x, B, 2 Williams and Saleeby: Treatment of Human Beribert 115 
knee reflexes were sluggish. The patient walked with difficulty 
on account of pain in the calves. Cidema was scarcely notice- 
able. The patient was very querulous and depressed. 
He was given in the abdomen a subcutaneous injection of the 
semicrystallized vitamine obtained from 20 kilograms of rice 
polishings. Within a few minutes he complained of being unable 
to see well, and later of dullness of all the senses and severe pain 
in the abdomen. As the patient was in a very timid and excit- 
able condition, perhaps no great importance should be attached 
to his statement of symptoms. There was a very slight rise of 
temperature. 
Little change was observable in the patient’s condition until 
the second day after treatment. On the third day the change 
was very marked. The visible heart impulse had almost disap- 
peared, and the dilatation had greatly diminished. The murmur 
and accentuation of the second sound were no longer heard. The 
pain in the muscles was very slight, and the patient could walk 
with ease and could stoop, flexing the knees without pain. The 
knee refiexes also became slightly more active, although not quite 
normal. Especially noticeable was the change in the patient’s 
spirits. He continued to improve for a week, and when last seen, 
a month after treatment, he said that he felt quite well and 
strong. 
CASE 26 
An infant, 40 days old, was examined and treated at home with 
the codperation of Dr. José Albert. The general appearance of 
the child indicated that it might have been premature. It was 
small, weighing 2,500 grams. The arms and legs were thin, the 
skin lying in folds. The mother showed no very marked symp- 
toms of beriberi, although the knee reflexes were sluggish. She 
had had 9 children previously, 7 of whom had died at less 
than 3 months of age. The eighth was living and well. The 
child had been sick two days. Dyspncea was very severe at 
times, the respirations reaching 140 and the heart beats 200 or 
more per minute. The pulse was scarcely detectable. Vomiting 
had not been frequent, and cedema was slight. The voice was 
husky, the face cyanotic, and the child was very restless and 
fretful. The symptoms presented were such that death was to 
be expected hourly. 
The child was given by mouth the semicrystallized vitamine 
from 10 kilograms of rice polishings in 2 doses at 6 and 11 p. m. 
About one fourth of this was lost in administration. There was 
no rise of temperature, and improvement in the condition of the 
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