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The height of the prevalence and incidence of the disease is thus seen to be during July, August and September. These months, together with the two preceding months when the curve commences to rise are the wet, damp and humid months of the year in this Colony, and it is a question whether these atmospheric conditions are contributory factors in the production and development of the disease.
It will be noted that though the curve for females is uniformly flat there is a marked rise in May and in August.
The Varieties of the Disease.
As we meet it here the disease presents itself in two varieties, known as the dropsical, moist or wet form, and the atrophic or dry form. The disease how- ever is a single entity-in its inception certain common symptoms manifest them- selves, in its development it assumes the characters of the one or the other variety. In the rapid onset and development of the first variety modified slightly in some respects but with an accentuation of the cardiac symptoms we get the acute pernicious variety. This form is very rarely met with here and is usually very fatal. The two varieties-the dropsical and the atrophic-occur in about equal proportions in their developed form, but it must be remembered that one form inay pass into and shew the characters of the other, that is, that celema, etc., may be implanted on the dry form and so convert it into the dropsical, or that the oedematous variety may pass through changes resulting in its assuming the atrophic forin. Beri-beric residual paralysis is a term which has been used in an analogous manner and with a similar meaning to diphtheritic paralysis. The pathology of the diseases being different, clear in one case, unknown in the other, the coin- parison does not hold, and any attempt to introduce new varieties, names, etc., is • to be deprecated.
A Picture of the Disease and its Diagnosis.
In a country where the disease is sometimes epidemic and always endemic the diagnosis on the one hand should present no difficulty, and on the other hand because so easily made not infrequently leads to errors. Indeed, so well are the symptoms known that patients frequently present themselves for treatment, having already diagnosed their condition.
What then are the symptoms upon which we rely for a diagnosis? In the first place, and we are here discussing the early stages, we find there is a feeling of malaise and lassitude, and then there is weakness of the legs and numbness, which is characteristic. Then comes on pains in the muscles of the calf of the leg, elicited by compressing the calf muscles, which amounts to exquisite pain some- times. The patient is unable to walk easily and freely, and he has a feeling as if he were treading on cotton wool or walking on a carpet. These signs by them- selves are sufficient for the patient and his friends. They indicate that he has Beri-beri. Further examination by an expert shews that there is loss of the knee reflexes, that there is anesthesia of the legs to a varying degree-that slight ædema exists over the shin bones, and that there may be shortness of breath and palpitation. The patient has progressive weakening of the muscles of the hand and forearm. His grip is weak, and there is wasting of the muscles of the thumb. The more advanced stages of the disease present no difficulty in re- cognition. There is wasting or there may be edema of the leg-the calf muscles in the former case being flabby and the skin dry, and there is loss of sub- cutaneous fat; or the whole leg is swollen and tense with a subjective feeling of fulness. In either case the sensibility of the skin of the leg is altered, either in the direction of total loss over the whole area or over irregular patches not necessarily corresponding to any particular nerve distribution, or there may be paræsthesia, viz., sensations of heat and cold, of pins and needles, of laucing pains, etc. In the early stages there is a loss of knee reflexes, an exaggerated reflex being seen perhaps in the first few days after onset. Then in the later stages corresponding with the loss of power in the leg muscles we have ankledrop marked. At this stage the patient is generally bedridden.
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