535 
The patient was a Filipino banquero, aged 26, a native of Rizal Province. 
There was a past history of beriberi. He was admitted to St. Paul’s Hospital 
suffering from ascites and splenomegaly, a condition which he said had been 
present for two months. He had an irregular temperature and a slight diar- 
rhea. (See chart No. 1.) His appetite was good. Blood examinations from time 
to time showed no malarial organisms, nor had quinine any effect upon’ his 
temperature. His urine showed a trace of albumen, and hyaline and granular 
casts. The stool examination was negative for parasites. Blood counts showed: 
Hemoglobin, 80 per cent; red blood cells, 4,264,000; leucocytes, 5,400. A differ- 
ential count showed :polymorphonuclear leucocytes, 74 per cent; large morphonu- 
clears, 10 per cent; small morphonuclears, 2 per cent; eosin, 11 per cent; cells, 3 
per cent. From the time of his entrance into the hospital he had an irregular, 
remittent and intermittent temperature. He died a month after entrance. The 
clinical diagnosis was Banti’s disease. Two days before his death a splenic 
puncture was undertaken and smears and cultures were made with the citrated 
material which was obtained. The smears showed a very small, polar-staining, 
rod-shaped or diplococcoid organism which was present in small numbers. The 
culture in glucose broth (+ 1 to phenolphthalein) after two days produced 
powdery growth in the bottom of the tubes and a slight diffuse cloudiness. Agar 
cultures gave no growth. The autopsy was performed six hours after death. 
Rigor mortis was present in the legs, feet, and jaws, but not in the anus. The 
pupils were normal. The lymphatic glands of the groins and axilla were slightly 
enlarged and firm. Over the area of splenic dullness, a few centimeters from 
the midabdominal line and about a hand’s-width above the pubis, was the puncture 
wound caused by the aspirating needle, The body was poorly nourished, the 
mucous membranes pale and slightly jaundiced. There were some pigmented 
scars on the shins, as there are in nearly all laboring Filipinos, but there were 
no periosteal irregularities. After opening the body, the point of entrance of 
the needle into the spleen could barely be seen, and about it there was no 
evidence of hemorrhage or inflammation. The omentum was curled up along the 
transverse colon. The peritoneum was Slightly dull in appearance and showed 
some points of injection. In the pelvis and flanks there was from 200 to 300 
cubic centimeters of blood-stained fluid. The appendix apparently was normal. 
The left pleural cavity was obliterated by old adhesions. The right was normal. 
Both lungs were somewhat edematous and the seat of moderate hypostatic 
congestion. 
The pericardium contained about 100 cubie centimeters of a clear, amber-like 
fluid. There was one large milk spot on the anterior surface of the heart. The 
myocardium was flabby and cloudy. The epicardial fat was somewhat increased 
in amount and along the auriculo-ventricular groove was a series of petechi. 
The cardiac valves apparently were normal. The auricles were filled with goose- 
fat clots. The liver weighed 750 grams and was very firm and resistant. Its 
surface was covered with nodular elevations varying in size from 1 to 5 mil- 
limeters. These elevations were of a greenish-yellow color in the center and 
were surrounded by zones of congestion. The cut section was granular and mottled 
yellowish-green and brownish. The increase of fibrous tissue, easily to be seen 
with the unaided eye, was diffuse. The gall bladder was small and contained 
no stones. The spleen weighed 1,770 grams and was firm in consistency. Its 
surface was smooth. It cut with increased resistance and the cut surface showed 
no tendency to diffluence. The increase in fibrous tissue was evident to the 
naked eye. The malpighian follicles were not noticeable. The kidneys were 
somewhat enlarged, pale and very flabby. The capsules were easily removed. 
The intestine contained liquid feces with uncinaria and trichuris. In the large 
