744 
During the post-mortem examination, two agar tubes were inoculated from 
the cerebro-spinal fluid obtained by puncture with a sterile syringe at the third 
lumbar vertebrae. Another tube was inoculated from the heart’s blood and pieces 
of the wall of the stomach and of the duodenum with some gastric contents 
were placed in a flask containing several hundred cubic centimeters of alkaline 
bouillon. The bouillon was then heated to 80° C. and kept at that temperature 
for about ten minutes. It was then cooled in the refrigerator and subsequently 
incubated. (Experiments with these cultures are reported above. ) 
MICROSCOPICAL EXAMINATION.—The myocardial fibers are a little hazy in stria- 
tion and here and there finely vacuolated. Fragmentation is pronounced. The. 
Dy o 
splenic sections show some increase in connective tissue, considerable endothelial 
proliferation, and pigment, and a number of malarial parasites. Pigment 
and malarial parasites are also found in the liver sections which also show some- 
what extensive acute inflammatory interlobular foci. There is some granular 
degeneration of the parenchyma cells. ‘The sections from the stomach and duo- 
denum show nothing abnormal. Those of the nerves reveal advanced degenerative 
changes. 
Case No. 8.—Subacute, wet beriberi.—Necropsy No. 913, March 7, 1904 (history 
kindly furnished by Dr. G. B. Cook): Antonio Ybalio, a Filipino, policeman, 36 
years old. Previous history: Patient was ill in Civil Hospital from January 
17 to 30, 1904, and was treated for amebic dysentery. At this time he com- 
plained of insomnia, pain in the abdomen, slight cough, and moderate fever 
(37°.7). There was no anasarca present. Amebe and ova of Trichocephalus 
dispar were found in his stools on January 18. Treatment with quinine enemata 
was instituted, under which he improved, leaving the hospital on January 30, 
1904. The report of the stool examination at this time was negative for amebe. 
Present illness: On February 28, 1904, he again entered the hospital stating 
that he had not been well since his illness in January, but during this time had 
become weaker and weaker, swelling of his legs had developed, and he had suf- 
fered, in addition, with pain in the abdomen, anorexia, dyspnea, insomnia, dif- 
ficulty in locomotion, and constipation. His temperature was subnormal through- 
out his present illness until just before he died, when it registered 37.7°. 
Physical examination: Expression heavy, face swollen, respiration labored ; 
general anasarea especially marked in feet and legs; abdomen, distended and 
painful on pressure. Pain was elicited on pressure over tibie. Apex beat, 
forcible and displaced to left of normal position about 2 to 2.5 centimeters. A 
double murmur of a blowing character could be heard most distinctly at the 
apex. The reflexes were not tested. Cowrse of illness and treatment: On admis- 
sion he was given Lig. potass. arsen. gtts. 6 three times daily, nourishing 
diet, and a cathartic of magnesium sulphate when necessary. On March 1 
the urine examination was as follows: Specific gravity, 1,023; acid; small 
amount of albumen; urea, 26.46 grams per liter; sediment slight, very many 
hyaline and a few granular casts. After receipt of this report the diet was re- 
stricted; Fowler’s solution omitted and infusion of digitalis and lithium citrate 
given. His condition steadily grew worse and he died on March 6, 1904, at 11.30 
p. m. 
Autopsy fourteen hours after death: Body of a well-developed Filipino, about 
35 to 40 years old. Post-mortem rigidity and lividity well marked. The 
integument is quite oedematous, particularly over the abdomen, the anterior 
surface of the legs and at the dorsum of the feet, where the skin pits on 
pressure. The scrotum is edematous and swollen to about two to three times 
its normal size. On both legs and forearms small, symmetrically placed pin- 
head sized petechie are visible. The sclerw are somewhat icteric. On section, the 
veins discharge a considerable amount of dark, fluid blood. The subcutaneous 
a ioe) 
