ETIOLOGY OF BERIBERI. 401 



disease. The symptoms of these cases did not improve until 

 the monotony of the diet was varied by the addition of dried 

 codfish and potatoes, Nos. 4 and 6 of this group suffered 

 merely from erosions about the corners of the mouths during 

 the experiment. It seems advisable to consider briefly the 

 symptoms in the cases which suggested the diagnosis of beri- 

 beri. In case No. 1 the loss of weight was constant throughout 

 the course of the experiment until the diet was changed, the 

 individual losing in all 7-9 kilograms (17.5 pounds) in weight. 

 From the time that fish and potatoes were added to the diet he 

 began to gain slightly in weight and the unfavorable symptoms 

 to improve. The striking symptoms suggestive of beriberi in 

 this case were the slight increase of knee jerks noticed first on 

 the eighty-first day of the experiment, pain in the abdomen, the 

 huskiness and almost complete loss of the voice, the development 

 of tachycardia, epigastric pulsation, slight oedema of the legs, 

 and tenderness of the calves. These symptoms certainly were 

 suggestive of beriberi. While it is an acknowledged fact that 

 all cases of beriberi do not show loss of knee jerks and that 

 usually, if perhaps not always, this symptom is a late one in the 

 course of the disease, nevertheless in an experiment of this 

 nature a definite diagnosis of beriberi was not made unless the 

 loss of knee jerks had occurred in conjunction with the appear- 

 ance of other symptoms of this disease. Also, it obviously is 

 impossible to state whether, had the diet been continued for a 

 longer period of time in this case, more definite symptoms of 

 beriberi would have developed, but his condition and the pro- 

 gression of the symptoms certainly suggested such a course. 

 In any case, a condition simulating beriberi was produced in 

 this individual. In case No. 3 the patient lost in weight almost 

 continuously up to the eighty-fourth day of the experiment, 

 4.5 kilograms (10 pounds) in all. The only symptoms of beri- 

 beri which were noted were the development of abdominal pain, 

 visible epigastric pulsation, pain and tenderness in the calves of 

 the legs, and huskiness of the voice. These symptoms improved 

 upon the addition of dried codfish and potatoes to the diet, but 

 the patient did not gain in weight until placed upon the regular 

 prison ration. (See Table VII.) The dried codfish, as may be 

 seen from Table II, contained 2.9 per cent phosphorus pentoxide, 



