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735 
The most characteristic histological changes in beriberi are found in 
the peripheral nerves. Here, a degeneration of the myelin sheath occurs 
which varies from insignificant alterations to the most profound lesions. 
The myelin sheath is broken up into balls and beads, becomes gradually 
honeycombed and finally entirely disappears. Where it is profoundly 
altered, the axis cylinders likewise show distortion, irregular outlines, 
coiling up, or complete disappearance. These changes have been so 
completely described on a number of occasions and particularly by 
Yamagiwa and recently by Duerck, that it is not considered necessary 
here to give any further description of them. A proliferation of the 
neurolemma nuclei is generally associated with the degenerative changes 
in the myelin sheath and the axis cylinder. However, I have never found 
any changes of an inflammatory nature and agree with those who think 
that the morbid processes in the peripheral nerves in beriberi are purely 
degenerative in character. I have seen the profound degenerations in 
the peripheral nerves from very acute cases which Duerck has described. 
This seems to point to the fact that the poison of beriberi, whatever it 
may be, accumulates in the body and then leads to a sudden explosion. 
It is clear that such fundamental alterations in the nerves as are seen 
in acute, pernicious cases, can not have been produced during the few 
hours or days in which the disease apparently has continued, it is more 
probable that they are due to an agent which has accumulated during a 
certain period of time without leading to any manifest symptoms. In 
the more chronic cases, degenerative changes are also seen in the muscles 
supplied by the peripheral nerves and in these instances the voluntary 
muscle fibers are found with indistinct outlines and striation, and the 
sarcoplasm is either homogeneously swollen or shrunken away from the 
sarcolemma. 
Rumpfe and Luce and Wright have also described degenerative changes 
in the axis cylinders and nerves of the cord and the latter mentions altera- 
tions in the ganglion cells of the spinal ganglia. 
POST-MORTEM RECORDS AND HISTOLOGICAL STUDIES OF A NUMBER 
OF CASES OF BERIBERI. 
The following post-mortem and _ histological studies of a number of 
cases are included for the purpose of illustrating the pathological types 
of the disease : 
Case No. 1.—Acute pernicious beriberi with advanced degeneration of periph- 
eral nerves.—Necropsy No, 1547, November 24, 1905: Lope Jacob, a Filipino 
prisoner in Bilibid penitentiary, had been working in the prison during 
November, 1905. As far as was known he had not been recently ill. During 
the night of November 23 he was attacked with palpitation of the heart, 
shortness of breath, weakness, and anxiety. At 1 a. m. his condition became so 
alarming that he was taken to the prison hospital. Here he rapidly failed and 
died at 5.25 a. m. 
