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Mild laryngeal and tracheal catarrh are often said to usher in the disease, or to be present in an aggravated form in the later stages. Such, however, we have never found in our cases.
The Diagnosis.
This presents no difficulty at all to any one who has the least acquaintance. with the disease. The points upon which we rely are :-
(1.) Anesthesia over legs.
(2.) (Edema over the shin.
(3.) Pain on pressure of calf muscles.
(4.) Loss of knee reflexes.
(5.) Heart touble-palpitation, &c.
Cases in the later stages present no difficulty whatever their appearance is diagnostic.
It may happen, however, that in some cases difficulties may present them- selves and, therefore, we should be careful to eliminate such diseases as may shew some likenes to Beri-beri.
A.-Alcoholic Neuritis.-In this there is a history of alcoholism to guide us-- there is progressive weakening of the legs, and anaesthesia, general tremulousness and perhaps albumin in the urine.
B.-Arsenical Neuritis.-Symptoms of arsenical poisoning are present, viz., diarrhea, abdominal pains, numbness, tingling, bloody urine. There is no œdema. Sensation may be lost. No ankle clonus or knee-jerk.
C.-Lead Poisoning.—Characterised by pains in joints, blue line on gums, colic, wrist drop-no pain in affected muscles.
D.-Malarial Cachexia.-No loss of reflexes. History of repeated attacks of fever. Anæmia-perhaps enlarged spleen. Microscope may help-shewing para- sites ; no anesthesia. No rapid wasting of muscles.
E-Locomotor Ataxia.-Characterised by girdle pains, Argyll Robertson pupil, anesthesia of soles of feet-loss of reflexes-chronic course-history of syphilis.
F-Epidemic Dropsy.-Sets in with sudden dropsy, fever, vomiting, diarrhoea -no pain in muscles, no loss of reflexes, no anesthesia.
G.-Heart Disease. Signs of affection, such as murmurs, enlargements: oedema of lower extremities, albumin in urine-no paralysis, no anesthesia.
H.-Bright's Disease.Indicated by swelling under eyes and in legs: albu- min in urine no loss of sensation, of reflexes, of power of movement,
I.-Ankylostomiasis.-This is very insidious-progressive anæmia and per- verted appetite characterise it. No paralysis or loss of reflexes, or anaesthesia. Miscroscope shews ova in fœces.
J.-Pellagra.-History of eating maize-knee-jerks exaggerated-very chronic course--tremors and tetany-inco-ordination of gait. No tenderness of muscles.
K.-Ergotism.-History of eating rye. Gangree of extremities sets in. Ting- ling in skin. Knee reflex lost.
L.-Lathyrism.-History of eating pulse. Knee-jerks increased. No tender- ness of muscles, no inco-ordination, no paralysis, no anesthesia.
M.-Myelitis.-Rapid onset and fatal result-loss of reflexes-paresthesia- incontinence of urine. No pain or tenderness over paralysed muscles.
All these diseases and conditions enumerated above run their own course and shew their individual particular symptoms: a careful consideration of the case and a recollection of the fundamental symptoms and signs should lead to no difficulty in the diagnosis.