i682 



BERI-BERI AND EPIDEMIC DROPSY 



In the former the post-mortem rigidity develops quickly, and is 

 well marked. In the latter, however, it is not so marked. On 

 cutting into the body the subcutaneous tissues are usually oedema- 

 tous, and the veins are filled with dark fluid blood. There is a 

 varying quantity of serous fluid in the abdomen, the chest, and the 

 pericardium, and there may be petechial haemorrhages under the 

 visceral pleura and pericardium in acute, but not in chronic, cases. 

 The throat and tonsils are generally congested in acute cases, 

 but they may be normal; the larynx may be congested or norm,al. 

 The mucosa of the trachea and broni hi may be oedematous, with 

 the lumen full of fluid. The lungs may be congested and oedema- 

 tous, and may contain little air. 



The right side of the heart is always greatly dilated in acute 

 cases, and is also hypertrophied in older cases, but it is rare for the 

 left ventricle to be hypertrophied, though it may be dilated to a - 

 moderate extent. The myocardium generalty shows fatty degenera- 

 tion, the striation is often absent, and segmentation and vacuolation 

 of the fibres, with an increase of the interstitial tissue, can also 

 be seen, and there is a round-celled infiltration beneath both endo- 

 and epi-cardium in acute cases. (These changes are said b}^ Scheube 

 to be like those found in rabbits after section of both vagi.) 



According to Wright, the entire nervous system of the heart is 

 damaged in acute cases, the cells of the bulbar nuclei and the 

 nucleus ambiguus on both sides being swollen, with excentrically 

 placed nuclei and a disappearance of Nissl's bodies in the processes, 

 and to a less extent at the periphery. These changes may also 

 be seen in the first and second pair of the thoracic ganglia, and 

 in the intrinsic ganglionic cells of the heart, while the vagal nerve- 

 endings show rounded droplets of altered myelin (neurokeratin?), 

 especially near the nodes. In chronic cases only the vagi may show 

 degeneration, the ganglia in the heart being normal. 



In acute cases the stomach and duodenum are markedly affected, 

 the mucosa being hypersemic, with more or less marked haemorrhagic 

 extravasations, and even at times effusion of blood into the lumen of 

 the viscus. This inflammation may extend to the ileum, or very 

 rarely even to the caecum, but usually the small and large intestines 

 show nothing abnormal, for the acute irritation is located to the 

 pylorus and the duodenum. 



Microscopically there is an acute congestion with round-celled 

 infiltration, with, according to Herzog, a very large number of 

 eosinophile cells and necrosis of the glandular epithelium. The 

 cells of Auerbach and Meissner's plexuses are degenerate, and the 

 nerve fibres in the stomach and duodenum also show signs of 

 degeneration. In chronic beri-beri these gastro-duodenal signs are 

 absent. 



In an acute case the lymphatic glands near the stomach and 

 duodenum are enlarged and congested. The liver is generally en- 

 larged and congested, and at times in a nutmeg-like condition, and, 

 according to Hewlett and Korte, there may be extensive hsemor- 



