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true inflaminatory nature do not appear much in evidence. Indeed, on the other hand, the conditions met with in the stomach and other parts of the gut suggest an absence of trophic nerve influence, nerve degeneration, and consequent vascular engorgement, stasis, hæmorrhage, etc.
The descriptions and interpretations of the condition of the alimentary gut given by us, are totally different from that recently furnished by HAMILTON WRIGHT; who somewhat forcibly drives home his theory of gastro-duodenitis as the prim- ary lesion of Beri-beri, indicating thereby the existence in this part of the gut of a definite acute inflammation, excited by some particular germ, and resulting in the advent of the well-known symptoms and signs of Beri-beri.
The liver is usually increased in size, weight and specific gravity. Its con- sistence is firm and capsule is stretched and usually has a congested parenchyma shining through it. Hæmorrhages into the capsule are rare. In cases of Beri- beri of short duration, the capsule of the liver is normal, but in the more chronic cases thickenings are frequently found in it. These are localised and scattered over the surface of the organ. They are greyish-white in colour, and ramify and branch in a tree-like fashion. This peculiar form of capsular thickening is also found in connection with the spleen and some other organs. It is not specially characteristic of Beri-beri and is found in other diseases, such as chronic malaria, but in the disease under consideration it is usually peculiarly well defined. On section the liver frequently drips with blood and watery fluid. The colour of the parenchyma is usually normal, or darker than normal. Fatty changes are often found well marked. Cirrhosis of the intra-lobular variety is frequently found in chronic dropsical cases. The gall bladder is usually distended with bile. walls are thickened, soft and edematous. Blood extravasations are rare. bile is thick, tenacious and dark-green in colour.
The
The
The spleen varies extremely in size and weight. It may be normal but in other cases spleens 3-4 lbs. in weight and of enormous dimensions have been found. This variation, however, would not appear to depend wholly upon Beri- beri and is due probably to other causes, e.g., malaria. Capsular thickenings of the spleen are very common, and may reach 3-6 m.m. in thickness. The organ is usually moderately congested and on section bleeding surfaces are left. A general fibrosis of the orgau is frequently present.
The condition of the kidneys varies. They may be normal, at other times cloudy swelling and congestion is present. Usually the capsule peels readily from the surface. Slight cirrhosis is not infrequently present. Hæmorrhages are rare..
The other genito-urinary organs are normal.
Edematous thickenings
are found in marked dropsical cases, being part of the generalised anasarea.
The supra-renals and pancreas are normal.
The membranes of the brain and spinal cord are thickened. This is either patchy or generalised. Their contained vessels are full of dark-red fluid blood. The cerebro-spinal fluid is usually in excess. The brain and spinal cord are usually normal to the naked eye, but are firmer owing to edematous infiltration below the pia mater, and the existence of slight increase of fibrous tissue.
To recapitulate-the naked eye pathological changes found in dropsical cases of Beri-beri may be summed up as follows:-
1. General anasarca and dropsical accumulations.
2. Venous hyperæmias and their results.
3. Fibrotic accumulations of varying degree.
The Atrophic Form.
The external appearances of atrophic Beri-beri cadavers are vastly different from that of the foregoing variety. There is a typical picture of anæmia and ad- vanced emaciation. In old standing examples of the disease the cadaver is prac- tically skin and bone, and as the body is viewed on the post-mortem table the pos- ture assumed is varied owing to the presence of inuscular contractures and other deformities.