INFANTILE BERIBERI. 73 



Muscular system. — The child is apparently well nourished. 

 There is no paralysis or paresis. An attempt was made to elicit 

 the reaction of degeneration in the muscles of the calves of the 

 legs of two infants by the Faradic and (ialvanic currents, hut, 

 owing to the early age of the patients and consequent un.satis- 

 factory result, it was abandoned. 



Cutaneous system. — The skin is anaemic, soft, and almost vel- 

 vety in touch. In many cases a general oedematous condition 

 is present. It may be well marked or only slight. 



Kidneys. — In many cases oliguria or even anuria is a late 

 symptom. When this makes its appearance the child has been 

 suffering for some time, although this is occasionally one of the 

 symptoms which first attracts the mother's attention. In several 

 cases the urine was examined during life and in a few others 

 was obtained from the bladder at necropsy, but in all instances 

 albumen was absent by the nitric acid and heat tests. 



Nervous system. — In many cases the child manifests periods 

 of restlessness and moaning; its sleep is disturbed. 



Voice. — Aphonia may be present for several weeks or it may 

 come on late. There may be complete loss of voice or only a 

 slight weakness. In many cases the voice has a peculiar shrill- 

 ness or whining tone which manifests itself soon after the disease 

 begins and remains till aphonia develops or till death takes place. 



Sex. — Both sexes are susceptible. 



Age. — The condition is most common between the ages of 1 

 and 3 months, although cases of 4, 5, and 6, and even 10 months 

 of age are noted. 



Social co7idition. — The disease is most common among the 

 extremely poor, but is occasionally found among the fairly well- 

 to-do classes. 



Season of prevalence. — According to the statistics of the Bu- 

 reau of Health, infantile beriberi is most common in the months 

 of September, October, and November, gradually decreasing in 

 numbers with the approach of the hot season (April, May, and 

 June) and then increasing as the rainy season advances. 



History of the mother. — In nearly all cases the mother shows 

 some symptoms of beriberi ; numbness and pains in the legs, 

 anaesthetic areas on the legs, formication, tachycardia, dysp- 

 noea on slight exertion, lack of coordination in walking, palpita- 

 tion, possibly distinct heart murmurs, loss of knee jerks and 

 other reflexes. In two cases we found the mother suffering 

 from such pain in the legs that she could not walk, but sat on 

 the floor and shuffled herself along. On inquiring as to the 



