PATHOLOGIC ANATOMY I have already mentioned in the preceding chapter, that we can not establtsb specific post-mortem findings, which correspond to and are produced by definite forms of diseases of nutrition. These diseases often show a lack of correspondence between the clinical symptoms and the results of pathologic investigation. For these reasons a condensed discussion of the pathologic anatomy of the diseases seems advisable.
Those who have an opportunity of performing many autopsies are frequently astonished to observe that the severest clinieal gastro enteric symptoms with widespread manifestations may show at the autopsy table such slight lesions that the pathologist, is in actual per plexity as to what he shall assign as the cause of death. This is true especially of diseases of nutrition with very aeute course, in which the post-mortem ehanges may be limited to passive congestion in certain regions, as meninges and brain, hypostatic congestion in the lungs, and slight swelling and punctate reddening of the mucous membrane of the stomach and intestine. In rarer cases this redness is more marked. The contents of the N'arIOUS divisions of the intestine are variable in their appearance, and in places scarcely deviate from the normal. They do not often show the reddish coloring and flocculent admixture charac teristic of true rice-water stools.
Older observers, as H. Schwartze, Muller, and others, have called attention to this peculiarity of the post-mortem findings, which they attribute to the action of soluble poisons. Where true choleriform symptoms have been present during life, the general appearance of the cadaver usually reveals the fact. The depressed fontanelle, the deeply sunken eyes, the overlapping, of the cranial bones, the pointed nose and chin, the loose wrinkled skin of the extremities, especially of the thighs, the indrawn abdomen, showing on its surface greenish discoloration only a few hours after death, and the half-flexed position of the arms and legs, all appear as signs of the severe course of the disease.
Upon opening the skull, one often finds in such cases, in addi tion to the hypermnia mentioned above, sinus thrombosis of varying extent, oedema of the brain substance, a slight and usually reddish colored exudate in the ventricles, less often seropurulent, or purulent inflammation of the pia mater, or of the cerebral tissue itself. Upon
opening the middle ear can be found fairly constantly an accumula tion of pus. When death has occurred very rapidly, with profuse V 0 111 iting and diarrhora, and alied symptoms (cooling of the body and a peculiar hardening of the skin), the brain appears notably dry, its sub stance is thickened, and the pia mater is of a peculiar adherent character.
The mucous membrane of the mouth and pharynx is swollen, reddened, and dry. In very young children a profuse growth of thrush is often found, which covers the dry, leathery, and brownish tongue; the gums, the inner surface of the cheeks and lips, and the soft palate, and extend downwards, occasionally deep into the cesophagus, rarely even into the stomach (Parrot).
The lungs are very hyperaemic in their dependent portions, and on section exude a reddish foamy secretion. More rarely, thickened areas may- be found, varying in size from a pea to that of a hazel-nut. The pleurx show little scattered ecchymoses, and, in consequence of the ;narked loss of water before death, are dry and leathery-, and occasion ally also the seat of purulent inflammation.
The cavities of the heart are filled with dark blood clots. The heart muscle shows no notable macroscopic changes.
On opening the abdomen, the appearances vary according to the length of time since death. If the autopsy is made shortly after death, the bowel is usually found collapsed, and its contents are either watery, occasionally resembling rice-water, or else greenish yellow- mixed with white lumps. The stomach as a rule is empty and contracted. If a longer time has elapsed after death, the intestinal loops appear dis tended with gas, their outer surface is occasionally reddened, and the stomach also shows some distention. Its mucous membrane, and that of the whole bowel may appear completely pale as if washed out, and show no trace of catarrhal swelling ; more frequently, however, it appear.s slightly swollen, somewhat cedematous, injected in spots and streaks, showing at times little hiemorrhages and erosions, or, with more profuse hremorrhage. dark brownish streaks. Corresponding to this condition there is either no intestinal contents, or a little mucus, or dark brown masses resembling coffee grounds floating in cloudy fluid.