The diagnostics and treatment of tropical diseasesStitt, E. R. (Edward Rhodes)
Science
The diagnostics and treatment of tropical diseases
Stitt, E. R. (Edward Rhodes)
Tropical medicine
Even Vedder, who states that from a theoretical standpoint wet and
dry beriberi may be considered separate pathological processes
(deficiency in the anti-cardiac degeneration vitamine rather than
the anti-neuritis one), is inclined to believe it inadvisable, from
a clinical standpoint, to consider the one type apart from the
other.
One sees cases which combine the features of dry and wet beriberi
which can best be designated _typical beriberi_. Again we see cases
where the vagal and vasomotor involvement is so marked that the
patient resembles a man with acute nephritis plus all the evidence
of extreme cardiac decompensation. Such cases may be designated
_fulminating_, _pernicious_ or better _cardiac_.
Again we observe cases which from the start show little if any
oedema and very slight cardiac involvement, but with marked motor
disturbances as shown by muscular atrophies and palsies. The
sensory changes are not so marked as the motor ones. Complete
anaesthesia is rarely present, it is rather paraesthesia and
blunting of sensation which characterize the sensory phenomena.
This is usually designated the _atrophic_ or _paraplegic_ type.
_Rudimentary or Larval Beriberi._—Scheube recognizes a rudimentary
type and it must have been the experience of every one in the tropics
that these indefinite types of beriberi are quite common.
In such cases there may be nothing more than some weakness of the
legs with vague manifestations of blunting of the sensation or
variation of the reflexes. At times there may be marked anaesthesia
in the region over the shin bones.
Many of these cases show cardiac palpitation on exertion and at
times we may note slight evidences of oedema about the lower part
of shin bone or dorsum of the foot. It is the frequency of such
cases that causes physicians in the tropics to consider almost
any affection showing neurological manifestations as of beriberi
nature. A careful study of the neurological features of cases in
the tropics will show that many of these cases are not beriberi but
rather the common cosmopolitan diseases of the nervous system.
=A Typical Case of Beriberi.=—The patient first complains of
weakness and heaviness of the legs, particularly after fatiguing
work. There is also noted a sense of fullness and tenderness in
the epigastric region. The slightest exercise brings about cardiac
palpitation and more or less dyspnoea.
As the symptoms of peripheral neuritis become more prominent we
have hyperaesthesia of the calf muscles so that squeezing these
muscles gives rise to rather marked pain. The thenar muscles or
those of the forearm may also be more or less hyperaesthetic.
Attention has been called to a circumoral anaesthesia.
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