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*« 
the latter in 93 cases of beriberi reported by Yamagiwa was 368 grams, 
whereas the normal Japanese heart weighs from 250 to 300 grams. The 
right ventricle was hypertrophic in 73 of these 93 cases, the average diam- 
eter being 6.1 mm., compared with a normal diameter of 2 to3 mm. The 
right ventricle, in particular, is generally not only hypertrophic but 
also markedly dilated, so that there is present a relative insufficiency of 
the tricuspid valve. All of the chambers generally contain a large 
amount of dark, fluid blood. Chicken-fat clots are also generally found 
in the heart in atrophic cases in which the death struggle has been 
protracted. The coronary veins are much dilated. The myocardium 
may be normal, but often it is found to be more or less cloudy and 
mottled, in consequence of diffuse, fatty degeneration. 
As a rule, the lungs are cedematous, congested, and contain little air; 
however, occasionally they are emphysematous, and we have also seen 
some cases in which they were exceptionally collapsed and dry. At times, 
some catarrhal bronchitis may be observed and in some cases, where the 
pneumogastric has been profoundly affected, aspiration pneumonia has 
been seen. In beriberi the spleen shows no changes characteristic for this 
disease. It is true that in the Tropics a considerable enlargement has 
frequently been observed in beriberi; but this must be looked upon as a 
mere coincidence, because one must not forget that in tropical post- 
mortem material, no matter what the immediate cause of death has been, 
enlargement of the spleen is very frequently found. However, in beriberi 
this organ often shows cyanotic induration of a moderate degree. The 
kidneys, in acute cases, are markedly congested, and some cloudy swelling 
and fatty degeneration are frequently observable. The liver is generally 
swollen and congested. Where chronic passive congestion has lasted 
for some time, on section we find the characteristic appearance of a 
nutmeg liver. 
In many cases of beriberi, particularly those of the subacute variety 
which have not lasted too long, we find great hyperemia of the gastric 
and duodenal mucosa. Occasionally, ecchymoses are even found in 
the mucous membrane of this organ. Ellis ** reports that he found 
the lining membrane of the stomach congested in 31 out of 5% fatal 
cases of beriberi, and in most of these it was intensely congested, 
especially on the ridges of the corrugations. In four instances there 
were blood clots present in the stomach, possibly due to the persistent 
vomiting from which the patient had suffered prior to death. This con- 
dition of the gastric and duodenal mucosa has so impressed several 
observers that they hold the stomach and duodenum to be the portal of 
entrance of the specific virus of beriberi. We have, like others, observed 
this hyperemia in most of our necropsy cases; but we are inclined to 
* Ellis: Contribution to the Pathology of Beriberi. London Lancet (1898), 
2, 985. 
me 
