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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    also frequently present. The ovum is oval, with a very thin shell and often a clear space between the wall (outline of shell) and the contents. It is always found in a state of segmentation, but only in the primary stage, there being no more than three or four segments present. If the ova be kept in a drop of water in a moist atmosphere for from twenty-four to forty-eight hours, the embryo is seen formed within the shell, and may be often observed in the act of passing out of it. Besides the form of the ovum, there is also a distinguishing characteristic, as the ova of the ascaris and trichocephalus have during this time advanced but little in the process of segmentation. The ovum of the trichocephalus dispar is further distinguished by the prominence at the extremities and that of the ascaris by the striated thickness of the shell. The differences in the segmentation of the ova can be seen figured in the plate attached to Lutz's treatise, figs, d and e, and the formation of the embryo in figs. M and n. 30. The prognosis is a matter of much difiiculty and uncertainty. In mild cases, when the parasites are expelled, and there is no danger of re-infection by the patient's removal from the place where he contracted the disease, and the anaemia yields to treatment, recovery is secured ; but where the disease has not been recognised in its early stage, a fatal result often ensues from the direct effects of the parasites. Where there is anasarca, or intercurrent disease, or where there is hypertrophy with dilatation of the heart and advanced cachexia, the prognosis is very unfavourable; still, with careful treatment, the worst chronic cases often improve. Recovery is to be looked for in the severest acute cases. Relapses are frequent when patients return to their former homes and mode of life, and such cases are difiicult to cure, frequently become chronic, and end fatally from the anaemia caused by the parasites or from some inter- current disease. In no disease is it more necessary to recognise the condition in its early stage and to adopt immediate treatment. 31. On post-mortem examination the anchylostoma may be found either attached to the intestinal wall, adhering firmly to the mucous membrane, if the examination be made soon after death, and loose in the mucus if made later. The parasites are found in the duodenum and jegunum, and they may be found even in the ileum, or single worms in the stomach or ceecum. Hoemorrhagic spots are also present. Depressions or small lesions are found the size of a millet- seed on the mucous membrane, which may represent the original position of the worm. There is increased raucous secretion. The liver and spleen are, as a rule, normal or atrophied, and the former often in a state of fatty or amyloid degeneration. The kidneys show similar changes. Wucherer describes the pancreas as enlarged. The parenchyma of the heart is flabby and anaemic, and the whole organ may be normal, or dilated, with or without hypertrophy. A high degree of aneemiais always present, visible in the pallor of the skin, muscles, meninges of brain, spinal cord, and organs. Extensive dropsy of the thorax and abdomen with oedema of the brain and spinal canal. The subcutaneous fat is, as a rule, well developed, but in old chronic cases it may be diminished. 32. Lutz makes the following four conclusions :— (1) With the presence of the anchylostoma doudenale there are met with in the intestines local lesions, consisting of small and large hoemorrhages in and under the mucosa. (2) In a number of cases there were found changes in the mucous membrane of the stomach and bowels, which must be looked on as chronic catarrh with increased mucous secretion. (3) As a result of the local processes, there have been observed poverty of blood, which is frequently accompanied by dilatation and hypertrophy of the heart. (4) The whole organism suffers from disturbed nutrition. This malnutrition of the whole system manifests itself in the individual organs by atrophic and degenera- tive changes. 33. It should be always borne in mind, that, curable as the disease is, if taken in hand in time, by removal of the parasites from the intestines, and by the prevention of fresh infection, etill in many cases there is little improvement even after the disappearance of the parasites. This occurs in long-neglected cases,where cardiac changes and other complications have supervened; but in recent cases, after removal of the parasites the anaemia is easily cured by suitable treatment: but if the anchylostoma be allowed to remain, no treatment has any effect on the angemia. 34. The treatment is to be considered under two heads, (1) the expulsion of the parasite; (2) the treatment of the anaemia, and complications, should any exist. 35. The expulsion of the worm is the first object. Several remedies have been tried, but there are only two really reliable, and in practice only one. These are—(1) Thymol (acidum thymolicum), and (2) perfectly fresh pure oil of the male fern. Thymol may be considered a specific. In the Colombo Civil Hospital Dr. Macdonald has obtained excellent results with thymol, and now he uses nothing else. This treatment was introduced by Bozzolo, and he gave it in from 30 to 150 grains in three to six doses in the day. The effect can be watched by counting the worms expelled, and seeing the discontinuance of the ova from the stools. Lutz's treatment is as follows : He prepares the bowels by the administration of a dose of calomel and podophylin, or calomel and senna. This is absolutely necessary to remove the profuse mucous secretion in the intestines, which protects the worms, and prevents the thymol coming in contact with them. The following is the prescription he recommends :— R/ Calomel grs. viii. Extract of Senna ... grs. xxx. Divide in pil. viii. S. Two to be given every hour till the bowels move freely. Dr. Macdonald gives the calomel in these doses, but uses the ordinary infusion of senna instead of the extract. The first dose is given two hours after the midday meal,—he allows a [ 544 ]