Page:Tropical Diseases.djvu/477

XXVI] of all the available evidence, concludes that epidemic dropsy is a disease sui generis. At the time of its occurrence in Calcutta many of the physicians there looked upon it as a form of beriberi; and, indeed, in many respects it resembles very closely those cases of beriberi in which dropsy is a prominent symptom, and in which the nervous phenomena are slight or altogether absent. But in epidemics of beriberi such cases are the exception— in fact, are very rare, and always concur with others in which nerve symptoms are pronounced, and with purely atrophic cases; such were not seen in either the Calcutta or the Mauritius epidemics. In epidemic beriberi the mortality is much higher than in the Shillong and Sylhet epidemics. Furthermore, beriberi is a much more chronic disease, is not accompanied by an eruption, and but seldom with well-marked fever.

Special symptoms.— According to McLeod, dropsy was almost invariably present. It usually appeared first in the legs, and in some instances was confined to the lower extremities; in others it spread and involved the entire body. Occasionally it was very persistent, lasting and recurring during convalescence. Fever also was a very constant symptom; sometimes it preceded, sometimes it accompanied, sometimes it succeeded the dropsy. It was rarely high, ranging usually from 99° to 102° F.; in a few cases —possibly from malarial complications— it reached 104°. Rigors were rare.

Diarrhœa and vomiting generally ushered in the disease in the Mauritius epidemic. In Calcutta these symptoms were not so frequent, although they were by no means rare there, occurring at both the earlier and later stages. Dysentery was common in the Calcutta epidemic. Nervous symptoms— such as burning, pricking, itching, and feelings of distension of the skin, sometimes limited to the soles and feet— often preceded the dropsy. Distressing aching of muscles, bones, and joints, worst at night, was usual. Anæsthesia of skin areas and paresis of muscles were never