PATHOLOGICAL FINDINGS IN THREE CASES OF 
ENCEPHALITIS LETHARGICA 
By Dr. W. de Leon 
Previous to the recognition of encephalitis lethargica as a 
distinct entity there were published in many European journals, 
chiefly British and French, reports of cases of a peculiar de- 
rangement of the central nervous system, mostly manifesting 
itself in queer mental torpidity, lethargy, at times unconscious- 
ness, and irritation of cranial nerves. 
Due to the similarity of symptoms, the British authors at 
first thought this mysterious disease to be identical with bot- 
ulism. Other writers described the disease under basal lepto- 
meningitis, toxic ophthalmoplegia, epidemic polioencephalitis, 
and encephalomyelitis, depending, upon the site of the irritation 
in the nervous system. Those who have had opportunity to per- 
form postmortem ‘examination of cases dying of this affection 
could find no definite gross anatomical lesions to account for 
death. 
About the latter part of 1919, and after the great epidemic 
of influenza which swept over these Islands, we used to meet 
cases at the autopsy table, from the Philippine General Hospital, 
with clinical evidence of nervous involvement, in which after 
examination we failed to find any corresponding gross anatomic 
lesions. 
Such was the fact with a body that was transferred to the 
morgue with the clinical diagnosis of typhoid with signs of me- 
ningismus during life. At autopsy, all the organs were negative 
except for the presence of marked passive congestion of all the 
viscera, and some edema and injection of the mucosa of the in- 
testines. There were absolutely no typhoid lesions in the gut. 
The brain, however, was not examined. 
It was then suggested by Doctor Wade that a careful, thorough, 
and minute inspection of the brain be made of those cases that 
gave history of disturbance of the central or peripheral nervous 
system, especially when no gross anatomical manifestation to 
explain death was found. To him also belonged the privilege of 
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