFANTILE BERIBERI. 71 



it would not be considered at the first glance to be sick, for it 

 smiles and plays as a normal infant should. Closer inspection, 

 however, will change this opinion. The onset of symptoms is 

 insidious ; they come so gradually that the mother does not notice 

 them till they become prominent. There is cyanosis around the 

 mouth and nose, slight dyspnoea, periodic restlessness, insomnia, 

 rarely a slight cough, occasionally vomiting, and possibly a 

 change in the child's voice. As a rule one of these symptoms 

 is more pronounced than the others and this is the one the 

 mother notices first and for which she seeks relief, although 

 several of the others may be present at the same time. Possibly 

 the mother has noticed nothing wrong with the child, yet it may 

 manifest several of these symptoms. When once the condition 

 is present the tendency is to increase in severity and seriousness. 

 Aphonia and oliguria appear, as a rule, late; this is especially 

 true of the oliguria. Patients not infrequently exhibit repeated 

 attacks of the disease with eventual recovery. On the other 

 hand, well-authenticated cases are on record where the infant 

 has been apparently well (at least the mother has noticed nothing 

 wrong) when suddenly the child is seized with a fit of crying 

 without any apparent cause; the crying increases in severity, 

 the infant finally goes into convulsions and dies in a few 

 hours. The child evidently suffers great pain, as the crying con- 

 tinues until death. Clinically, I have never seen such a "case, 

 but I have observed cases at necropsy in which the attending 

 physicians gave such a history and have found the typical patho- 

 logic picture of beriberi to be present. I do not doubt that cases 

 with such chnical histories occur, but the child probably had 

 been sick for some time and the mother had noticed nothing 

 abnormal, and not until an acute heart attack set in was the real 

 condition of affairs revealed. Possibly the child began crying 

 for other reasons and the exertion thus produced precipitated 

 an acute attack of heart failure. This form of the disease is 

 spoken of by the Filipino doctors as the acute peniicious type. 



CLINICAL OBSERVATIONS. 



This study includes a series of 27 infants, 8 of which came to 

 necropsy. Several died in which necropsy was not permitted. 



Circulatory system. — The pulse is rapid, ranging from 130 to 

 170, or more, per minute. The latter rate is not unusual. It 

 is usually of good volume. There is an increase of dullness 

 both to the right and the left in the praecordial area. The second 

 pulmonic sound is accentuated. The apex beat is usually clear. 



