PREDISPOSING CAUSES 



1681 



Philippine gaol outbreak. This racial incidence is most marked. 

 Thus, Braddon says that of the Chinese immigrants into the Straits 

 and Malaya, it may be reckoned that of every 1,000 living, 120 suffer 

 and 16 die of the disease. The Malayas are said to suffer but little, 

 if at all. In the Bilibid Prison in Manila, on the other hand, ac- 

 cording to Fales, the Filipinos suffered most severely, the Chinese 

 were almost exempt, only one or two contracting the disease, while 

 the Americans were entirely free. 



With regard to age, it is most commonly met with in young adults 

 between fifteen* and thirty years, but it has also been noted in babies 

 at the breast and in old men. It is more commonly met with in 

 men than in women. 



Occupation has been carefully investigated by Hunter and Kcch 

 in Hong-Kong, and they con lude that the disease is universally 

 present throughout the community, but especially affects the 

 working classes, while the professions, the mei'chants, and the 

 leisured classes are practically, but not entirely, exempt. Other 

 predisposing causes are disturbance of the soil and a high atmos- 

 pheric temperature. 



Important Features. — The peculiar features of the disease are 

 that, though it generally occurs among rice-eating peoples, yet at 

 times it occurs in other communities, as in the British regiment, in 

 whose ration there was but a small quantity of rice, which was cured 

 Rangoon rice. Finally, if observers are to be trusted, there are 

 places where beri-beri occurs and rice is not eaten. 



Pathology. — -As the cause of the disease is unknown, but little 

 can be said as to the pathology, but Mott and Halliburton have 

 performed an experiment which throws much light on the disease. 

 They injected blood taken from an acute case of beri-beri info a 

 cat, and found a fall of blood-pressure, with dilatation of the vessels 

 of the stomach, intestines, and hver, as well as general venous 

 engorgement, and they also noted dilatation of the right side of the 

 heart, and microscopical haemorrhages into the liver. This would 

 clearly indicate that a poison capable of producing great vaso- 

 motor changes was circulating in the blood of beri-beri patients. 

 In addition to the engorgements found in the cat, the human being 

 suffers from congestion of the pharynx, and degeneration of the 

 cardiac, muscular, and sensory nerves. The oedema is probably 

 due to the vasomotor disturbance. 



Durham considers that the urine indicates a serious diminution 

 of the metabolism. 



Morbid Anatomy. — The morbid anatomy and histopathology 

 have been studied by numerous observers, among whom the in- 

 vestigations of Wright, Duerck, and Scheube must be especially 

 mentioned. In acute cases there is always some oedema, but at 

 times this may be excessive, and the veins of the neck are swollen. 

 Hypostasis is always well marked, but may be excessive, especially 

 about the face. There is often froth at the mouth. In chronic 

 cases the body is pale, and may be swollen with dropsy or emaciated. 



