17,1 De Leon: Encephalitis Lethargica 127 
small, mononuclear infiltration. Both the anterior and the pos- 
terior cornua were affected, where most of the vessels are en- 
gorged and profusely infiltrated peripherally. In these regions 
the nerve cells did not appear to be normal; most of them were 
pale, not taking the stain properly. The tigroid granules were 
irregular in size and distribution, having lost their concentric 
arrangement around the nucleus. 
The lung showed bronchopneumonic consolidations, hemor- 
rhagic, with no fibrin in the exudate but wholly polymorpho- 
nuclear, and large desquamated vacuolated cells. In many 
alveoli purely red cells were found. There was also purulent 
bronchitis. The heart showed injection of the capillaries, in- 
trafascicular and interfibrillar hemorrhages with myocardial 
degeneration. The findings in other organs were of congestion 
and a chronic inflammatory condition. 
There was marked engorgement of the vessels of the pancreas 
and the adrenals. There was slight acute hemorrhagic tubu- 
loglomerular nephritis with slight thickening of the media of 
the vessels. The spleen showed intense injection with minute 
interstitial hemorrhages, diminished pulp, atrophied malpighian 
corpuscles, and thick-walled vessels with hyaline degeneration. 
The liver showed moderate passive congestion, organizing focal 
degenerations with marked dilation and engorgement of the 
vessels and the sinusoids. 
In view of the histological examination the pathological diag- 
nosis of this case has been revised to include encephalitis 
lethargica. 
The second case was a male Filipino, 17 years, who died after 
a 25-day stay in the hospital, with a clinical diagnosis of tu- 
berculous meningitis (?). Autopsy performed four hours after 
death gave the following anatomical diagnosis: Encephalitis 
lethargica (?); congestion of all the viscera, marked; paren- 
chymatous degeneration of liver and kidney, slight. Body, 
emaciated, presenting all the external evidences of an attack 
of a severe disease but, except for the marked passive conges- 
tion of, and the finding of petechial hemorrhages in, the viscera, 
together with capillary hemorrhages in the brain, the anatom- 
ical findings are absolutely negative. 
Microscopically, sections of the brain presented the same 
marked engorgement of the vessels with distinct perivascular 
infiltration of small mononuclears and spilling of red cells into 
the perivascular spaces. In some of the vessels distinct rupture 
of the walls can be seen and the hemorrhages from them look 
