Page:Tropical Diseases.djvu/478

436 observed in Mauritius. Harvey remarked two cases in Calcutta exhibiting doubtful paretic symptoms; these are the only two recorded in which there was anything resembling the paretic symptoms usually so prominent a feature in beriberi.

An exanthem, erythematous on the face, rubeolar on the trunk and limbs, was frequently seen in Mauritius, less frequently in Calcutta. It appeared about a week after the œdema, and lasted from ten to twelve days.

Circulation and respiration.— Disturbances of the heart and circulation were prominent features in nearly all the cases. The pulse was weak, often rapid and irregular; cardiac bruits were also noted. Breathlessness on exertion occurred in all cases; severe orthopnoea in many. Signs of pleural and pericardial effusion, of œdema of the lungs, of pneumonia, and of cardiac dilatation were common in Calcutta.

Anœmia was usually present and marked; so were wasting and prostration. Scorbutic symptoms occasionally showed themselves.

The liver, spleen, and kidneys were not specially affected. The urine was rarely albuminous.

Morbid anatomy.— Beyond general œdema and occasional pleural and pericardial effusion, nothing special was remarked post mortem.

Treatment.— In the absence of anything like precise knowledge of the cause and pathology of epidemic dropsy, treatment must be entirely symptomatic. Mild purgatives, the exhibition of digitalis when there is evidence of cardiac weakness, and the occasional use of the nitrites in the fits of orthopnœa might prove serviceable. During convalescence iron and arsenic are indicated.