Sessional_Paper_1906 — Page 491

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(3.) Experimentally, it has been found impossible, by any method, to call forth the

disease in any animal.

(4.) In our experience, true Beri-beri does not exist in monkeys infected either

naturally or experimentally.

(5.) Beri-beri, as the result of our investigations, would appear to be non-micro- organismal in nature. We are inclined to bring some chemical poison into causal relationship with the disease.

(6.) Our results are in direct opposition to those obtained by Dr. HAMILTON

WRIGHT.

8. Rupture of the Spleen.-Rupture of the spleen, as a cause of death, figures con- spicuously, in coroner's enquiries and in the Supreme Court of Hongkong. Such cases frequently excite a considerable amount of local interest, and much speculation would appear · to exist as to the amount of violence required to occasion such an injury which usually results in the death of the individual. Ruptures of the abdominal organs, and in particular, of the spleen, liver, and kidneys, may be due to violence or disease. Upon the degree of such ruptures depends the length of time of survivorship of the individual affected, and such cases, varying in causation, length of survivorship, etc., may have an important bearing in a charge of murder.

1

Rupture of the spleen is an ever-recurring cause of death at the Public Mortuary, and the opportunities afforded for a study of the condition are many. About 12 cases occur annually, and the exact circumstances under which the individual cases occur have always been noted. In a malarial country, like our own Colony, the spleen is usually found en- larged and brittle, (malaria), and the violence required to effect a rupture of such a diseased organ may be very slight, compared with that requisite to call forth a' similar condition in a healthy spleen. This fact is one of importance, and the question as to the existence of a healthy or unhealthy spleen must always be taken into account from a medico-legal stand- point, as this circumstance may in certain cases mitigate the act of an assailant. In the majority of the cases which have come under my notice, such an ague spleen has been present. However, notwithstanding the presence of disease, it has always been a matter of great difficulty to form an accurate estimation of the amount of violence necessary in each individual case, to occasion a fracture of the organ.

From my own experience of cases of rupture of the spleen, I venture to put forward the ' following remarks in regard to the question of violence in such cases :—

1. Extreme violence may be used over the splenic area of the abdominal wall if the organ is bealthy. Although the spleen, like the liver, is much exposed to rupture, yet it will not yield to a sudden shock so readily as the stomach and intestines. Cases of this nature have come under my notice. On two occasions I had an opportunity of examining the dead bodies of healthy individuals who had been run over by rapidly driven, and heavily laden dray carts. The wheels passed over the abdomen in the hypogastric and upper lumbar regions. In each case there was rupture of the stomach and fracture of the lower ribs. The spleen was unaffected.

Occasionally the question, as to the presence or absence of distension of the stomach, due to food, exercising a favourable influence on the possibility of rupture of the spleen, is raised.

a

Experiments, in regard to this factor, have been made upon cadavers and show that "full stomach" has practically no significance in favouring the fracture. My own experience would appear to support the experimental side of the question. I know of no case, during the past four years in Hongkong, which could be said to have a distended stomach as a predisposing factor of the rupture.

2. Slight violence may be used over the splenic area and cause a rupture of the organ, but only if the spleen is hard and brittle. Slight pokes with the fingers or fists may cause the injury. Two Chinamen were "larking"; one happened to poke the other below the left ribs. The "tap" could in no sense of the word be called a "blow", yet the individual died in one hour and the post-mortem examination showed a well-marked rupture of an enlarged and brittle spleen.

In a

3. The violence may be of the nature of compression of the waist by the arms. case which came under my notice, two Chinamen were wrestling, each gripping the other tightly round the waist. One of the two suddenly became faint and died soon after of rupture of an enlarged spleen. The spleen in this case was over 3 pounds in weight ie., about 8 times its normal size.