INFANTILE BERIBERI. 79 



description, organ by organ, the findings are identical; or, if any 

 difference exists, it is of degree only. 



In these cases there are four points of special intcrost: lirst, 

 the dilated and hypertrophiod right heart; second, the congestion 

 of the viscera; third, anasarca; fourth, the absence of otker 

 fiiidhigtf to account for death. I have relied on these points in 

 making the diagnosis of infantile beriberi. In several cases I 

 have seen a hypertrophied right heart in which I could account 

 for the condition by a patent foramen ovale, which was not 

 competent, or by an imperfect interventricular septum. All 

 these cases have been excluded. Whenever death could be attri- 

 buted to causes other than beriberi, this has been done. 



Since the description of the gross findings corresponds with 

 that of moist beriberi of the adult, the question has oft6n 

 occurred to me: Is there an atrophic form of infantile beriberi 

 corresponding to the atrophic form in the adult? One such case, 

 I think, occurred in the present series. The infant was 10 months 

 old and was greatb/ emaciated. The condition was undoubtedly 

 chronic. The baby developed fever a couple of days before 

 death and at the necropsy there was a slight bronchopneumonia 

 present. The right heart was greatly hypertrophied and dilated. 

 The calves of the legs and the dorsum of the feet were slightly 

 oedematous. Such cases are not common. 



MICROSCOPICAL FINDINGS. 



In the paper of two years ago we gave no microscopical 

 description of tissues for fear the post-mortem changes would 

 render the lesions obscure. In the present cases this difficulty 

 was overcome, and the microscopical findings are as follows : 



Heart. — The muscle fibers of the right heart are hypertrophied 

 and the muscle nuclei are apparently increased in number. In 

 nearly all cases the cross striations are distinct without any 

 appearance of degeneration. In a few cases there is a slight 

 clouding of some of the fibers. The fibers of the left heart are 

 of normal size, cross striations are distinct and no clouding of 

 fibers is present. Congestion is present. 



Lungs. — The lungs present the picture of extensive hypostatic 

 congestion and more or less oedema. The vessels are greatly 

 congested, and the alveoli in the dependent portions of the lungs 

 contain more or less granular debris. A few epithelial cells are 

 scattered here and there in the alveoli and sometimes a few 

 red cells. There is no evidence of fibrin by the hematoxylin 

 and eosin stain and only a few leucocytes are to be seen. The 



