Report on anaemia, or beri-beri, of Ceylon / by W.R. Kynsey.

  • Ceylon. Civil Medical Officer.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Report on anaemia, or beri-beri, of Ceylon / by W.R. Kynsey. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    24. A few anchylostoma present in the intestines may give rise to slight or no symptoms at all, and even many may not be felt for a time if the food is good and varied ; but should the infected person become weakened by illness, such as an attack of ague, or exposed to bad food, as often occurred in old days on board ship, severe and even dangerous symptoms may rapidly develop : the number of parasites present may vary from a single worm to upwards of three thousand. It has been established by Lutz that the presence of five hundred produces severe disturbance even in the strongest adult, and if the individual be unfavourably placed as to diet and bad hygienic surroundings, a much smaller number will do the same. He adds : The idea that the worms are not the cause but the consequence of the disease seems, after all our patho- logical experiences, rather an unintelligible anachronism. To retain such an idea, knowing what v?e do of its mode of development, its mode of infection, and its mode of living, would be something strange. The variety and severity of the symptoms in anchylostomiasis depend mainly on the number of parasites present. Sometimes severe symptoms are coincident with the presence of a fewjparasites. Lutz states that when this is the case we have to do with old cases in which the anchylostoma had either been expelled or disappeared in the course of time. In children a few parasites often give rise to severe symptoms. 25. The symptoms of anchylostomiasis may be divided into three stages :—(1) the dyspeptic ; (2) the anaemic ; (3) the dropsical. 26. The patient very often looks robust, with a fair development or even an increase of subcutaneous fat,— so much so, that on superficial inspection there are no signs of illness. He will probably state he always enjoyed good health, and never had malarial fever, but that for some time past his strength has been gradually failing, and that the least efiort fatigues him ; he feels weary and sleepy, and is unable to work. His appetite has not diminished, and may even be increased, and is frequently perverted by a desire for unripe fruit or vegetables or uncooked food. Among children, geophagy is common, and even among adults it is not unknown. He complains of disturbance of digestion with pains increased on pressure in the right and left hypochondria, and at the ensiform cartilage, meteoric distension of the abdomen, flatulency, nausea, vomiting, and the bowels are either obstinately constipated or there is constipation alternating with diarrhoea. In the anaemic stage there is cardiac pain with palpitation and dyspnoa on exertion. Lutz attributes the cardiac pain to exhaustion of the heart, and classifies it with the pain felt after violent walking, riding, or rowing. The face has usually a yellowish tint; the eyes are bright, and the conjunctiva pale and bloodless to a remarkable degree, well seen on everting the lower lids. There is well-marked pallor of the mucous membrane of the mouth and tongue, which strikingly contrasts with the apparently good condition of the patient. If the disease is not recognised and treated, oedema of the face and extremities sets in, occasionally attended with a certain amount of fever. He now complains of giddiness and dimness of vision, with a tendency to syncope on sitting up, headache, tinnitus aurium, muscular pains, and inability to move, or even partial loss of power over the limbs with numbness. This weakness no doubt results from the diminished supply of blood, and the supply of watery blood to the cord. It is similar to the weakness of the extremities in aortic regurgitation, or it may be due to peripheral irritation, and in advanced cases from effusion into the spinal canal. There will frequently be found an anaemic murmur at the base of the heart, or even heard over the whole cardiac region and in the vessels of the neck. If the disease still further advances the dropsical stage sets in, there will be effusion into the pleuree and pericardium, hoemorrhage from the bowels, troublesome diarrhoea, and death, which frequently occurs in an appallingly sudden manner, just as described in the old reports of beri-beri and by Dr. Maclean in his lecture on this disease. If the disease becomes chronic, there is emaciation with disappearance of the subcutaneous fat. Aneemia of varying degrees of intensity, cardiac hypertrophy, and dilatation, with fatty degeneration, dropsy of the extremities, abdomen, &c., with intestinal hoemorrhage. Children suffering from anchy- lostomiasis for years during the developmental period are small and puny, and at twenty-five years of age look like children of ten or twelve. 27. In chronic cases with atrophy and weakness the latter no doubt depends on peripheral irritation and anaemia of the cord, which is brought about in anchylostomiasis by the quality and quantity of the blood-supply dependent on the disease, and possibly on spasmodic contraction of the vessels caused reflexly or from the fluid effused into the spinal canal, 28. The complications enumerated by Lutz are diarrhoea, intestinal hoemorrhage, malaria, struma—other intestinal parasites, those generally present being the trichocephalus dispar, ascaris, lumbricoides, oxyuris vermicularis, and angniluUa —chronic catarrh, pulmonary tuberculosis, epilepsy, arthritic rheumatism, and chronic ulcers, under any of which anchylostomiasis may be, and I have no doubt has been returned. It is the presence of complications and the non- recognition of the effects of the anchylostoma which have hitherto prevented a more accurate knowledge of the disease. 29. The diagnosis of anchylostomiasis can be made with great certainty by attending to the following points :— (1) The history of the case, with the peculiar anaemia. (2) The red blood corpuscles are diminished in number : in some cases to one-fourth or one- sixth the normal. The hEemoglobulin is said to be reduced in the same ratio. The ratio between white and red corpuscles persists for a long time, but ultimately the former become comparatively more numerous, without, however, any actual increase in their number. (3) The detection of the ova in the faeces. As the ova of the anchylostoma are, as a rule, uniformly distributed throughout the faeces, they are found with the greatest ease by taking a small portion of the faeces, diluting it, if necessary, with distilled water, and placing it on the microscopic slide,—a quarter-inch object glass is required. The ova of the anchylostoma are easily distinguished from those of the trichocephalus dispar and the ascaris lumbricoides, which are 77-87 [ 543 ]