'224 PHALEN AND NICHOLS. 



When he was admitted to the Division Hospital lie was suffering from diarrhoea 

 and cramps. His heart action was weak, vapid and irregular, and a diagnosis 

 of myocarditis, probably due to beriberi, was made. 



Autopsy by Dr. Whitmore three hours after death of the patient. The body 

 is well developed and well nourished and, with the exceptions hereafter noted, 

 the organs present no macroscopical alterations. Upon opening the abdomen, the 

 liver and spleen are found to be moderately enlarged, the latter being somewhat 

 adherent. The liver is not cirrhotic in appearance, but presents pale patches 

 over its surface, and, more particularly, many whitish nodules varying in size 

 up to the head of a pin, and situated under the capsule. On excising and crushing 

 these nodules, oval eggs are found measuring approximately 70 by 40 /x. On 

 section, many more nodules are seen scattered throughout the entire organ. The 

 small intestines harbor a small number of hookworms; they present no gross 

 changes, while the large intestine shows only one small area situated low down 

 in the bowel, where the mucous membrane is swollen and injected. The bowel 

 contents show ova similar to those in the liver, but these are few in number, 

 and ova of uncinaria are also present. 



Histologic examination. — Tissues were secured from the liver, kidneys, lungs 

 and intestines. These were preserved in Kaiserling's solution and in formalin, 

 imbedded in paraffin, sectioned and stained with haematoxylin and eosin and 

 with Bismarck brown and eosin. A microscopic study of the liver shows the 

 presence of ova either in groups or singly, usually occurring in the interlobular 

 connective tissue (PI. I, fig. 1), but also occasionally throughout the parenchyma, 

 and in one instance an ovum is found apparently lodged in the intralobular 

 vein. There is a considerable increase in the connective tissue around the lobules 

 and encroaching upon them. The staining of the tissue is irregular, being quite 

 faint in places. 



The most striking feature is the presence of the miliary nodules noted above: 

 (PI. I, fig. 2.) These tubercular-like nodules are mentioned by Katsurada, but 

 are said to occur rarely in the parenchyma. Our sections show them situated 

 exclusively in the parenchyma occupying the place of a lobule or of two or more 

 lobules fused together. The central area stains deepest, and is composed of an 

 indefinite mass of nuclei, red blood cells and fibrin. It is quite sharply defined 

 from the next zone which is made up of young connective tissue radiating toward 

 the center. This zone gradually merges with a ring of still younger connective 

 tissue belonging to the interlobular tissues. Some nodules have a small center 

 and are evidently being gradually walled off and replaced by new connective tissue 

 growth beginning at their peripheries. Throughout this connective tissue there 

 is a new formation of bile channels, apparently an effort to repair the damage 

 to the lobule. Ova are usually present in small numbers in these nodules. 

 (PI. I, fig. 3.) 



Sections of the large intestine show the presence of ova in small numbers 

 in the submucosa, accompanied by a moderate increase in the connective tissue. 

 They occur in small groups outside the vessels close to the muscularis mucosm. 

 Ova are also found in the mucosa lying close to the epithelial cells of the glands 

 of Lieberkuhn. The muscular layers are apparently unchanged. No ova are 

 found in the small intestine nor in the other tissues. The ova in the walls of 

 the intestine seem much more compressed and distorted than those in the liver. 

 The vessels of the mesentery of the large intestine were carefully searched for 

 the adult parasites, but without success. 



Measurements were made of a muriber of the ova in the tissues, and 

 they were found to average 62 jx in length by 39 p in width, dimensions 

 which are approximately those give by Stiles, Woolley, Katsurada and 



