THE PHILIPPINE 



Journal of Science 



B. Tropical Medicine 



VOL. XII JULY, 1917 No. 4 



DEGENERATION OF PERIPHERAL NERVES ^ 



By C. Manalang 



(From the Department of Pathology and Bacteriology, College of Medicine 

 and Surgery, University of the Philippines) 



TWO PLATES 



It is customary in the routine work after an autopsy to ex- 

 amine the peripheral nerves of a beriberic or "suspect" for fatty 

 degeneration of the myeline sheath by the Marchi method, after 

 which a final diagnosis is made. Therefore a person who is not 

 aware of the possible presence of degeneration in nonberiberics 

 and who is not in the habit of examining nerves of cases other 

 than beriberics will often be misled in his conclusions. If the 

 degeneration of the peripheral nerves is accompanied by oedema 

 of the subcutaneous tissue with moistness, congestion, and pe- 

 techia of the serous surfaces, marked dilatation and hypertrophy 

 of the right ventricle, congestion and oedema of the lungs, con- 

 gestion of the viscera, and acute duodenitis, then a diagnosis of 

 beriberi is justified. However, it is possible that the above 

 morbid anatomy may be present in cases which are clinically 

 nonberiberic, with the exception of a right-sided hypertrophy. 

 On the other hand, such an important finding as hypertrophy of 

 the right ventricle may be and is often absent in the acute cases 

 of beriberi. (Edema is a constant symptom in the course of 

 beriberi, but may be so trivial in the acute pernicious form, in 

 the rudimentary form, and in the late stages of the disease that 

 it becomes unrecognizable at autopsy. A previous attack of 

 typhoid, pneumonia, diphtheria, or any acute infectious disease 

 may leave sufficient degeneration in the heart muscle to cause 

 sudden cardiac dilatation. Acute cardiac dilatation also occurs 

 in pernicious anaemia, chronic interstitial nephritis, and gener- 

 alized arteriosclerosis. It is in these cases of sudden deaths of 

 which a clinical history is often lacking that the morbid anatomist 

 will be confronted with difficulties, and the mere presence of 



' Submitted as a thesis for the degree of Doctor of Tropical Medicine. 

 Received for publication April, 1917. 



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