Page:Tropical Diseases.djvu/459

XXV] limb muscles with corresponding deformity. The variety in the severity, progress, and duration of beriberi is infinite; but in all cases the essential symptoms are the same— greater or less œdema, especially over the shins; muscular feebleness and hyperæsthesia, especially of the legs; numbness, especially over the front of the shins, of the fingertips, occasionally of the lips; liability to palpitation from cardiac dilatation, and to sudden death from the same cause.

Progress of the cases.— As the visitor watches the progress of the cases he will be astonished that those which he thought examples of locomotor ataxia, or of progressive muscular atrophy, or of ascending spinal paralysis, gradually improve, begin to walk about, and finally quit the hospital quite well. He will be astonished to see, after perhaps a profuse diuresis, the bloated carcass, that could hardly turn itself in bed, rapidly shrivel to little more than skin and bone, and assume all the appearances of the atrophic cases; and, later, perhaps after many months, to find the patient become rehabilitated, and, in due course, walk out of the hospital quite well. He will notice that the cardiac bruits come and go; that the degree of dilatation of the heart is subject to fluctuations; that what seemed confirmed organic disease completely disappears.

Cardiac attacks.— But he will also be astonished, as he goes his rounds, to see so often empty beds where the day before lay men whom he considered by no means seriously ill— certainly not dying. Some day he will come on a patient, whom the previous day he thought to be by no means seriously ill, actually in extremis. The poor fellow is propped up in bed, he is struggling for breath, his face is purple, his eyes are starting out of his head, his whole attitude is expressive of the utmost distress; he has a horrible, tearing, boring, crushing pain under his sternum and in the epigastrium; the vessels of his neck are throbbing violently, but his pulse is quick, small, intermittent, and his extremities are cold. In a short time the patient is dead. Some of the fatal cases,