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easily compressible, and 100 beats per minute. After the patient had walked about 
the room for a short time it increased to 141. The heart’s area of dullness was 
increased downwardly and to the right, and a systolic bruit could best be heard 
at the base of the organ. The lower extremities were somewhat cdematous, the 
skin pitting slightly on pressure. There was no pain complained of in the calves. 
The patellar reflex on the left side was normal, that on the right accentuated. 
On May 22 the condition of the patient became worse, the difficulty in respiration 
increased, and the temperature at 8 o’clock in the evening had risen to 39°. He 
died at 2.30 a. m. on the next day. 
Autopsy, eight hours after death. Body of a strong, well-nourished native, no 
deformities, medium weight, apparent age 25 to 30 years. Post-mortem rigidity 
very marked, involving extremities, jaws and the muscles in general. Pbdst- 
mortem lividity present in the dependent parts of the body. The lymphatie 
glands are not palpable. On section, the superficial vessels discharge a considerable 
amount of dark, fluid blood and the subcutaneous connective tissue is found to 
be edematous; the muscles are quite moist. The pleural cavity contains a few 
ounces of clear, straw-colored serum. Both pleurse show a number of petechie. 
The lungs in general form are normal and of pinkish-gray color. They are 
inflated. On section, the blood vessels are found to be congested and a large 
amount of watery fluid can be pressed out of the tissues. The trachea and bronchi 
are normal but the epiglottis shows a few petechie. Heart: the pericardium 
contains a somewhat increased amount of clear, serous fluid. The myocardium 
exhibits a few spots of subepicardial hemorrhages; it is of normal consistency. 
The right side is considerably dilated, markedly hypertrophied, and the whole 
heart weighs 360 grams. It contains dark, fluid blood and gelatinous clots. The 
muscle is pink in color, with a few grayish-yellow spots. The coronary vessels 
are tortuous and distended. The abdominal cavity contains about 300 cubic 
centimeters of straw-colored, clear fluid. The mesenteric and _ post-peritoneal 
glands are not enlarged. The spleen weighs 540 grams. It is very soft, dark 
grayish-purple externally and on section dark brownish-black. The pulp is 
very soft and protrudes over the surface. The trabecule and the Malpighian 
bodies are not distinct. The liver is tiormal in size, somewhat increased in 
consistency, surface smooth, externally reddish-brown. On section its vessels 
discharge a considerable quantity of dark, fluid blood. The gall bladder, which 
contains about two to three dozen small, very dark stones, is normal except that 
its walls are very edamatous. The kidneys are normal in size, their surface is 
smooth, dark grayish-pink in appearance, consistency rather soft, capsules peel 
off easily. On section the vessels appear moderately congested, the surface is 
rather dull, tubules grayish-white. Ureters, bladder, pancreas, ete., normal. The 
stomach and the intestines show nothing abnormal. Their mucosa is rather pale- 
gray as far as the stomach is concerned, but hyperemic in the small and large 
intestines. The brain is normal but quite oedematous. The ventricles contain 
about 30 to 50 cubic centimeters of clear fluid. The peripheral nerves show no 
changes. 
ANATOMICAL DIAGNOSIS.—Dilatalion of the right side of the heart, moderate 
general hypertrophy of the myocardium, adema of the lungs and of the brain, 
moderate general anasarca, acute, parenchymatous nephritis, congestion of the 
liver, colelithiasis, enlargement, pigmentation, and softening of the spleen. Acute, 
wet beriberi (complicated, as shown by the microscopical examination, with westivo- 
autumnal malaria). 
MIcROSCOPICAL EXAMINATION.—Myocardium: the fibers, aside from fragmen- 
tation, show no changes. The nuclei are well stained and clear cut. Striation 
of the sarcoplasm is*very distinct. In the lungs, the blood vessels are dilated 
