Sessional_Paper_1906 — Page 250

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4. PATHOLOGICAL ANATOMY.

Excellent opportunities are afforded at the Government Public Mortuary for a careful study of the Pathology of Beri-beri. During the past three and a half years over 500 cases of Beri-beri have been examined post-mortem, and the chief lesions and changes noted. All varieties of the disease have been found, but for general purposes, it has been found preferable to divide the cases into Dropsical forms and Atrophic forms.

From our experience in Hongkong, the dropsical form of the disease has formed the larger number of the cadavers sent for pathological examination. This type of the disease would appear to be the most frequent in Hongkong, and this frequency of one particular form of Beri-beri in different parts of the world has been noted repeatedly by other observers. Variations in different places in the same country are also found, and the malignancy of the disease often varies in different years.

The post-mortem examinations which have been held in Hongkong have been upon cadavers of all ages and both sexes. A few cases have occurred in young adults and children but whether the occurrence of Beri-beri symptoms and patho- logical appearances in the latter, are to be regarded as true Beri-beri is still a matter for dispute. The discussion of this question will be dealt with under a separate heading.

By far the largest number of autopsies have been made upon male cadavers. The female sex would appear to enjoy a comparative immunity from the disease. During the period mentioned only 5% of the total number of post-mortem examin- atious on cases of Beri-beri have been made upon female cadavers. An explana- tion of this freedom is difficult to offer. In all probability it is dependent upon the differences in the manner of living, between the sexes.

It is to be regretted that in the majority of cases examined a history of ill- ness was not ascertainable. This was due to the fact that most of the bodies sent for section were found in the streets, in deserted houses, or on the hill-sides.

Beri-beri cadavers shew pathological changes which are of great interest. These structural alterations are generalised throughout the body and are usually so profound as to be easily recognised. Taken individually none of the pathological changes can be regarded as distinctive of the disease. It is only by careful collec- tion of the lesions present, and by a process of exclusion, that a diagnosis of true Beri-beri may be arrived at.

As no recent references regarding the pathology of the disease as met with in Hongkong have been made within recent years, an account of the results obtained during the past 3 years is of interest.

As already mentioned two types of the disease have been distinguished, namely, the Dropsical form and the Atrophic form. The following is a descrip- tion of the post-mortem appearances of each.

The Dropsical Form.

To an expert the external appearance of the dropsical Beri-beri cadaver is fairly typical. The cyanotic swollen face with starting eyes, the engorgement of the veins of the head and neck, appearing as blue cords below the skin, the bloody froth about the nose and mouth, and the general corpulent appearance of the body and extremities, coupled with occasional subcutaneous hæmorrhagic extrava- sations, lead us to suspect the cause of death. In countries in which Beri-beri is endemic, these external appearances presented by a cadaver are held by many tropical sanitary experts to be sufficient to establish a correct diagnosis and thus obviate the necessity of post-mortem examination. In our opinion such methods of corpse inspection are unscientific and much to be deprecated, and with the gra- dual disappearance of native prejudice, corpse inspection ought to be completely supplanted by routine post-mortem examination. If this be not done such statistics as may be compiled are of little value, and the relative incidence of the disease- throughout our Colonies determined by a method directly opposed to the princi- ples and practice of medicine.