164 The Philippine Journal of Science wis 



ANATOMIC DIAGNOSIS 



Purpura hsemorrhagica ; ecchymoses, cutaneous, epicardial, pleural, retro- 

 peritoneal, retropleural, gastric, and intestinal; partial atelectasis of lungs; 

 anaemia of the viscera; haemorrhage into intestines; ascariasis; trichu- 

 riasis; ankylostomiasis. 



BACTERIOLOGIC DIAGNOSIS 



Cultures made from the spleen and the haemorrhagic area behind the 

 left knee joint on agar-agar, in bouUion, and on blood serum remain sterile 

 forty-eight hours. 



PROTOCOL 



Body is that of a fairly well-nourished Filipino child, weighing 

 17.10 kilograms and measuring 110 centimeters in length. Rigor mortis 

 is present. Over the right outer canthus is a minute bluish area, and 

 there are two or three isolated, small bluish areas over the lower extrem- 

 ities. (These during life were bright red, ecchymotic areas.) The cornese 

 and conjunctivae are clear. Ears and nose normal. The margins of the 

 teeth are blood-stained, but the gums themselves are pale. 



On section there is a small amount of subcutaneous fat. Muscle tissue 

 is moist and brown. On stripping muscles from the thorax, the right 

 fourth intercostal muscle near its sternal attachment shows considerable 

 infiltration of blood. The peritoneum contains a small amount of blood- 

 stained fluid. That covering the anterior abdominal wall is smooth and 

 pale. The serosa of the intestine is smooth, but there is extensive sub- 

 peritoneal ecchymosis over the left kidney extending on to the mesocolon 

 and mesentery. This is also extensive in the tissues at the lesser curva- 

 ture of the stomach and along the vertebrae surrounding the abdominal 

 aorta. Diaphragm at the fourth interspace on the right, fifth interspace 

 on the left. On removal of the sternum, the tissues on its under surface 

 show extensive ecchymosis. Lungs are considerably retracted, there being 

 some blood-tinged fluid in both pleural sacs. The pericardium contains 

 some excess of clear fluid. The structures of the neck and thorax were 

 removed en masse. 



Thorax; organs of neck. — The tongue is blood-stained on its superior sur- 

 face throughout its anterior half. Tissues at the base of the tongue are not 

 blood-stained, and the lymphoid tissue is not unduly prominent. Tonsils 

 are of normal appearance. (Esophagus, larnyx, and trachea are normal. 

 Surrounding the trachea and oesophagus in the posterior mediastinum, 

 the tissues are infiltrated with blood to an area of about 2 centimeters 

 peripherally from the oesophagus in all directions. Thymus gland is 

 small, and contains very abundant fat. 



Heart. — There are numerous minute ecchymoses in the epicardium. 

 The heart itself contains fluid blood. Its myocardium and endocardium 

 are intact. It is of about normal size, and the musculature is extremely 

 pale. Heart weighs 85 grams. 



Lungs are retracted and of small volume, the right lower lobe being 

 adherent to the tissues about the vertebrae at the extreme lower portion, 

 that is, near the median line. The lungs present numerous, dark, de- 

 pressed, firmer areas which have regular outlines, and the lower portion 

 of the right lower lobe which was adherent along the median line is still 

 firmer than these areas. On section of the lungs they are pale, except 



