20 The Philippine Journal of Science i9i6 



The clinical diagnosis was Hirschsprung's disease (megaco- 

 lon) , hydrocele, umbilical hernia, and rachitis. 



My report of the autopsy in full, performed on September 10, 

 1915, is as follows: 



The body is that of an underdeveloped and greatly emaciated Filipino male 

 child, measuring 58 centimeters in length and weighing 3.46 kilograms. 

 Rigor mortis and hypostasis are not present. The abdomen is so much 

 dilated and the extremities so small that the body looks like that of a frog. 

 The anterior fontanelle is open, but the sutures are closed. The face has an 

 expression of suffering. The eyelids are open. The pupils cannot be dis- 

 tinguished. The lips are reddened as well as the tongue and buccal mucosa. 

 The thorax is well expanded, but the muscles are poorly developed; the 

 intercostal spaces are depressed, and the costochondral joints are marked. 

 The abdominal wall is very thin and is uniformly distended. In the right 

 lower quadrant there is an egg-shaped mass which is well formed but can 

 be pressed and made to assume different shapes. The coils of the intestines 

 are well marked. On turning the baby to one side, the distention is still 

 present. The inguinal glands are not very much enlarged. The rectum 

 admits the small finger very well. 



On section subcutaneous fat is absent. The musculature is very thin. 

 The peritoneum is pinkish, and there are about 20 cubic centimeters of 

 sticky fluid in the peritoneal cavity. All the coils of the intestines are 

 dilated, but the large colon is enormously hypertrophied and dilated. The 

 appendix measures 5 centimeters in length, is under the mesentery of 

 the ileocaecal valve, and contains some faeces. The ascending colon has 

 a slight twist upon its longitudinal axis; it is bluish and large, having 

 a diameter of approximately 3 centimeters. The transverse colon is very 

 much dilated and measures 6 centimeters in diameter. The descending 

 colon measures 4 centimeters in diameter, and the upper part of the 

 sigmoid flexure is about 3 centimeters in diameter, curves toward the 

 right side in a twisted way and is well covered by the peritoneum and by 

 the other portions of the large intestine. The sigmoid and rectum are 

 just as long as the ascending, transverse, and descending parts of the colon. 

 The rectum measures approximately 10 to 12 cefntimeters in diameter and 

 contains large faeceslike masses; it diminishes in diameter toward the anus. 

 The inferior portion of the rectum has a diameter of 2 centimeters. The 

 walls of the large intestine are very thick and measure about 9 millimeters 

 in thickness. The mesentery of the large intestine has a lower origin than 

 that of the small intestine, and the longest place of the mesentery of the 

 large intestine (or mesosigmoid) measures 11 centimeters. All the blood 

 vessels and lymph channels are very prominent, as well as the mesenteric 

 glands. The small intestine has a thin and congested wall, and nearer 

 the stomach the diameter becomes normal. The stomach is not markedly 

 dilated and is covered by the transverse colon. The liver is small, and 

 the diaphragm reaches the second space on the right side. The omentum 

 is almost absent, and what remains seems to be mucoid tissue. 



Thorax. — The thymus gland is very small (0.74 gram) and is pinkish 

 yellow. 



Heart. — The pericardium contains about 3 cubic centimeters of clear, 

 straw-colored, viscid fluid. The heart is dark blue and is small. Fora- 

 mefn ovale is patent, and the orifices of the heart are apparently normal. 



