eo valli 
high magnification revealed the fact that this homogeneous substance was a 
7ol 
Yamagiwa,™ after a study of a large autopsy material, enumerates the most 
important pathologic changes in beriberi as follows: (1) Dilatation and hyper- 
trophy of the right ventricle, and dilatation of the left; fatty metamorphosis 
of the myocardium; (2) degeneration of the peripheral nerves; (3) atrophy and 
degeneration of the skeletal muscles; (4) parenchymatous degeneration of the 
kidney; (5) hydrops. In other words, all the pathological changes in kakke are 
regressive in nature, with the single exception of the hypertrophy of the 
myocardium. 
Yamagiwa, assisted by Yamanouchi,” recently has investigated the claim of 
Glogner—i. e., “that beriberi is primarily a disease of the heart and skeletal 
muscles (fragmentation) with a loss of continuity of the elastic tissue of the 
vessels, particularly of the pulmonary artery and its branches.” The Japanese 
authors from their histologic studies conclude that Glogner’s statements are 
not at all tenable and that the elastic fibers of the pulmonary artery and its 
branches are practically intact in beriberi. 
In seven beriberi necropsies Plehn (1. ¢.) found the liver in six presenting 
the changes of interstitial hepatitis and in one, those of chronic congestion with 
secondary induration. This observer is therefore inclined to look upon the inter- 
stitial hepatitis as an important morbid change in beriberi. 
Hermann Duerck,* who also has recently studied beriberi in Sumatra, states 
that the surrounding connective tissue, the fine connective tissue—i. e., the endo- 
neurium—the myelin sheath, and even the axis cylinders of the nerves are all 
affected and that alterations are to be found even in acute cases. In the instance 
of a Chinese coolie, sick only fourteen days, who complained mainly of dyspnea 
and palpitation of the heart, disturbances of locomotion increasing almost to 
complete paralysis were present. In this case sections of the vagus nerve showed 
almost complete degeneration of the myelin sheath, with irregularly fringed 
fragments, or with fragments resembling portions of a rosary. In other places 
the axis cylinders were entirely devoid of their myelin sheaths, many of which 
were found collapsed and with the neurolemma nuclei increased. The axis 
cylinders were spirally twisted, irregularly undulating, and in some places even 
broken up into fragments. The heart in the same case was dilated and resem- 
bled a flabby, thin-walled sac. Microscopically, the myocardium showed most ex- 
tensive changes. The muscle cells were attenuated, having been pushed apart 
by a homogeneous, glassy mass, in which small, undulating clefts containing 
cell nuclei surrounded by some granular protoplasm were occasionally seen. A 
« 
degeneration product of the fibrils of the heart muscle cells. In many places 
there could very distinctly be seen a direct transition of the striped substance 
into the hyaline mass. The muscle cells were also separated longitudinally into 
a number of fine, parallel bands. This process resulted in the picture of free 
nuclei surrounded by a small amount of granular sarcoplasm. The bands evidently 
had undergone hyaline degeneration and the hyaline material included the nuclei, 
with a small amount of sarcoplasm. According to the report, the degeneration of 
the nerves could be followed step by step by the melting of the hyaline sheath, 
vacuolation, and the formation of honeyecombed or foamy masses. Large cells, evi- 
dently leucocytes loaded with some of the degenerated hyaline, were found in the 
immediate neighborhood of the capillaries which supply the endoneural connective 
“Yamagiwa: Beitrage zur Kenntniss der Kakke. Virehow’s Arch. (1899), 
156, 451. 
* Yamagiwa and Yamanouchi: Ueber das Wesen der Kakke. Salkowski Fest- 
schrift. 
* Duerck: Ueber Beriberi, ete. Miinch. Mediz. Wochenschr. (1905), 52, 1913. 
