ETIOLOGY OF BERIBERI. 379 



pulsation but no prajcordial throbbing was visible. The knee 

 jerks could not be elicited. On the seventy-fifth day the note 

 made was as follows: Pulse 120; respirations 50; point of max- 

 imum impulse visible outside the nipple line; area of cardiac 

 dulness increased transversely; there is slij^ht pnecordial pul- 

 sation ; at the apex the first sound is short, and the spacing 

 between the sounds equal ; there are no definite murmurs, and 

 no accentuation of the sounds at the base; there is marked 

 dyspnoea, and the legs are oedematous ; the knee jerks are absent. 

 He complains of pain and tenderness over the chest and in the 

 shoulders, neck, and calves of the legs. At 4 p. m. the pulse 

 was 120, respirations 4Q, and the pulse very weak. The patient 

 was placed on a general nourishing diet, and stimulation started. 

 On the seventy-sixth day the pulse was very weak. The patient 

 was very drowsy and responded slightly when spoken to. He 

 was only semiconscious. The heart sounds were rapid and 

 evenly spaced. On the seventy-seventh day the note was made 

 as follows : Still weaker ; there is marked general twitching of 

 the muscles all over the body and some coarse tremors of the 

 muscles of the shoulders; there is marked general oedema and 

 general tenderness ; no ascites ; the pulse is very .rapid and very 

 weak; respirations 40; the temperature has been practically 

 normal since he entered the hospital. The patient gradually 

 Bank and died at 2 p. m. on the following day. The urine in 

 this case was greatly diminished in amount. On April 13, six 

 days before his death, the amount for twenty-four hours was 

 only 360 cubic centimeters, and the amount diminished each 

 day until the day before his death, when only 60 cubic centi- 

 meters were passed. The specific gravity during this time varied 

 between 1022 and increased gradually so that the day before 

 death it was 1030. The urine contained no albumin at any time 

 and no casts. 



NECROPSY. ONE-HALF HOUR AFTER DEATH. 



Anatomical diagnosis. — Acute beriberi; degeneration of heart muscle; 

 epicardial, pleural, peritoneal, renal, hepatic, gastric, and duodenal ecchy- 

 moses; congestion and oedema of lungs; acute gastro-duodenitis; acute par- 

 enchymatous degeneration of kidney; acute congestion and degeneration 

 of liver; pial oedema; hydrothorax; anasarca. 



The cadaver is that of an adult male Filipino of about 40 years of age. 

 measuring about 150 centimeters in length. The body is still warm. There 

 is marked general subcutaneous cedema which is most marked over the 

 legs, scrotum, and face. Hair of the head abundant, black, and straight. 

 Beard moderate. Scant axillary and thoracic hair. Pubic hair of the 

 male Caucasian type. No scars found on the body. Pupils are equal, 



