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The general nourishment is extremely poor, the eyes are sunken, rigor mortis is variable in its degree, and post-mortem lividity is usually present in traces about the most dependent parts. The skin may shew atrophic changes, and sores of various kinds are frequently present especially over the bony prominences of the posterior parts of the cadaver, and there is increased pigmentation. In general, the impression produced by the corpse inspection of a typical and advanced case is that some constitutional disease of an extremely chronic nature was the cause of death and that the latter supervened only after the individual had been reduced to a condition almost approaching mummification.
On opening the body one notes the extreme wasting of the muscles. They are soft and flabby and tinged of a yellow colour. The subcutaneous fat is at a minimum. The tissues often appear as if dried and shrivelled. In some cases a slight quantity of thin, serous fluid oozes ont from the tissue spaces.
The pericardial sac usually contains a slight excess of fluid. This is of a clear yellow colour and watery character. The pericardial layers are thickened, and often present an opaque white appearance due to an increase in the amount of dense white connective tissue. Frequently the mucoid and swollen appearance is found, similar to the condition met with in the dropsical forms of the disease. Pericarditis is scarcely ever found.
The condition of the heart varies. It may be enlarged and flabby. Usually however the organ is normal in size, in a condition of systole and its walls thickened. A certain degree of hypertrophy of the right ventricle is found asso- ciated with more or less dilatation. The left ventricular wall is also thickened. The walls of the heart are usually somewhat hard and friable. The amount of granular and fatty degeneration of the cardiac muscle varies in each individual case. Sometimes the already mentioned jelly-like substance is found in consider- able amount in the walls. It lies embedded between the layers of the cardiac muscle, under the epicardium, and also along the course of the coronary vessels. The valves are usually competent. The presence of petechiae is uncommon.
The blood is similar to that found in the dropsical variety. It is fluid, very dark in colour, and clots after its removal from the body. Firm clots are fre- quently found in the ventricular cavities. Frequently these are of ante-mortem origin.
The lungs, on opening the chest, do not collapse. They are usually hyper- crepitant throughout and emphysematous changes are predominant. Edema to a varying degree may be present, particularly about the posterior and basal regions of the organs. The visceral layers of the pleura are usually thickened owing to fibrosis and in this membrane and lying beneath it one frequently finds accumu- lations of varying amount of the clear jelly-like substance of a yellow colour.
The pleural cavities usually contain a small but varying amount of clear yellow fluid.
Pleurisy is rarely met with.
The peritoneum is usually normal. Thickenings of the membrane are occasionally found, and are due in most cases to localised modules of mucoid tissue. A varying increase in the amount of peritoneal fluid is usually present and its character is identical with that found in the other serous cavities of the body.
The alimentary canal presents nothing of any great significance. The variable changes found in the dropsical variety are rarely met with in this type. Generally speaking the whole of the gastro-intestinal tract is in a state of atony, its walls are thinner and pigmented, and jelly-like material is present in varying amounts, especially along its mesenteric attachment. There is nothing in the alimentary tract to stamp it as the primary focus of the disease.
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