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BERI-BERI AND EPIDEMIC DROPSY 



Sequelae. — Many authors do not believe in sequelae to beri-beri, 

 but certainly there may be the contraction left after the paralysis 

 and anaemia, and attacks of palpitation may occur. 



Diagnosis. — The principal positive signs on which to base the 

 diagnosis are: (i) Loss of knee-jerks; (2) patches of anaesthesia, 

 and occasionally hyperaesthesia, on the legs; (3) pain on pressing 

 the calf muscles; (4) oedema along the shin; (5) absence of marked 

 albuminuria; and (6) the absence of fever. 



Suspicious early signs in endemic areas are loss of appetite and a 

 desire for lighter food, together with tenderness over the pylorus 

 and duodenum, with exaggerated knee-jerks. 



Several diseases have to be distinguished from beri-beri; first of 

 all the different kinds of peripheral neuritis — ^5.^., alcoholic neuritis, 

 by the history and the general tremulousness; arsenical neuritis, 

 by the abdominal pains and the diarrhoea; lead paralysis, by the 

 colic and the blue line of the gums. 



Secondly, dropsies due to heart disease are recognized by the 

 murmurs and the history of rheumatic fever, or other infectious 

 disease; kidney disease, by an examination of the urine; ankylo- 

 stomiasis, by the ova being found in the faeces; epidemic dropsy, 

 by the fever and the absence of anaesthesia and paralysis; malarial 

 cachexia, by the enlargement of the spleen, and perhaps the para- 

 sites in the blood; and kala-azar, by the enlarged spleen and liver. 



Thirdly, certain diseases of the spinal cord ; myelitis, by the loss 

 of control over the bladder and rectum; locomotor ataxy, by the 

 Argyll- Robert son pupil; pellagra, by the skin eruptions. 



Fourthly, certain intoxications, such as ergotism by the gan- 

 grene and the history, and lathyrism by the absence of tender 

 muscles. 



Prognosis. — The acute pernicious form is always fatal, the rudi- 

 mentary never. The general mortality varies in different countries, 

 as follows: — 



Per Cent. 



Sumatra . . . . . . . . .. 60 to 70 



Hong-Kong . . . . . . . . . . 48'6 



Malaya . . . . . . . . . . 19-7 



Java . . . . . . . . , . . . 2 to 6 



Japan 2-5 to 3-5 



But it apparently depends upon many things, of which the most 

 important is the avoidance of sudden cardiac failure. If the patient 

 is treated carefully in bed the danger is much diminished, but if he 

 is allowed to sit up and move about the danger is great. Complica- 

 tions are most unfavourable. 



An attack does not confer an immunity. On the contrary, it 

 rather predisposes to another attack. 



Observers who believe in the infectious nature of the malady are 

 generally of opinion that there are no relapses, but that reinfections, 

 even shortly after an attack, are common. 



Treatment.— -The treatment is essentially symptomatic, the 



