SYMPTOM A TOLOGY 



1685 



The disease is insidious in its onset, and is characterized by 

 gastro-intestinal, cardiac, and nervous symptoms. For purposes 

 of description three types may be recognized— viz., (i) the acute 

 pernicious form ; (2) the typical form ; (3) the rudimentary form. 



1. Acute Pernicious Form. — The acute pernicious form may 

 exhibit itself in several ways. The most acute is when the person, 

 without previous illness, suddenly dies, and the autopsy reveals 

 that he has died of beri-beri. 



The more usual history is that the patient feels a disinchnation 

 for food, followed in a short time by a sensation of depression or 

 pain in the epigastrium, and nausea. Tenderness is evinced if 

 pressure is made over the pylorus or duodenum, while the throat is 

 seen to be congested. The temperature is usually normal, though 

 slight febrile rises have been recorded. Soon the heart symptoms, 

 characteristic of the attack, appear in the form of a sensation of 

 oppression over the heart, throbbing vessels in the neck, epigastric 

 pulsation, cardiac palpitation, and dyspnoea, while the slightest 

 exertion increases the pulse-rate markedly. The right side of the 

 heart dilates, and hsemic murmurs are heard. As a result of this 

 cardiac disturbance the urine diminishes and dropsy appears, but 

 this varies from being trivial to fairly considerable, with effusion 

 into the pericardium, pleura, and peritoneum. 



There may early be found patches of anaesthesia or hyperaesthesia, 

 particularly in the course of the anterior tibial and musculo- 

 cutaneous nerves. Paralysis now appears, and may be slight, or 

 may be so extensive as to prevent all voluntary movements, and 

 at the same time the anaesthesia may increase considerably. 



Sooner or later the cardiac symptoms become worse; the peri 

 cardial distress becomes agony, the lungs become engorged, and 

 the unhappy individual, unable to obtain proper aeration of his 

 blood, gasps for breath with open mouth and expanded nostrils, 

 while the pupils dilate. His face becomes cyanosed, his extremities 

 cold, and he becomes unconscious, and shortly dies of cardiac 

 failure. During this dying agony the mind is clear almost to the 

 last. The duration of such an attack is from twelve hours to a 

 few days. 



2. The Typical Form. — The typical form of the disease begins 

 insidiously with malaise, lassitude, loss of appetite, dull pain in the 

 stomach, tenderness on pressure over the pylorus and duodenum, 

 headache, difficulty of breathing and palpitation, often some 

 oedema along the shin, exaggerated knee-jerks, and a sensation of 

 heaviness in the limbs, especially in the legs. Sooner or later a 

 difficulty in walking sets in, and the knee-jerk diminishes and dis- 

 appears, or the patient may suddenly find himself on wakening in 

 the morning unable to raise himself. If he is capable of walking, 

 the gait is peculiar, somewhat resembling that of locomotor ataxia, 

 but generally being more of the ' high-stepping ' type, the foot 

 being raised with difficulty from the ground, brought forward 

 with a jerk, and lowered abruptly. He walks with a support, and- 



