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about twice the normal size; it is soft, intensely congested, dark brownish- 
black; follicles and trabecule, distinct. The kidneys are normal in size, rather 
firm in consistency, pinkish-gray externally; capsules, smooth, peel off easily. 
On section, tubules, grayish-white, slightly cloudy; vessels, congested; pelves, 
normal; ureters, bladder, ete., normal. The mucosa of the stomach is slightly 
hyperemic at the apices of the folds; that of the duodenum is likewise hyper- 
wmic. The ducts of the gall bladder are open. Liver: swollen, tense, grayish-dark 
in color; on section, brownish-yellow. The mucosa of the rectum and colon 
is hyperemic and shows a few shallow ulcerations; otherwise, normal. 
ANATOMICAL DIAGNOSIS.—Hydropericardium, hydrothorax, ascites, hypertrophy 
of the myocardium and dilatation of the right heart ; congestion, hypertrophy and 
pigmentation of the spleen, parenchymatous degeneration of the kidneys and 
liver. Hyperamia of the gastrie and duodenal mucosa; amoebic ulcerations, of 
the large intestines. Subacute, wet beriberi. 
MICROSCOPICAL EXAMINATION.—The myocardium shows an indistinct striation, 
fine, with a coarser vacuolation here and there, fragmentation and segmentation 
and some increase in connective tissue. The pulmonary sections show no pro- 
nounced changes. In the spleen, a considerable amount of pigment and a moderate 
number of malarial parasites are seen. The renal sections exhibit considerable 
cloudy swelling of the uriniferous tubules. In the liver there is found congestion 
ot the intralobular capillaries, cloudy swelling and fatty degeneration of paren- 
chyma cells and interlobular, periportal, subacute, inflammatory foci. The 
stomach and the duodenum do not show any particular changes. In the large 
intestine there are erosions and ulcerations with leucocytic infiltration of the 
mucosa. Ameebe, however, were not discovered in the sections examined, The 
degeneration of the peripheral nerves is very pronounced, there are irregularities, 
beaded swellings, honeycombing, and sometimes a complete loss of the myelin 
sheath, 
Case No, 11.—Chronic, dry beriberi—Necropsy No. 1617, January 19, 1906: 
Evaristo Rivera, a 35-year-old Filipino, a prisoner at Bilibid, was admitted to the 
hospital on January 5, 1906. He had been suffering for some time from indefinite 
symptoms and from muscular pains with some disturbances of motion. His case 
was first diagnosed as muscular rheumatism. Later on, absence of patellar reflex, 
enlargement of the heart toward the right side and other symptoms suggested the 
diagnosis of beriberi. On January 18, 1906, at 8 a. m., the patient exhibited a 
subnormal temperature of 35.1°, the temperature at noon had risen to 36.3°; 
pulse 86, respiration 38. At 1.30 p.m. the patient died in syncope. 
Autopsy twenty-two hours after death: Body of medium-sized, normally devel- 
oped native, about 30 to 40 years old, poorly nourished. Rigor mortis: moderate. 
Post-mortem lividity well marked on the dependent parts of the body. The 
surface in general is moderately cyanotic. On section of the body, the superficial 
veins discharge a considerable amount of dark, fluid blood. The muscles are 
pale-pink, not very moist. The lymphatics are normal. The pleure of the 
lungs are smooth. The lungs are inflated and of a very pale-pink color except 
in the dependent part where they are light-purple. They are highly cdematous 
and on section a large amount of watery, foamy fluid escapes. The heart is 
markedly enlarged. It weighs 370 grams; the hypertrophy is particularly notice- 
able in the right ventricle which is also considerably dilated. Its wall has a 
diameter of about 7 to 8 millimeters. The chambers contain a considerable 
amount of dark, fluid blood, and in addition chicken-fat clots. The myocardium 
is of fair consistency and of a pale, gray-pink color. There are no evidences of 
marked fatty degeneration. The pericardium and endocardium are smooth; no 
ecchymoses or petechiae being present. The intestinal serosa is rather pale, but 
translucent; appendix, normal. Mesenteric and post-peritoneal glands somewhat 
ahh etl Sia 
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