732 
tissue. The neurolemma nuclei were enlarged and proliferated, and the prolif- 
erating endoneurium had given rise to fibrous tissue. The voluntary muscles 
of the body also showed profound changes. Individual fibers could be seen, 
twisted spirally and drawn together between other muscle fibers, which were still 
well preserved, The sarcolemma nuclei were much increased. The sarcolemma 
sheath was partly retracted from the contents; it also in many places showed 
irregular protrusions. The contractile protoplasm had been expelled in the shape 
of circumscribed, roundish masses which no longer showed any striation. 
SUMMARY OF THE PATHOLOGY. 
The following is a general outline of the special pathology of beriberi, 
summarized from a study of the literature on the subject and from that of 
a number of fatal cases examined by the author in Manila during the 
past three years: 
The bodies of patients dead of beriberi generally promptly develop 
marked post-mortem rigor. However, in cases which succumb slowly to 
the atrophic type or in which complicating, wasting diseases, such as 
tuberculosis, ameebic dysentery, malaria, etc., are present, the post- 
mortem rigidity may be quite insignificant; this, however, is the excep- 
tion and not the rule. When death has occurred very rapidly, as in 
the acute pernicious variety, the author has observed the post-mortem 
rigor develop very early and to become as strong as that met with in 
fulminating cases of Asiatic cholera or bubonic plague. According to 
M. Miura, post-mortem rigidity generally shows itself in beriberi within 
two hours after death, reaching its maximum within five or six hours 
post-mortem and lasting for a considerable period of time. The skin of 
the corpse is pale, with cyanotic patches scattered here and there. Oc- 
casionally cutaneous hemorrhages may be observed. On section the super- 
ficial veins discharge a large amount of dark, fluid blood and in the 
majority of cases, excepting only those of the atrophic variety or of long 
standing, the subcutaneous tissue is cedematous and exudes a considerable 
amount of serous fluid. The subcutaneous cedema is usually best marked 
at the anterior thoracic region and over the anterior surfaces of the lower 
extremities. Hydropericardium, ascites, and hydrothorax are very fre- 
quently encountered in beriberi autopsies. Hydropericardium is_ the 
most common of these serous effusions. The average of the post-mortem 
figures given by Scheube, Lodewjik-Weiss, Pekelharing and Winkler, 
and Yamagiwa, in a total of 256 cases, shows 66 per cent of hydroperi- 
eardium. The author has likewise found hydropericardium in the 
majority of his autopsies on cases of this disease. Subepicardial and 
subpleural petechiz are also not infrequently encountered. 
The heart, of all the internal organs in beriberi, most constantly shows 
very characteristic changes. ‘The myocardium, as a whole, is hyper- 
trophic, and the hypertrophy is usually most marked in the right ventri- 
cle; but the left one may likewise be enlarged. The organ is then in- 
creased in size in all of its diameters and in its weight. The average of 
ype, eee Peres 
