_Digestive and Urinary Symptoms._—Those who considered beriberi as an acute infectious disease were disposed to note frequently evidences of toxaemia as manifested by nausea, vomiting and epigastric distress. As a matter of fact these symptoms only become very prominent in pernicious beriberi and may well be connected with the cardiac decompensation. However caused vomiting is of unfavorable prognostic import. The amount of urine is markedly decreased when oedema is advancing but is succeeded by a polyuria when this diminishes. If albumin should be present it is not connected with beriberi but some other condition. _Other Features._—There is nothing characteristic about the blood other than a slowly developing anaemia. Oedema is the most striking feature of wet beriberi. When slight this oedema may only involve the pretibial-region or sternum. Circumscribed areas of oedema may be present on the upper parts of the body as neck and trunk. Hydropericardium is the most frequent of the exudates into serous cavities. Fever is almost always absent except in epidemic dropsy. DIAGNOSIS When the case is one of mixed type with the oedema, cardiac involvement and signs of peripheral neuritis the diagnosis is readily made. A diagnosis of nephritis is often given the wet type of beriberi and locomotor ataxia the dry form, by those who have not in mind the possibility of the disease existing in an oriental crew after a long voyage. The urine in beriberi is as a rule normal and there are no peripheral nerve disorders in nephritis. Chagas has noted that a quartan form of malaria gives rise to oedema about the ankles and is often mistaken for beriberi by the physicians of the Amazon region. The cardiac manifestations of beriberi differ from those of valvular disease in that the murmurs are muffled and there does not exist the definite areas for the location of the murmurs of the various valvular lesions. The rapid development of a pericardial effusion is also against valvular heart disease. The absence of lancinating pains, typical Romberg sign and Argyll-Robertson pupil should differentiate from tabes. The tripod gait of beriberi takes its name from the wide separation of feet and use, with the hands, of a cane in front. It is a steppage gait instead of the ataxic one of tabes. On account of the lack of power to raise the toes in walking, the beriberic lifts the hip and swings to one side in order to avoid scraping his toes. In progressive muscular atrophy the palsy attacks the hand first and in a more advanced case showing the main-en-griffe there would also be deltoid involvement. Of course beriberi may show the main-en-griffe characteristic but the greater involvement of the feet with vagal phenomena differentiates.