Page:Tropical Diseases.djvu/470

428 and signs of hyperæsthesia of the calf muscles sought for. The significance of these signs of what may be described as larval beriberi is too frequently overlooked until some sudden death, which, with earlier recognition of the disease, might have been avoided, puts the practitioner on his guard. All paretic affections, all cases of œdema, all cases of palpitation, and all cases of rheumatic-like pains occurring among the natives of warm climates, therefore, should suggest the possibility of their being beriberic, and also the necessity for a detailed examination with this in view.

Treatment.— The first and most important thing to be attended to in the treatment of a case of beriberi is the diet. From this, rice, especially white rice, should be eliminated, and some article rich in vitamine— such as beans, peas, peanuts, barley, wheaten flour (not over-milled), or oatmeal substituted, and, in view of the fact that we as yet cannot be certain that beriberi is not in some way dependent on an unknown germ, the patient should be removed, if practicable, to some place away from the endemic spot, to some dry locality, if such is available. He should sleep well off the ground in a thoroughly ventilated, sunny room situated in an upper storey. He ought to clothe sufficiently and feed well, taking care that the food is of a varied and not of a bulky character, and that it contains a sufficiency of nitrogenous and fatty elements. Apart from other considerations, rice is found to be a bad food for beriberics; it is too bulky. Animal food, including fat, must enter into the dietary in reasonable amount. Milk and eggs are beneficial. Yeast is credited with curative properties, and extracts of rice-polishings, prepared in various ways, have undoubtedly a beneficial effect and, when procurable, ought to be given.*