An examination at this time will probably show an active patellar reflex, some oedema over the shin and malleoli, possibly extending to the dorsum of the foot, with partial anaesthesia in the oedematous areas. It is a blunting of sensation as though a layer of cotton were interposed between the skin and the examining instrument. Other favorite sites for the oedema are the sacral and sternal regions. Occasionally sharply defined oedematous patches may be observed, particularly on the arms. The exercise attendant upon the physical examination will probably cause a rather marked cardiac palpitation. The pulse is usually rapid and its rate is markedly affected by the slightest exertion. The systolic pressure is low. The anaesthesia noted in the lower extremities soon tends to show itself about the back of the hands and the finger tips, so that it may be difficult for the patient to button his coat. There is also weakness of the grip. The temperature is normal and the mind is entirely clear. The results from a blood examination are practically negative, although later on there is the blood picture of a secondary anaemia. In cases where the oedema is more marked and generalized and when pericardial or other effusions are developing we find a diminution in the amount of urine, but with an absence of albuminuria. Later the case may show a dropsical condition more or less resembling nephritis, but with only slight scrotal oedema. At the same time there will be found a dilatation of the right heart with blowing systolic murmurs and equal spacing of the heart sounds. There may be marked pulsation of the veins of the neck. At this time the patellar reflex may be diminished and the anaesthetic areas more extensive. This condition of wet, dropsical or oedematous beriberi may be fairly rapidly succeeded by a disappearance of the oedema with, as a result, the making more striking of the muscular atrophy incident to the neuritis of the peripheral nerves. In this, the atrophic, dry or paralytic beriberi, the _jongkok test_ is of value. With the hands over the head the patient squats down on the calves of his legs and attempts to rise—something impossible for the beriberic. At this time the patellar reflex probably cannot be elicited and later on there will be found foot and wrist-drop with atrophy of muscles. With complete foot-drop, the reactions of degeneration will be found. A combination of the dry and wet types of beriberi is often described as the mixed type. It must always be remembered that the course of the ordinary case of beriberi is essentially chronic, running over months or years.