582 The Philippine Journal of Science 1923 



NOTES ON FATAL CASES 



The following are notes on five of the six cases who died 

 during the observation period. One, Case 10, N. T., has already 

 been described. 



Case U, clinical features.— F. Y., male, 46 years old. Treatment was 

 begun June 9, 1922. Patient fairly strong, though somewhat emaciated. 

 Apices dull, bronchial breathing right, but no rales. 



In four weeks six doses totaling 8 milliliters had been given. Com- 

 plained of weakness, and haemoptysis occurred on the day after the last 

 injection. Dropped from treatment and gradually improved. Haemop- 

 tysis did not recur. Two months later tenderness noticed in right iliac 

 region over a mass which gradually became more superficial. Death a 

 month later, when the mass, apparently a psoas abscess, seemed about 

 to rupture. Unfortunately, autopsy was not performed. 



Case 28, clinical features. — M. N., female, 34 years old. At beginning 

 well nourished, apparently strong, though with fairly advanced pulmon- 

 ary tuberculosis. Upper parts both lungs dull, with bronchial breath- 

 ing and a few subcrepitant rales. After the fifth injection severe 

 abdominal pain and diarrhoea developed, appetite completely lost, with 

 marked prostration. A few days before death cough increased and fever 

 became constant. The lung lesions had progressed very rapidly, with 

 signs of cavity formation in both lungs. 



Although severe abdominal pain was frequently complained of, there 

 was no localized tenderness. Spleen and liver not felt. Urine became 

 positive for albumin, but there was no oedema. Died two months and 

 eight days after beginning treatment, having received but five injec- 

 tions in the first month. 



Autopsy 78 (Dr. E. V. Pineda) .—Upper lobe left lung almost com- 

 pletely destroyed by tuberculous cavitations. Right upper lobe contained 

 cavities and also conglomerated tubercles. Numerous tubercles in lower 

 lobes, both lungs. Indications are of a rapidly advancing process. 



Spleen flabby and slightly enlarged, cut surface deep chocolate, marked 

 increase in the stroma. Liver enlarged, soft, flabby, and friable, cut sur- 

 face opaque, lobules rather indistinct. Nothing of interest in the alimen- 

 tary tract. Genital organs congested and hypoplastic, otherwise negative. 

 Kidneys slightly smaller and firmer than normal; on section cortex thin 

 and slightly translucent, minute red vessels shining through. Capsule 

 stripped with difficulty, tearing kidney tissue at points. 



Diagnosis: Pulmonary tuberculosis, ulcerative and chronic miliary; 

 pleuritis, chronic; nephritis, chronic; leprosy. 



Case 18, clinical features.— S. V., female, 40 years old. Had ulcera- 

 tions of feet and legs and dry gangrene of tips of the toes. Diarrhoea 

 developed after beginning treatment, persistent and weakening. Also 

 severe neuralgic pains along legs. Lungs markedly dull at apices, bron- 

 chial breathing, a few sibilant rales. 



In twelve injections was given only 21.5 milliliters over a period of 

 thirteen weeks. Urine showed traces of albumin before; after second 

 month, cast found. Death occurred September 20, 1922, fifteen weeks 

 after the beginning of experiment. 



