23,6 Rodriguez and Eubanas: Leprosy with Antimony 583 



Autopsy 99 (Dr. E. V. Pineda). — Lungs filled with miliary tubercles. At 

 apices conglomerated and surrounded by fibrosis. Peribronchial lymph 

 nodes enlarged, black, rather soft; on cut surface a few grayish white 

 tubercles. Heart slightly heavier than normal, pale, with a few yel- 

 lowish glistening streaks in the muscle tissue. Spleen slightly larger than 

 normal and flabby, grayish red, stroma markedly increased. Liver nor- 

 mal in size, slightly congested, cut surface rather opaque, lobules fairly 

 distinct, with central congestion, tissue friable. 



Kidneys normal in size, weight, and color of cut surface; cortex and 

 medulla both thin. First portion of caecum showed slight hyperplasia of 

 lymphoid element, with a few petechial hemorrhages. Brain showed slight 

 oedema of pia. Two ulcers found on epiglottis. 



Diagnosis. — Pulmonary tuberculosis, chronic, miliary; nephritis, chronic 

 (slight); multiple ulcers,, skin; ulcers, epiglottis; leprosy. 



Case 20, clinical features. — S. R., female, 43 years old. At beginning, 

 apices dull and a few moist rales, right infraclavicular. A low systolic 

 murmur was heard best at the base. Second pulmonic distinctly accen- 

 tuated, but the murmur not transmitted to axilla and cardiac area not 

 enlarged. Tender mass in right axilla. Patient anemic. Only traces of 

 albumin in the urine; no oedema seen. 



Patient under actual treatment for twenty-two weeks, receiving twenty 

 injections totaling 32 milliliters. No untoward symptoms noticed, but 

 occasional fever, headache, sometimes chest pain. After second and fourth 

 months abundant albumin and casts found. 



Died suddenly November 11, three days after the last injection of 1.5 

 milliliters. Complained of severe abdominal pain at midnight, vomited 

 several times, dying within three hours. 



During treatment the multiple superficial ulcerations much improved. 

 An acute adenitis, right axillary, developed and burst; the fistula healed 

 very slowly. 



Autopsy 130 (Dr. F. Solis). — Axillary sinuses only important finding 

 noted. Communicated with enlarged lymph nodes containing abundant 

 caseous material liquefied centrally. In lungs, peribronchial nodes, heart, 

 liver, kidneys, alimentary tract, and brain nothing pathological recognized. 

 Spleen was smaller and firmer than normal, stroma reddish brown, dis- 

 tinctly increased. 



Diagnosis.— Cause of death not determined. Adenitis, tuberculous; 

 leprosy. 



Case 21, clinical features.—?. S., female, 36 years old. Fairly well 

 nourished. A few sibilant rales left interscapular, with impaired reso- 

 nance. Slight oedema of legs; only traces of albumin in urine. 



Injected twenty times in twenty-six weeks, totaling 34 milliliters. After 

 second month urine loaded with casts, and albumin heavy. (Edema not 

 more marked. Twice severe lepra reaction developed, principally fever 

 and generalized papules that soon ulcerated but healed completely in 

 remarkably short time, two weeks. 



Suddenly, two weeks after last injection, complained of severe abdominal 

 pain with vomiting and collapse, rapid, soft pulse, subnormal temper- 

 ature, extremities cold, sweat-covered. Restless, moaned continuously, 

 but answered questions fairly well. Face livid, respiration shallow and 

 accelerated. Lungs dull at apices, with bronchial breathing right. No 



