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connective tissue is cdematous, in places even gelatinous. On opening the 
spinal canal and the cranial cavity, the dura is found to be tense, the amount 
of cerebro-spinal fluid increased. The vessels of the pia-arachnoid are injected, 
and the brain itself is rather edematous; fluid in the ventricles is increased; 
otherwise, the brain and the,cord are normal. The thoracic as well as the 
abdominal cavity contains a moderate amount of clear, straw-colored fluid. 
Pericardium: smooth, glistening, translucent, distended by an increased amount 
of clear, serous fluid; probably three to four times as much as normally found. 
The heart is large, soft, and flabby; dimensions, 16 centimeters from base to 
apex, 12 centimeters from side to side, 7.5 centimeters from before to backward. 
Visceral pericardium, smooth; coronary veins much injected, deep-bluish-purple 
in color; both auriculo-ventricular openings somewhat enlarged. Auriculo-ven- 
tricular valves on right side not quite competent. Endocardium, smooth except 
over the aortic valves. These are markedly thickened, somewhat nodular, and 
slightly retracted toward their peripheral attachment. However, there are 
neither loss of substance nor any adhesions. Beginning of aorta, ather- 
omatous. Lungs: adherent by old fibrous adhesions, which are difficult to 
separate. Adhesions present at the apices as well as at the diaphragmatic sur- 
faces. Purplish-gray in color at the upper lobes, quite deep purplish at the 
lower ones. On section, much blood and cedematous fluid .escapes. The lower 
lobes in particular contain a considerable amount of dark, fluid blood and very 
little air. The bronchi contain frothy mucus. Mucous membranes of trachea 
and bronchi, somewhat injected and swollen. Spleen: 10 by 8 by 5 centimeters. 
Capsule, on the whole, smooth though slightly wrinkled; pinkish-red; on section, 
dark-brown. Trabecule, well-marked; pulp, fairly soft, somewhat protruding. 
Kidneys: 11.5 by 6 by 5 centimeters; pinkish-reddish-purple; after removal 
of capsules, which strip off easily, areas of a more grayish color are seen. On 
section, cortex 3 to 9 millimeters; vessels, injected; tubules, grayish-yellow; 
pyramids, dark brownish-red, much injected. Mucous membrane of pelves, 
smooth; suprarenals, swollen, enlarged, quite soft, dark-purple in color. Liver: 
rather small, pinkish-gray; capsule, smooth, translucent; center of lobules 
appear as rather pale, shiny grayish areas. On section, color is in general rather 
dark pink-purplish mixed with grayish-yellow. Vessels contain much dark blood. 
Gall bladder: distended with turbid, dark green bile; mucous membranes, smooth, 
no stones. Pancreas: large, rather soft; otherwise normal. Stomach: serosi 
smooth, shining, transparent; veins much injected, particularly those radiating 
from the lesser curvature; gastric mucosa thrown into prominent ruge, much 
congested, of a pale, pink color with a hue of purple. Oesophageal mucosa, 
likewise, though more moderately, injected. Intestines: the serosa is markedly 
injected over the whole length; the process is more marked in the serosa of the 
small intestine. Duodenwm: mucosa, somewhat swollen; vessels, injected, pink- 
ish-red in color. The mucosa of the jejunum and ileum is likewise injected, 
though less than that of the duodenum. Peyer’s patches distinctly swollen. 
Appendix, normal. Large intestines, practically normal except slight injection 
of the mucosa. 
ANATOMICAL DIAGNOSIS.—Hydropericardium, dilatation and hypertrophy of the 
myocardium, chronic endocarditis of the aortic valves, atheromatosis of the aorta, 
congestion and cedema of the lungs, hyperemia of the gastric and intestinal 
mucosa, parenchymatous degeneration of the kidneys and liver, enlargement and 
chronic congestion of the spleen, hydrothorax, ascites, general oedema of the 
subcutaneous connective tissue. Subacute, wet beriberi. 
MIcROSCOPICAL EXAMINATION.—Myocardium: striation of fibers in places com- 
pletely lost; fine and coarse vacuolation; granular degeneration very pronounced ; 
