that the filaria, the ankylostomum, the trichiuris, and the ascaris are quite as prevalent outside as inside the hospital, and in the healthy as in the sick.
Past history of patients.— On inquiry he will learn that most of the cases come from two or three centres where similar disease is endemic from some particular institution, plantation, mine, or village. He will also remark that the same places supply both atrophic-paraly tic cases and dropsical-paralytic cases; and he will learn that many of the atrophic cases commenced with dropsical symptoms. From this he will make the important deduction that he is dealing, not with two diseases, but with two phases or clinical forms of the same disease; a disease which sometimes assumes atrophic features, sometimes dropsical features, and sometimes is of a mixed character. Some of the patients will give a history of fever at the outset of their troubles; in some there is a history of indigestion or diarrhœa; in some the paralytic or dropsical symptoms developed very slowly; in others, again, they came on rapidly. In some there is a history of a similar attack the previous year, or a yearly attack for three or four years in succession. Some will tell that they have been ill for several months, others that they have been ill for a week or two only.
Uncertain course.— The visitor will learn that this disease, which is beriberi, slowly or rapidly declares itself after an incubation period as yet undetermined but variously stated as of weeks or months, that it may be preceded by a period of intermitting languor, aching legs, palpitations, breathlessness, slowly advancing œdema of legs or face; or that the patient may wake up some morning and find that during the night he has become dropsical or paretic. Thus the disease may develop slowly or rapidly. Equally uncertain are its progress and danger; within a day or a week, or at any time during its course, it may assume fulminating, malignant characters. It may completely subside in a few days, or it may drag on for months. It may get well apparently and then relapse. It may, and generally does, clear up completely; or it may leave a dilated heart, or atrophied
