INFANTILE BERIBERI. 77 



legs is soft and flabby, and, as a rule, pits on deep pressure. 

 Occasionally the skin has a tough, leathery feel, a leaden color, 

 and a slight goose-flesh appearance. 



Subcutaneous fat is present, apparently in good amount, 

 grayish-white and very moist; the muscles are aniemic. Owing 

 to the oedema, one is apt to overestimate the amount of fat 

 present and hence the bodies may not be as well nourished as 

 they appear. Generally there is an increase of peritoneal fluid 

 which is distinctly yellowish. 



Heart. — The pericardial sac contains a clear, greenish fluid. 

 Probably the most striking and constant change is found in the 

 right heart. Its musculature is coarse and firm and forms much 

 the larger part of the organ including the contour of the apex. 

 Its trabeculiE and papillary muscles are prominent and its cavity 

 is enlarged. The wall of the right ventricle equals or exceeds 

 that of the left. In many cases the foramen ovale is still patulous 

 but is apparently competent. The ductus arteriosus, when 

 not closed, is represented by a very minute opening. In this 

 series it was entirely closed in half the cases. The circum- 

 ference of the pulmonary ring exceeds that of the aortic by 4 

 millimeters on an average. The circumference of the tricuspid 

 ring exceeds that of the mitral by 6 millimeters. The muscula- 

 ture of the left heart is soft and flabby, and darker than that of 

 the right. The blood vessels of the heart are congested and 

 prominent, and frequently a few haemorrhages are seen along 

 the auriculoventricular junction. 



Lungs. — These organs are light pinkish-gray anteriorly and 

 light purplish-gray posteriorly. They fill the pleural cavities 

 and crepitate throughout. The anterior part of the lung is 

 lighter and more fluffy than the posterior. Few or many pete- 

 chial haemorrhages may show beneath the visceral pleura, espe- 

 cially along the junction of the lobes. Occasionally there is a 

 slight increase of the pleural fluid. In two cases in this series 

 bronchopneumonia was present. It was not marked and was 

 clearly a terminal affair. 



A cut section shows a pinkish-gray surface which may or may 

 not exude some blood. Air can be expressed from all portions 

 of the lung and usually also a slight amount of oedematous fluid. 

 The posterior part of the lung is darker in color and is heavier 

 than the anterior, and more fluid can be expressed from it than 

 from the anterior part. The bronchi do not appear to be hype- 

 raemic, but contain more or less frothy material and nwcus. 

 Sometimes this can be expressed from the smaller bronchi. 



