ale 7 a 
740 
Case No. 4.—Acute, pernicious beriberi.—Necropsy No. 1663, February 20, 1906: 
Andres Rabamontano; residence, 346 Cabildo; native Filipino, 18 years old; 
died quite suddenly at 11 a. m. February 19, 1906, without any previous illness. 
Autopsy twenty-four hours after death; Body of a strong, muscular native. 
The post-mortem rigidity is still marked, but it is less strong in the upper 
than in the lower extremities. Post-mortem lividity well marked, particularly 
on the dependent parts and around the neck. The face is somewhat puffed, 
the thorax and sides markedly cdematous; however, there is no appreciable 
edema of the lower extremities. On section, the superficial veins discharge a 
large amount of dark, fluid blood. The subcutaneous tissues of the thorax and, 
to a lesser extent, those of the abdominal walls are edematous. The pericardium 
contains about 300 cubic centimeters, the abdominal cavity about 400-450 cubic 
centimeters of a clear, straw-colored, serous fluid. Heart: The myocardium 
is hypertrophic, the wall of the right ventricle has a diameter of about 0.6 
centimeter, its walls are of a pink color with a few grayish-yellow spots. It 
weighs 340 grams. Lungs: congested, edematous, increased in consistency, and 
on the cut surface rather dark brownish-red in color. Spleen: capsule very tense, 
grayish-reddish-purple color; cut surface, brown-red; pulp, rather firm, does 
not protrude; follicles and trabecule, distinct. Kidneys and liver: much con- 
gested, somewhat increased in consistency, otherwise normal. Gall-bladder wall, 
highly @dematous; its mucosa swollen, Gastric and duodenal mucosa, moder- 
ately hyperemic. Otherwise all internal organs normal. Nerves and skeletal 
muscles show no macroscopic changes. 
ANATOMICAL DIAGNOSIS.—Hydropericardium, hypertrophy of the myocardium, 
adema, congestion and cyanotic induration of the lungs, congestion of the spleen, 
kidneys, and liver, ascites, edema of the subcutaneous connective tissue. Acute 
pernicious beriberi. 
MICROSCOPICAL EXAMINATION shows fragmentation of the myocardium (other- 
wise the fibers are perfectly normal), cloudy swelling and fatty degeneration 
of liver parenchyma cells; and subacute interlobular inflammatory foci. The 
popliteal and peroneal nerves show a minor degree of degeneration of the myelin 
sheath. (The nerves in this very acute pernicious case were removed, handled, 
and fixed with great care, so that the changes noticed are not due to artefacts. ) 
Case No. 5,—Acute, wet beriberi with splenomegaly.—Necropsy No, 1225, 
January 28, 1905: Examination seventeen hours after death in Bilibid Prison 
morgue of the body of Placido Bajian, Visayan, 34 years old. The patient had 
been previously working with a gang of prisoners at Fort McKinley. A few 
days before his death he had been returned on account of sickness to the prison 
hospital. Clinical diagnosis: Wet beriberi. Pulmonary adema. 
Aurorsy.—Body of a strong, well-nourished native, post-mortem rigidity well 
marked; post-mortem lividity present over dependent parts. The skin over the 
entire body is slightly edematous and pits on pressure. On section the subcuta- 
neous tissue discharges a small amount of serous fluid. The muscles are quite pale 
and moist. Both the thoracic and abdominal cavities contain a few ounces of 
slightly cloudy, serous fluid. Pericardium: smooth, transparent, contains a some- 
what increased amount of fluid. Heart: somewhat enlarged in all of its dimen- 
sions, epicardium, smooth and transparent, subepicardial fat very moderate in 
amount. Myocardium, soft and flabby. Both auriculo-ventricular openings en- 
larged in diameter; the cavities contain chicken-fat coagula and dark, fluid blood. 
Endocardium : smooth, all valves normal, no atheromatous spots in aorta. Color 
of myocardium, pale, pink, grayish-yellow, cut surface dull, Weight of heart, 325 
erams. Lungs: pleural surfaces, smooth, few old fibrous adhesions on the lower 
lobe of the left side; when inflated, pale-grayish-pink except the posterior surfaces 
woes ae 
