Sessional_Paper_1904 — Page 386

280

Kocu himself who has performed innumerable necropsies, only remembers having seen 2 cases during his many years' practice. Again, 2 cases of tubercular peritonitis were met with during the past year.

In both of these cases the inesenteric glands were enlarged and caseous, and at first sight the condition would have been diagnosed as Tabes Mesenterica or consumption of the bowels " -terms which are justly rapidly disappearing from medical nomenclature. The intestinal mucous membrane in each case was normal. In one case the lungs and cervical glands showel tubercular foci. In the other a large tubercular and caseating axillary gland was found. In these cases. no one would be justified in. concluding the infection by way of the intestine. My results therefore are impor- tant from the standpoint that infection in_tuberculosis is extremely rare through the intestine and practically negligible from the point of view of prophylaxis.

The question as to the etiological significance of food in the production of tuberculosis is by no means settled but nevertheless it appears to me that the dan- gers attached to food have been greatly over-estimated." It may be argued that the food used by Chinese differs greatly from that of Western Nations, but that cannot have much weight when we bear in mind the great frequency of tuberculosis amongst Chinese and their methods of preparing and partaking of their diet.

One has only to look at the variety of primary intestinal and mesent eric tuber- culosis in Chinese children and even adults and compare it with the relative fre- quency of other forms of tuberculosis, in order to estimate the exact position of affairs.

Beri-beri.

During the year, 160 post-mortem examinations have been made upon the hodies of persons dead froin this disease. In by far the majority of cases, the dropsical form of the disease has been present. This form of the disease would appear to be the most frequent in Hongkong. This frequency of one particular form of the disease in different parts of the world has been noted repeatedly by others. Differences in different places in the same country are also met with and the malignant character of the disease may vary in different years.

Conditions of

The reasons for these variations are by no means obvious. weather exhibit practically no influence on the appearance of the disease, an aver- age of from 10 to 15 cases being brought to post-mortem in each month. The appearance of the disease therefore resembles that met with in Japan where beri- beri occurs throughout the year.

Almost all the cases occurred in males, the figures being males 151, females 9. This probably depends upon the difference in the manner of living amongst females. As regards age, the cases show that the disease is most prevalent during the working or wage-earning period of life.

Age.

0- 1 year, 1 5 years,

10

10-20

20-30

30-40

40-50

Over 50

21

No. of Cases."

3

0

.14

.43

..53

29

..18

.160

Total,

These figures also bring out another point—the occurrence of cases of the disease between the ages of 1 to 5 years. Two of these cases occurred in males aged about 3 years, the third in a female aged about 4, Each presented the post-mortem appearances of a case of dropsical beri-beri. It is generally recognised that children are almost never attacked. The youngest patient which SCHEURE had was 8 years of age. These 3 cases which I have included under beri-beri probably belong to the class of case met with by GRAHAM of Sumatra and Hora and MIURA of Tokyo, whether these cases are to be regarded as true cases of heri-beri, is a matter of dispute. The question of the etiology of beri-beri is quite obscure.

That it is an infectious disease there seems to be little doubt. How the casual agent reaches the tissues of the body is unknown. My observations are in accord with those of WRIGHT'S in the Federated Malay states.