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enlarged. The spleen is slightly enlarged, moderately indurated, dark, steel-gray 
externally and on section, dark brown-red. The pulp is quite firm, the trabeculi 
widened and the follicles not very distinct. The liver is somewhat increased in 
size, swollen and of increased consistency. Its capsule is smooth, transparent 
and translucent. Externally, the organ is of bluish-purple color, with numerous 
yellow streaks and dots visible through the capsule. The cut surface presents 
the typical picture of a nutmeg liver. Gall bladder and gall ducts normal. 
Kidneys: normal in size. Capsules, smooth, peeling off easily; external color, 
pinkish-blue. Consistency of these organs increased. On section, the blood ves- 
sels are found to be moderately congested. ‘Tubules are decidedly grayish-white, 
the pyramids are moderately congested. The gastro-intestinal tract is normal 
except that the mucosa of the small, as well as that of the large intestine, is 
much congested, so that the veins stand out very prominently, The congestion 
is best marked in the first part of the duodenum. On dissecting out the popliteal 
nerve and its branches on the left side, it is found that the sheathes show numerous 
ecchymoses. Such ecchymotic spots also extend into the substance of the gastroc- 
nemius muscle. The muscles of the calf in general are very flabby, and of a pale, 
grayish-pink color. The brain is very pale, the ventricles contain a moderate 
amount of fluid; otherwise, the organ is normal. Weight of the brain, 1,165 grams. 
ANATOMICAL DIAGNOSIS.—Hypertrophy of the heart, particularly of the right 
ventricle, edema of the lungs, chronic cyanotic induration of the spleey, congestion 
and parenchymatous degeneration of the kidneys, chronic passive congestion of 
the liver, congestion of the internal mucosa, ecchymoses into the sheath of the 
left popliteal nerve and branches, general anemia, chronic, dry beribert, 
MICROSCOPICAL EXAMINATION.—The noteworthy changes found in sections of the 
various organs are: Myocardium, no marked microscopic changes, except a mod- 
erate increase in the perinuclear pigment. Spleen, considerable increase in the 
connective tissue of the trabecule and of the pulp, some proliferation of pulp and 
endothelia, crowding of the pulp spaces with erythrocytes; follicles, very indistinct 
and ill-defined. Hidneys, cloudy swelling of epithelia of uriniferous tubules; 
fibrosis and obliteration of some of the Malpighian tufts; however, no general 
increase of connective tissue; fairly numerous hyaline casts in the tubules. Liver, 
great congestion of the intralobular capillaries, atrophy and fatty degeneration 
of the parenchyma cells in the center of the lobule. Some round cell inflam- 
matory infiltration of the interlobular connective tissue. Gastrocnemius (inner 
head), some of the muscle fibers have lost both transverse and longitudinal stria- 
tion and are swollen and almost homogeneous; however, others are perfectly 
normal in appearance. Popliteal nerve and branches, the degeneration of the 
myelin sheath and axis cylinders is well advanced. 
SYMPTOMATOLOGY. 
Clinical types of the disease—From a clinical standpoint, beriberi may 
be divided into three main types, namely—the acute pernicious, the wet 
or edematous, and the dry or atrophic beriberi; however, this classifica- 
tion ig somewhat arbitrary. A rudimentary variety of the disease, in 
which the symptoms are so mild that medical aid is generally not sought, 
also frequently occurs in addition to these three well-defined types. 
Malaise, weakness of the lower extremities, and increased heart beat on 
slight exertion are usually noticed in these cases. ‘These symptoms may 
speedily and spontaneously disappear, or they may increase in intensity 
-and then lead to one of the well-defined severer types of the disease. 
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