734 
look upon it as a purely mechanical, passive process due to general 
venous congestion, which often finds so marked an expression in the 
condition of the liver. ‘The small intestine, excepting the duodenum, 
and the large intestine show no particular changes in beriberi. 
The peripheral nerves, particularly those of the lower extremities, are 
almost without exception profoundly affected in this disease, but the 
changes are rarely noticeable to the naked eye. The changes found on 
microscopical examination clearly indicate that the most characteristic 
anatomical morbid process in beriberi is the degeneration of the peri- 
pheral nerves. This observation was first made by Baelz, Scheube, Miura, 
and Yamagiwa, and has later been confirmed by a considerable number of 
observers, including Pekelharing and Winkler, Wright and Duerck. 
Summary of the histopathological changes—In sumimarizing the 
histopathological changes the following lesions should be emphasized: 
The myocardium usually shows a more or less incomplete loss of the 
striation of its fibers. The latter are finely vacuolated, although larger 
vacuoles are also occasionally seen. Fragmentation and segmentation 
are generally present but it is not justifiable to attach as great a signifi- 
cance to these lesions in beriberi as Glogner has recently done, because 
they are so frequently found in a variety of diseases that they are not 
of specific importance. Among the changes in the myocardium must 
also be mentioned an occasional increase in the interstitial connective 
tissue. The lungs show no characteristic histological changes, but, in 
cases where there has been much congestion and oedema, dilated and 
densely filled interalveolar capillaries are present. and the alveoli them- 
selves contain a granular or coagulated, homogeneous material. Oc- 
casionally there is an increase of the interalveolar, the perivascular, and 
the peribronchial connective tissue. The spleen shows no characteristic 
changes, but an increase in the connective tissue, more or less endothelial 
proliferation and crowding of the pulp spaces with blood elements are 
frequently encountered. In the kidneys, as emphasized by Yamagiwa, 
are usually found cloudy swelling and fatty degeneration of the tubular 
epithelia. In uncomplicated cases, these parenchymatous changes are 
usually of a moderate degree. In the liver there is a great congestion 
of the intralobular capillaries, with fatty degeneration and cloudy swelling 
and even complete necrosis of the parenchyma cells. A change in the 
liver, to which Plehn has recently attached considerable importance, we 
have met with almost without exception. It consists of interlobular, 
inflammatory foci, composed of small, round cells which infiltrate the 
interlobular fibrous connective tissue. In fact, Plehn speaks of an inter- 
stitial hepatitis in beriberi. The mucosa of the stomach and duodenum 
exhibits dilated and congested vessels and in a number of cases a profound 
eosinophilia has been present. In the cases in which the eosinophiles 
were increased the presence of uncinaria could be excluded, and it is 
possible that this eosinophilia may have a certain significance in beriberi. 
