While greatly resembling beriberi clinically the following points of difference are usually noted by those who hold that it is a distinct disease entity.
1. The presence of fever, which rarely exceeds 102°F. and is usually only about 99° to 100°F.
2. An erythematous rash upon the oedematous portions of the extremities.
3. The frequent generalized oedema, which suggested the designation dropsy for the disease, cannot be differentiated from wet beriberi.
4. The neuritis manifestations are slight or absent. There may be formication of the feet but anaesthesia is wanting. The vagal involvement gives cardiac disturbances. There is anaemia.
Infantile Beriberi.—There is also a condition in nursing infants which would be difficult to recognize if unaware of the existence of this type of beriberi. It is called infantile beriberi.
In 1898 Hirota first noted the existence of a condition in infants nourished by beriberi mothers which has more recently been carefully studied by McLaughlin and Andrews and to which the name infantile beriberi is now generally given. In the Philippines it is called “taon.” Clinically there is restlessness, vomiting, altered voice, increased heart action, oedema and cyanosis. After death there is found a marked hypertrophy and dilatation of the right side of the heart with no change of the left side. The peripheral nerves also show the lesions of beriberi of adults but of less intensity.
The disease most often shows itself in an acute form, the child rather suddenly being seized with great pain, crying constantly and soon becoming cyanosed. Death, which may occur in a few minutes or hours, is often thought to be due to meningitis, although there is no fever or true convulsions. There is only rigidity of the body. Less frequently the disease appears in a chronic form in which vomiting and constipation are most marked. There is often a history of the loss by the mother, who herself may have only a rudimentary beriberi, of several children from this disease.
The infants improve rapidly when other infant feeding is substituted for the mother’s milk. An extract of rice polishings gives striking results in these cases.
Asylum Beriberi.—The beriberi outbreaks which have frequently been reported from European and American camps, prisons and asylums do not differ from the cases one may see in the classical distribution of the disease among the rice-eating populations of the Orient. The cause is the same, a deficiency in beriberi-preventing vitamines, and the symptoms are similar. These vitamines may be deficient in the rice or other cereal or proteid food supplied. Again they may have originally been present in sufficient quantity but later destroyed by too great heat or otherwise.