i686 



BERI-BERI AND EPIDEMIC DROPSY 



often with the legs wide apart, in order to give stability to his 

 locomotion. He cannot stand long with closed eyes, and complains 

 that he feels as though he were walking on something soft. In 

 addition he suffers from cramp, and his calves are very tender, and 

 sensations of pins and needles, burning, etc., may be felt. It will 

 be noticed that the anterior tibial and the peroneal muscles are 

 mostly affected, and that often there is a tendency for the foot to 

 assume the equino-varus position, and that ankle-drop is often 

 seen. 



The forearms may also be paralyzed, and wrist-drop, with great 

 loss of power in the grip, may be noted. As the paralysis proceeds 

 the muscles waste, and electrical excitation is much altered. Miura's 

 rule is that if the foot can be flexed on the ankle, the excitation 

 is only diminished; if only the toes can be dorsally flexed, there 

 is a partial reaction of degeneration; but if no dorsal movement is 

 capable of being made, then the reaction of degeneration will be 

 fully developed. The paralysis spreads to the muscles of the calf, 

 the muscles of the thigh, and the gluteal region, and to those of the 

 hand and arm; then to the abdomen, the diaphragm, the inter- 

 costals, and the larynx, and, in rare cases, to the intra- and extra- 

 ocular muscles. 



Fletcher has drawn attention to jongkok, or squatting test The 

 person places both hands on the top of the head, and slowly squats 

 down on his heels, and then rises up again. In beri-beri this cannot 

 be performed. 



Associated with the paralysis there is at first hyperaesthesia, 

 especially in the calf muscles; paraesthesia, as alreadj^ mentioned; 

 and partial anaesthesia, which may be characterized by saying that 

 the patient feels as though he were touched through some protecting 

 cloth. There is also loss of sense of heat, and cold, and pain. This 

 anaesthesia varies much in site and extent. Usually it begins about 

 the feet and wrist, and moves upwards over the legs, thighs, fore- 

 arms, and arms, and down into the fingers. It is this numbness of 

 the fingers which incapacitates the patient from doing many simple 

 actions. There is said to be a peculiar ring of anaesthesia around 

 the mouth. The areas of loss of sensation do not correspond with 

 segmental or nerve areas, but are remarkably patchy. The nerves 

 of the affected regions may be tender. 



The heart is also markedly affected, being dilated, especially the 

 right side, with a diffuse apex-beat, a spacing of the sounds, so that 

 the intervals may be nearly equal; while systolic murmurs ma}^ be 

 heard, and reduplication of the second sound is common, particu- 

 larly over the pulmonary area. Palpitation and epigastric pulsation 

 are common, as is pulsation of the carotids and veins of the neck. 

 The pulse is usually much increased in frequency and low in tension. 

 The great danger of the disease is death from sudden cardiac 

 failure. 



The blood does not show much abnormaUty beyond a certain 

 amount of anaemia. The differential leucocyte count contains about 



