War Oedema.—In those areas of Europe where famine conditions were approached during the great war a condition of weakness and oedema was noted by many observers and to this symptom-complex various designations were applied such as war dropsy, war oedema, etc. The oedema was more marked than would be true in ordinary cases of starvation so that such factors as consumption of large amounts of water and salt in the thin soups so prominent in the dietary, plus hard work, must have been additional causes.
The oedema was most common in the feet and legs, at times extending to the thighs and trunk, and in about one-half the cases involving the face. Marked muscular weakness and alimentary disturbances were common. There was dyspnoea on slight exertion with a slow pulse, but cardiac disturbances were not features of the disease. The urine was pale, of low specific gravity and free of albumin. There was reduction of red cells and a tendency to leukopenia. These cases showed marked emaciation upon the disappearance of the dropsy. As is well known the deficiency in fats was marked in Central Europe so that it was to be expected that ocular manifestations should be frequently noted, deficiency of fat soluble A being the exciting cause of xerophthalmia. The cases tended to recovery under proper diet and hospital care.
Probably the most important conditions to consider in differentiation of beriberi are the peripheral nerve involvements caused by alcohol and arsenic.
In alcoholic neuritis there is the history of alcoholic excesses, long-standing digestive disorders and tremors of hands, lips and tongue. Chiefly characteristic, however, is the mental involvement, such cases almost always showing loss of memory and defective mental concentration.
Mental symptoms and tremors are practically absent in beriberi and we have here the marked feature of vagal involvement plus vasomotor phenomena.
In arsenical neuritis we have an early puffiness under the eyelids and pigmentation of the skin which first shows itself in areas normally pigmented. A dysenteric syndrome may also be present.
There would be less chance of confusing lead palsy as this chiefly involves the upper extremity. Punctate basophilia, lead colic and the blue line on the gums should differentiate.
In diphtheritic palsies the muscles of the soft palate are involved in more than 75% of cases. Ocular palsies are also not infrequent.
In lathyrism we have a history of the eating of the chick-pea (Lathyrus sativus) or other vetches, as may occur in times of famine. Pain in the back, weakness of the legs and symptoms of spastic paraplegia appear. The spasticity differentiates. The heart is not affected.