STUDIES ON INFANT MORTALITY. 155 



The great discrepancy between the clinical diagnoses and the autopsy 

 findings can partially be explained by the fact that in many instances 

 the native doctor is not called to see the patient until the latter is mori- 

 bund, or, in some cases, until after death, and the family want a death 

 certificate signed. 



In 1898 and 1900, Professor Hirota, of Tokyo, described a disease found in 

 some infants brought to his clinic, which he called infantile beriberi. A few 

 years later, 1905 (?), the native doctors of Manila and the Philippines accepted 

 Hirota's findings and began signing death certificates giving the cause of death 

 as infantile beriberi. So far as the writers know, no effort was made by the 

 native physicians to establish by necropsy any relation between the findings of 

 Hirota in Tokyo and the disease called infantile beriberi by the Filipinos. For 

 some reason, the subject has never been taken up by the American physicians in 

 the Islands, owing, possibly, to the fact that they do not come in contact with 

 the poorer Filipinos, and hence are never, called upon to treat them. In the 

 various hospital dispensaries the children are looked after by the native doctors. 

 A number of Filipino physicians have recognized the condition here and one 7 has 

 described a typical case with necropsy. 



In the pathologic entity which we have termed "infantile moist 

 beriberi," and for which we know no better name, we find the following 

 conditions : 



The body ,is that of an apparently well-nourished infant, plump; skin is 

 usually pale and anemic. The face is full, with almost a swollen appearance. 

 Flesh of thighs and legs is soft and flabby and, as a rule, pits on deep pressure. 

 Occasionally the skin has a tough, leathery feel, a leaden color and a slight goose- 

 flesh appearance. 



Subcutaneous fat is present, apparently in good amount, grayish-white in 

 color and very moist; muscles are anaemic. Owing to the oedema, the real amount 

 of fat present is deceptive and hence the bodies may not be as well nourished as 

 they appear. 



Most often there is an increase of peritoneal fluid, which has a distinct yellow- 

 ish color. 



Heart. — The pericardial sac is filled with a clear fluid, having a greenish tint. 

 Probably the most striking and constant change is found in the right heart. Its 

 musculature is coarse and firm and forms much the larger part of the organ, 

 even in the contour of the apes. Its trabecular and papillary muscles are prom- 

 inent, while its cavity is enlarged. The wall of the right ventricle may measure 

 from 5 millimeters to 7 millimeters in thickness, whereas the left measures only 

 3 millimeters to 5 millimeters. (See Plate I.) The musculature of the left 

 heart is soft and flabby and darker than that of the right. The blood vessels of 

 the heart are congested and prominent and frequently a few haemorrhages show 

 along the aurieulo-ventricular junction. In many cases the foramen ovale is 

 still patulous, but is competent. 



Lungs. — These organs are a light pinkish-gray anteriorly and a light purplish- 

 gray posteriorly. They fill the pleural cavities and crepitate throughout. The 

 anterior part of the lung is lighter and more fluffy than the posterior. Few or 

 many petechial haemorrhages may show beneath the visceral pleura, especially 



8 CentralU. f. inn. Med. (1898), 19, 385; ibid. (1900), 21, 273. 

 'Albert. This Journ., Sec. B (1908), 3, 345. 



