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

Ceylon. Civil Medical Officer.

Date:: 1887

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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fact was clear to him that they must have had an injurious effect on the organism, although he did not recognise in what way. The parasite was also found in Milan by Castiglioni, in 1844. It was next observed by Pruner, in 1846. He remarked that the worms affected in particular rachitic and cedematous scrophulous patients. Yet he, like many after himjbeheved the presence of the parasite was dependent on the pathological conditions, instead of adopting the more rational view that the pathological conditions were due to the parasite. The symptoms of anchylostomiasis as a whole were known to him, and were described by him as cachexie aqueuse. Bilharz also observed the parasites in Egypt so often that they never failed him in a single case of autopsy. On the contrary, they occurred in hundreds and thousands. He proved that the worm pierced the mucosa and sucked blood. Griesinger, who examined the matter along with Bilharz, came to the conclusion that the worm was the direct cause of Egyptian chlorosis—a disease affecting at that time about one-fourth of the entire population. His publications spread the knowledge of the cause, and to some extent was of help in the diagnosis of the disease. On the other hand, 1 am doubtful whether the very rational treatment adopted by him had been really of any use. At least, the anthel- mintics (ol. terebinth and calomel) recommended by him have had no result in the hands of competent observers.* The knowledge of the parasite was further spread by the discovery of the same in Brazil by Wucherer in 1866. Cognisant of the discoveries of Griesenger, he examined the intestines of a patient who died of extreme anjemia, and found there a number of worms, the identity of which with the anchylostoma duodenale was later on confirmed by Schneider. The symptoms otherwise present corresponded with the descriptions of Griesenger. After him numerous other observers made the same discovery in the bodies of those dead of tropical anaemia, as Rodriguesde Moura, 1866; Fauvray, 1869 ; Tourinho, 1871; Souza Vaz, 1876. There are also observations quoted from Faria, Silva-Lima, Santos Pereira Teixeira da Rocha, Marques da Cruz. Notwithstanding, the knowledge of these relations was but little noted outside the province of Bahia. The old, unintelligible view, which looked upon the worm as the consequence of the disease, still prevailed, and the cause of the disease was attributed to imperfect nourishment, over- exertion, psychical depression, &c. The Professor of Medicine in Rio, Torres Homem, still continued to describe it so in 1883, and in his clinical lectures on oppila^ao, or tropical anaemia, and its treatment, ignored its connection with the anchylostoma, notwithstanding the numerous proofs before him, supporting his view on the occurrence of one case diagnosed, and that correctly, as tropical anasmia, and yet in which on autopsy only five anchylostoma were found. (Further on I shall discuss this case.) Although the spread of the knowledge of the cause of the disease, notwithstanding even popular descriptions, was still very limited,—a fact to be explained by the rarity of the disease in town and the small number of post-mortem examinations made ; yet the treatment, notwithstand- ing the discoveries of the last year, had even made less progress, and was limited to the old and insufficient remedies, whilst the disease made enormous inroads on the people. How complete the knowledge of the cause and effect was, almost twenty years ago, may be seen from the classical work of Leuckart (Parasit. Mensch., II. Band, 2 Leipzig,'1868), where already the search for the ova is recommended as a means of dia.gnosis. After the publications of Wucherer, the parasite was also found at Mayotte, by GrenSt and Monastier, in 1867 ; Cayenne, 1868 (Camuset and Rion de Kerangal); Senegambia, 1882 (Borius); and Japan (Baelz and Schube), as well as in Nether- land-lndia (Stammeshaus). In Abyssinia and India they are also said to occur. (Davaine.) In the meantime, the knowledge of the anchylostoma bad made constant progress in Italy, although the materials for observation there were small, in comparison with other countries. Sangalli, in Pavia, discovered the worm (1866) in one-half of the bodies examined by him, and once in such numbers that he could not help looking upon it as the cause of the deadly disease, —anjemia,—although he blamed neither the direct loss of blood by suction nor the fact that the worm fed on blood, as the cause as a rule. Sounini and Morelli observed anchylostoma in Florence (1877); Grassi and Parona in Milan (1878) ; the latter and Ciniselli also in Pavia (1878). Grassi was the first to detect the ova in the ffeces, which, strange to say, Wucherer sought for in vain. Grassi also found the worm in the stools, and studied its anatomy and mode of development, and advanced our knowledge by the observation of Dochmius balsami s. tubseformis. He laid stress on the haemophagic mode of life of the worm, and its detrimental results. A number of observations in this respect were made by Bozzolo at the Clinic in Turin, and published by him and his assistant, Graziadei. These were made on bricklayers of the same province (six to seven patients, 1879). Perroncito also observeda case from the province of Turin. Individual cases were observed, out of Italy, by Kundrath and Heschl, in Vienna, in 1872 ; by Roth, in Basel, in 1879. In the first case the infection most probably occurred in Venice ; in the latter in Java and Borneo, or Egypt. The medical world was to some extent prepared, when, on the occurrence of a great epidemic in Europe, such materials for observation were at its disposal as had never before existed on that continent. This took place during the construction of the Gotthardt tunnel. All the conditions favourable to the development of the parasite being present, there was suddenly developed a colossal brood, where previously the parasite had never been observed. This gigantic work, which for years gave employment to thousands of labourers, was, as is well known, commenced simultaneously at both ends, Airolo and Goschenen. The labourers at both ends * Ul. Terebinth. Calomel, &c., were tried by me without any results prior to Dr.Kynsey placing in my hands this treatise. — Trans. [ 554 ]

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

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