The diagnostics and treatment of tropical diseases

by E. R. Stitt

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.

Ship Beriberi.—A disease of importance on Scandinavian sailing ships to which the designation “ship beriberi” has been given resembles beriberi in that we have oedema particularly of the lower extremities and at times generalized so that a case would appear to be one of wet beriberi.

More or less dyspnoea and cardiac palpitation are features of the disease as of beriberi. In fact death often is the result of acute cardiac paralysis. The striking point of difference is the generally reported absence of manifestations of neuritis and Nocht in an autopsy of a case failed to find evidence of degeneration of the peripheral nerves.