X, B, 5 Williams and Johnston: Notes on Beribert 839 
Perhaps the most cogent argument against such a supposi- 
tion is that beriberi in its severest form almost invariably de- 
velops very rapidly. Often within the space of a few days an 
apparently healthy and normal person reaches a condition of 
severe prostration. Recoveries are likewise prompt upon the 
administration of vitamines in some form. A process of star- 
vation with respect to some essential food would be expected to 
produce a very gradual development of the symptoms. It is 
true, of course, that chronic human beriberi does often develop 
in this way. In fowls fed exclusively on polished rice gradual 
appearance of the symptoms is not observable in most cases, 
but nevertheless frequently occurs. In a series of 150 fowls fed 
exclusively on polished rice 10 have survived at the end of 
periods of from four to eight months. Of the 10, four showed 
marked lameness and spasticity of gait at the end of from 
thirty to forty days, which condition continued from three to 
ten days, after which they recovered except for a very slight 
stiffness of gait and an apparent dullness of sensation. The lat- 
ter condition was evidenced by a retarded response when prod- 
ded or otherwise disturbed. It amounted to nothing more than 
a slight torpidity. The remaining 6 fowls gradually developed 
the mild, chronic condition without passing through an acute 
stage. It may be noted here that among the 150 fowls at least 
3 showed an unmistakable cedema in the feet. 
The development of beriberi in breast-fed infants is particu- 
larly rapid. When completely weaned from the breast and fed 
artificially on fresh milk rapid improvement frequently begins. 
In a number of cases we have noted that a single nursing at 
the breast causes a prompt and more or less severe exacerbation. 
Such a result would not appear to be accounted for by a simple 
deficiency, the less so since Gibson * has shown that fresh milk 
does not possess antineuritic properties in any extraordinary 
degree. 
In addition, Sawazaki* has recently reported the production 
of a paralytic condition in fowls by injection of the milk of beri- 
beric women. 
The existence of various very dissimilar forms of beriberi 
have led to a classification as wet and dry, acute and chronic. 
This classification, however, is very indefinite and its value 
may be questioned. The only distinction that need be drawn 
* This Journal, Sec. B (1918), 8, 469. 
* Mitt. Med. Gesell. Tokio (19138), 27, No. 3, Abstract in Zentralbl. f. 
Biochem. u. Biophys. (19138), 15, 314. 
