747 
MIcrROSCOPICAL EXAMINATION.—The myocardial fibers show a fairly distinct 
striation and some fine, dust-like vacuolation. Nuclei, well stained, fragmenta- 
tion present to a moderate extent, interstitial connective tissue somewhat in- 
creased. The pulmonary interalveolar capillaries and the vessels of the lungs in 
general are congested; the alveoli partly filled with a cellular and serous exudate ; 
the peribronchial connective tissue here and there somewhat increased, In the 
spleen the connective tissue is much increased and the pulp spaces are crowded 
with blood cells; outlines of follicles, indistinct. The tubular epithelia of the 
kidneys show cloudy swelling and fatty degeneration, but in general only in 
moderate degree. The hepatic sections show congestion of the intralobular capil- 
laries, fatty degeneration of the cells in the center of the lobule and interlobular, 
periportal, subacute, inflammatory foci. A pronounced eosinophilia is found in the 
mucosa of the stomach and of the duodenum. ‘The degenerative changes in the 
popliteal nerve and its branches are well advanced. 
Case No. 10.—Subacute beriberi complicated with malaria and amebiasis.— 
Necropsy No. 1636, February 1, 1906 (history kindly furnished by Dr. G. B. 
Cook). Donoso Coronel, a native Filipino of 45 years, light-house keeper in 
Manila Bay, assumed the duties of his position some time in December, 1905. 
Seven days after going to work in the light-house (according to the statements of 
the patient, who appears to be quite dull mentally) he became sick, but remained 
in the light-house for three more weeks, when he finally entered the Civil Hospital. 
On admission, patient could not walk on account of partial paralysis of the legs; 
his expression was heavy and he complained of pain in the abdomen; lower 
eyelids, puffy, and lower extremities, edematous, pitting on pressure. Pulse, 
114, apex beat displaced outward and downward, the second sound at the apex 
is prolonged and the second pulmonic sound is accentuated. There is visible 
pulsation in the upper epigastric region. The patient complains of pain in the 
abdomen and in the muscles of the legs and forearms. There is decided pain on 
pressure of the calves. The legs are moved slowly and with difficulty, extension 
of the feet and legs is weak; there is no ankle or wrist drop; the patellar reflexes 
are absent. On admission, the temperature registered 38.5°, Adstivo-autumnal 
malarial parasites were found in the blood and amebe in the stools. On January 
26 the patient was examined by the writer, who found all of the more typical 
symptoms of subacute, wet beriberi. Some of the blood of the patient was drawn 
from the median cephalic vein and used for incubation and for animal experi- 
ments (reported above). The patient died February 1, 1906, at 4.20 a. m. 
Autopsy four hours after death: Native Filipino of medium size and good 
nutrition. Post-mortem rigidity marked; post-mortem lividity, beginning to 
show on dependent portions of the body. The dorsum of the feet and of the legs 
is slightly edematous. On section, the superficial veins discharge a considerable 
amount of dark, fluid blood. The subcutaneous connective tissue is slightly 
cedematous. The pericardium contains about 100 cubic centimeters of a clear, 
straw-colored serum; the pleural and the abdominal cavities, each several hundred 
cubie centimeters. The heart is considerably enlarged in all of its dimensions. 
The right auriculo-ventricular opening admits five fingers; the myocardial wall 
of the right ventricle measures 6 to 7 millimeters in thickness. ‘The left auriculo- 
ventricular opening admits three fingers, and the myocardium of the left side is 
likewise hypertrophic. Epicardium and endocardium, smooth and otherwise nor- 
mal. Myocardium of fair consistency, but pale yellowish-gray. Papillary muscle 
of left side considerably hypertrophied. Lungs: collapsed, poor in air, bound 
down by some old, fibrous adhesions; externally, grayish-pink with some 
purple in the lower and posterior parts. They are found to be rather dry 
on section, The bronchi contain a rather thick, foamy liquid; the mucosa is pale 
and not swollen; the bronchial glands are normal. The spleen is enlarged to 
