THE TYPICAL I' CRM 



1687 



58 per cent, of polymorphonuclears, 36 per cent, of lymphocytes, 

 4 per cent, of mononuclear leucocytes, and 2 per cent, of eosino- 

 philes. 



The cerebrospinal fluid is generally normal. Lumbar puncture 

 rarely shows, in our experience, any alteration of pressure, although 

 a few authors have noted an increase. 



The urine may be much diminished when there is oedema, but 

 when this is passing off there is a large increase in the quantity. 

 The total solids are said to be below normal, urea and chlorides 

 being diminished, phosphates and indican being increased, and 

 albuminuria being rare. 



Dropsy may or may not be present, but some oedema, most 

 marked anteriorly in the legs, is a practically constant symptom. 

 It usually begins along the shin in the form of a rather solid oedema. 

 It may spread over the legs into the scrotum, on to the abdominal 

 wall, and into the face and arms, and is characterized by being at 

 times in peculiar localized patches, and if it takes place in the 

 muscles, gives rise to an appearance like pseudo-hypertrophic 

 paralysis. Along with the cutaneous oedema there is often exuda- 

 tion into the peritoneal, pleural, and pericardial cavities. 



When the dropsy is marked there may be a great diminution of 

 the urine. This dropsical condition is often improperly considered 

 to form a separate variety of the disease, and is called the 

 ' wet,' ' hypertrophic,' or ' dropsical ' form, while another variety, 

 called ' dry ' or ' atrophic ' beri-beri, is mentioned by many 

 authors, the two forms being merety the early and late stages of the 

 disease. 



The tongue is usually clean; the throat may be slightly con- 

 gested; digestion is fair, but a large meal will increase the praecordial 

 or epigastric distress. Vomiting is a bad sign. The bowels are 

 often constipated, the temperature normal or subnormal. The 

 urine may be diminished, increased, or normal in quantity, accord- 

 ing to the presence, the passing off, or the absence of oedema. 



The larynx may be paralyzed partially or completely, and the 

 voice rendered raucous or lost. The lungs may be oedematous. 



In this condition the patient may remain, at times better, at 

 times worse, for weeks and months, and may proceed slowly to 

 recovery, with, of course, deformities if paralysis remains, or may 

 die suddenly of cardiac failure when sitting up or getting out of 

 bed, or from some complication. 



3. Rudimentary Form. — There is a rudimentary, abortive, or 

 ambulatory form in which the symptoms are so slight that perhaps 

 the sufferer does not seek medical advice, but in whom there may 

 be first increase and then diminution of the knee-jerks, patches of 

 anajsthesia, some muscular weakness, some gastric catarrh, and 

 general malaise. Repeated attacks may occur. 



Complications. — Whenever fever develops in a beri-beri patient 

 there is sure to be a complication. The most common are tuber- 

 culosis, dysentery, and malaria. 



