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extends upwards towards the abdomen, there is a general sense of lassitude
and aversion to motion, and the hands, arms, and chest (and in a few
cases even the neck and lips) are gradually benumbed. There is oppres-
sion and weight at præcordia, dyspnœa on slight exertion, diffused and
irregular pulsation in the cardiac region, and the face and hands are puffy
and œdematous. The patient is often found dead in bed, or sinks after
several fainting fits or throbbings at the heart ; or the œdema rapidly
increases and extends up the trunk, violent dyspnœa and inability to lie
down in bed comes on, with anxiety, cold sweats, cold extremities,
rapid feeble pulse, urgent thirst, and partial suppression of urine.
At the commencement the urine is always scanty, of a deep red colour,
without cloud or sediment, and possessing very peculiar properties ; in
some old cases it becomes copious, turbid, and pale, with a large white
deposit, and is passed with pain from, an irritable bladder. The stomach
is irritable in many bąd cases, and pain and tenderness in the epigas-
trium is sometimes complained of; there is, in a few, pain in the abdomen,
or a sense of heat is diffused over it and the chest. Effusion takes place
into the chest, and more rarely into the abdomen, and there are now and
then some signs of inflammation of the pleura or bronchi. In the early
stage the pulse may be full, hard, and frequent or little altered ; when the
face is puffy and there is weight and oppression at the præcordia, it is quick,
often irregular, and usually small, although it is occasionally strong.
"Various dyspeptic symptoms occur ; the bowels are often costive, the
stools green and variously disordered, and the eyes are often tinged yellow.
The skin is rather cold, unless there is pyrexia, which is often present in
the evening. The disease is sometimes fatal in a few hours, but is often
chronic, and in these the patient is liable to sudden death, to rapid aggra-
vation of the symptoms, or supervention of new and more formidable ones,
by which he is soon carried off ; and if he survives these, he may live for a
long time bedridden, dropsical, and a true paralytic."
Pekelharing gives the generally described earlier symp-
toms as follows :—
"At first a slight œdema along the crest of the tibia, the face puffy
and doughy, diminished motor power in walking or going up stairs, &c.,
parræsthetic and antesthetic symptoms affecting the lower extremities ;
palpitation of the heart ; a pulse somewhat accelerated, or perhaps normal
during repose, but which rises to 90---100 on the least exertion * * *
* * * Beri-beri always commences gradually aud without fever, but in
a later stage there may occur a sudden exacerbation of the malady, accom-
panied with fever
* * * * * * Au acute exacerbation may
bring about a sudden termination of the case, from the nerves of the
heart becoming involved, or become the cause of dropsical complications.
Beri-beri does not always commence with cramps, but, during a certain
stage, an acute exacerbation affecting a large number of motor nerves
may be accompanied with the phenomena of irritability of the muscles. At
first parasthesia is not a prominent symptom ; but an acute exacerbation
may be accompanied by neuralgic pains, and causo the terrible suffering
known as anæthcsia dolorosa."
Both authors, too, remark on the circumstance that
residence within an endemic area of some duration is necessary
before the disease can definitely manifest itself, and are equally