pie Te een ork 
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in color. On section the organ discharges a large amount of dark, fluid blood and 
the surface presents to a moderate extent the picture of a nutmeg liver. The gall 
bladder contains a considerable quantity of dark, greenish-yellow bile, its walls 
are somewhat cedematous. The mucous membrane of the stomach and duodenum 
is moderately hyperemic but does not show either petechia or ecchymoses. In 
general, the intestines are normal. Pancreas is normal. The brain is quite 
cedematous, somewhat hyperemic, but otherwise normal. The peripheral nerves 
and skeletal muscles show no macroscopic changes. 
ANATOMICAL DIAGNOSIS.—Hypertrophy of the right ventricle, congestion and 
adema of the lungs, enlargement, fibrosis and congestion of the spleen, marked 
parenchymatous degeneration of the kidneys, congestion of the liver, hydroperi- 
cardium, ascites, slight general adema of the subcutaneous tissues, edema of the 
brain. Acute pernicious beriberi. 
MICROSCOPICAL EXAMINATION.—The myocardial fibers show a moderately clear 
striation; here and there may be distinctly seen the fine dust-like vacuolation 
of fatty degeneration and the coarse vacuoles of fatty infiltration. Occasionally, 
fragmented fibers are met with. The nuclei are generally sharp in outline and 
well stained. The interstitial connective tissue is slightly increased. In_ the 
pulmonary sections the vessels are all congested, particularly the inter-alveolar 
capillaries. There is some increase of connective tissue around the veins and 
arteries but the inter-alveolar connective tissue is not increased. Many of the 
alveoli contain granular material, desquamated epithelia, few leucocytes and a 
considerable number of erythrocytes; some alveoli are completely filled with blood. 
In the spleen the trabecule are widened and the connective tissue of the pulp 
is increased. A considerable proliferation of endothelial cells of the pulp spaces 
is discernible. The follicles are ill-defined. Malarial pigment or plasmodia are 
not found. In the renal sections considerable cloudy swelling of the epithelial 
cells is seen. In the hepatic sections the central areas of the lobules show com- 
plete fatty degeneration and even necrosis of the parenchyma cells. Between the 
lobules small, round celled subacute inflammatory foci are visible. The inner head 
of the gastrocnemius shows no minute changes, the striation of the fibres is very 
distinct, the nuclei well defined and well stained; in fact there are no signs of a 
degenerative process. The degenerative changes in the peroneal nerve and 
branches are moderate in degree but are characteristic. There is irregularity of 
the myelin sheath, swelling, rarefaction, and vacuolation. 
Case No. 3.—Acute pernicious beriberiimNecropsy No. 1619, January 20, 1906: 
Gregorio Flores, 26 years old, a Filipino prisoner in Bilibid, under a death 
sentence, was admitted January 18, 1906, to the prison hospital. He complained 
of weakness and shortness of breath. On admission at 8 a. m. his temperature 
was 36°.8 C.; pulse, 132; respiration, 32. During the afternoon the temperature 
rose to 37°.5 C. A urine examination on the morning of January 19 showed 
specific gravity 1,018, acid reaction; albumen present in small amount, some 
leucocytes and red-blood corpuscles. At 8 p. m. on January 19 the temperature 
was 38° C. At 8.20 p. m. the patient suddenly died. 
Autopsy forty-eight hours after death: Body of a medium-sized, fairly well- 
nourished native. Post-mortem rigor well marked. Post-mortem lividity over 
the dependent parts of the body and around the neck. Skin somewhat cyanotic. 
On section, a considerable amount of a dark, fluid blood issues from the superficial 
veins. The muscular tissue is fairly moist and of a good pink color. The 
muscles of the calves are very soft and flabby. ‘There is no marked cedema of the 
subcutaneous connective tissue. The abdominal cavity contains a small amount 
of clear fluid, but the pericardial fluid is@markedly increased. Heart: The 
pericardium is normal. The epicardium, smooth; it shows a few small petechiz. 
Myocardium somewhat hypertrophic, especially the right ventricle. Heart muscle 
= ae 
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