A CASE OP INFANTILE BERIBERI. 347 



The liver measures 12 by 7 by 4 centimeters. Its consistence is firm, the 

 edges are sharp, the color is mottled. On section there is a pale yellow area 

 near the surface while the general color is a brownish red and opaque. 



Intestines: The mucous membrane is pale. There are swollen areas in Peyer's 

 patches in the lower portion of the Ileum. 



Histological examination oy Dr. Gilman. — Microscopically the heart shows a 

 diffuse, cloudy appearance with some separation of the muscle fiber and in places 

 rather an abundant infiltration of round cells. 



The lungs show a slight oedema with a few red blood cells free in the alveoli 

 in various areas. The bronchial glands are normal. The kidneys show early 

 post-mortem degeneration. The glomeruli are generally congested, the tufts being 

 packed with red blood corpuscles. 



The spleen shows a marked grade of congestion; the malpighian areas appear 

 smaller than normal and are widely separated by the pulp, the sinuses of which 

 are markedly engorged with red corpuscles. 



The liver is markedly congested and the cells forming the periphery of the 

 lobules show quite advanced fatty infiltration. 



Both vagi show swelling of the fibers with complete degeneration of about one- 

 half of the nerve; the remaining fibers stained poorly and showed in areas a 

 slight round cell infiltration. 



A section of the right cervical ganglion shoves a general sioelling of the nerve 

 cells and their nuclei with an eccentric arrangement of the latter. A few of the 

 cells show a granular change in the protoplasm. 



I have been led to present this report since, with the confirmation by 

 autopsy of this case of infantile beriberi, that nosological entity acquires 

 definitely and indisputably, a rightful place in the pathology and statis- 

 tics of infantile mortality in the Philippines. 



The discovery of the existence of beriberi in nursing infants is due 

 to Professor Hirota, of Tokyo, who first published, in the "Centralblatt 

 fur Innere Medizin," in 1898, his studies on this condition which he 

 began in 1888. Before the publication of his studies, such eminent 

 authors as Back and Scheube denied the existence of beriberi in nursing 

 infants. Even at the present time, Scheube is not convinced that nurs- 

 lings may acquire beriberi from their mothers through the milk. 



It may be said that the recognition of the existence of infantile beri- 

 beri in the Philippines is of rather recent origin, since it is only four 

 or five years ago, and clue to Scheube's work on tropical diseases, that the 

 observations of Hirota became accessible to the Filipino physicians, 

 especially through Drs. Luis and Manuel Guerrero. But our clinical 

 recognition was little more, than a mere suspicion, as it had not been 

 confirmed by a pathological demonstration on the cadaver as in the 

 present case. Dr. Herzog, of the biological laboratory of the Bureau 

 of Science, in Manila, who published in 1906 a most thorough research 

 on beriberi, was not able to adduce a single autopsy on a case of beriberi 

 in a nursing infant, undoubtedly because there had been no opportunity 

 to perform one. He therefore limited himself to admitting the exist- 

 ence of infantile beriberi and citing the clinical testimony of the Filipino 

 physicians. , 



