Sessional_Paper_1906 — Page 253

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The following is a brief resumé of the results of our post-mortem observa- tious :-

The mouth, including the teeth and tongue, is usually normal. The pharynx may be congested and its mucous membrane swollen owing to celem- atous infiltration. The esophagus is in almost every case normal-congestion is uncommon. The condition of the stomach varies according to the severity and duration of the disease. In well-marked cases of moderate duration, this viscus will be found dilated and in a condition of muscular atony. The peritoneal cont is normal. The other coats and especially its mucous membrane are usually thickened, soft and cedematous. On opening and cleansing the organ the appear- ance of the mucous membrane is very variable. It may be normal, and all grades from this to the presence of passive congestion, necrosis, and hæmorrhagic extra- vasation, are to be found on examination of a large number of cases: In a few, as already stated, the mucosa is normal to the naked eye. In others the cardiac end is normal, whereas the pyloric end is congested, angry-looking, and presents a few blood extravasations. At other times small points of necrosis of varying size may be found in addition, In still another series of cases the whole mucous coating of the stomach is congested, reddish-black in colour, and contains numerous scattered extravasations of blood of variable size. The necrosed areas may or inay not be present. If they are. they are of varying size and shape, and the dead tissue may be removed easily, leaving a raw but dead-looking floor. These irregularities in the mucous membrane caused by sloughing are not marked by the presence of surrounding cellular infiltration, and their edges and floors shew but little attempt at re-organization. Lying between the folds of the mucosa one usually finds a considerable amount of thick, greyish-yellow, tenacious mucus.

The condition of the duodenum also varies within wide limits. The gut may be normal or it may shew the changes already described under the stomach. The hemorrhages, punctiform or diffuse, into the mucous membrane of the duo- denum, are chiefly found on the coats of the valvulæ conniventes. Necrosis of the mucous membrane has not been observed.

The jejunum is frequently congested, but in many cases nothing abnormal is to be noted.

The ileum may be normal. At other times congestion to a varying degree is present and may be accompanied by the presence of a few punctiform blood

extravasations.

The lymphatic tissues of the small intestine do not appear to be affected

The condition of the cæcum resembles that of the other portions of the small intestine.

The large intestine presents no characteristic change of a pathological nature. The mucosa may be thickened and soft owing to the presence of œdematous infiltration. therwise it is usually normal.

The rectum is usually normal.

In dealing with the large gut one has to be careful to exclude any lesions of a dysenteric nature which may be present. A thickened colon with old scars and increased pigmentation is frequently found amongst the Chinese, and is to be referred to recent or remote inflaminations of a dysenteric nature.

The mesenteric lymphatic glands may be normal. Frequently, however, they are found moderately enlarged owing to oedematous infiltration and congestion. The latter is only slight and cortical.

The mesentery is thickened and sodden, being drenched with oedematous fluid.

The foregoing description of the pathological changes found in the alimentary canal have been formulated from the results of a large number of typical cases of dropsical Beri-beri. It will be noted that such changes as are found are subject to considerable variation. Congestions, mostly of a passive character, are common, and, as a result of this and other factors, which will be discussed later, necrosis of limited extent, and hæmorrhages make their appearance. Tissue changes of a