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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description under the article Anaemia, given by St. Vel in the Traits des Maladies des pays chauds. As early as 1648, Piso mentions a disease occurring in Brazil under the term oppilatio, evidently a corruption of the term oppila^ao, a term yet commonly used there for anaemia. Other terms, such as hypophemia tropical, amarellao, and can9a9ao, are used, of which the second derives its origin from the pallor of the skin, and the third from the great and coastant exhaustion. Among the German colonists it is called Bleich oder Gelbsucht ; since those days it has been observed and described and in many countries gecerally recognised. Its connection with anchylostomiasis is easily proved. I have myself found in about 150 faecal examinations of recent cases, without exception, the eggs present in great quantities, and many thousands of anchylostoma expelled. In Italy, the disease as such was described by Volpato, in 1848, and designated allotrio- phagia. Older descriptions come from the southern states of the American Union. Yet, on the whole, there are extraordinary lacunae in the history of the disease. We do not know how long it has existed in Egypt, where, from immemorial time, it must have found a suitable soil. The reports from the Old World are of comparatively recent dates, although the infection must have long existed there in all probability, and possibly the disease has found its way to America within historical times. In the New World, the slave trade facilitated the spread of the parasite, although the spread' was not altogether due to that. It does not appear to me pro- bable that the parasite existed in America before its discovery in 1492. To summarise shortly what has been already stated, and complete it by some additions, it may be stated that the following geographical distribution of the parasite itself, and of the symptoms directly traced to its influence, occur. In Europe, anchylostomiasis is met with in mining districts : in France and Hungary (Perroncito and others), in Sicily (Grrassi), in Sweden (doubtful), in the province of Turin, among the brickmakers (Bozzola). Further, the disease prevailed among the Gotthardt labourers. Among the agricultural population of Italy, rice-cultivators in particular, it appears to be common. We have had communications on the subject from Milan (Dubini, 1838 ; Castiglioni, 1884 ; Grassi and Parona, 1878), from Treviso (Volpato, 1848), Pavia (Sangalli, 1866 ; Grassi and Parona Ciniscelli, 1878), Turin (Bozzolo and Gaziadei, Perroncito, from 1879), Kovarra, Toscana, (Bozzolo, 1880). In Africa, we have observations in Egypt. Pruner, Bilharz, Griesinger, &c., have observed the parasite from 1847. The disease was observed already earlier than this. Abyssinia (noticed by Davaine), Senegambia (Moulin, Thaly, Borius), Coast of Guinea (Stormont, Clarke), Zanzibar (Lostalet-Bachee), Mayatte (Monastier). From Asia reports are but few. Hirsch believes that a communication of Day's from Cochin-Ohina refers to it; Davaine mentions cases in India ; L, V. Leens in Borneo. More recent communications come from Japan (Balz and Scheube), as well as from Dutch India (Stammeshans). The communications from America are very numerous. The disease was reported as existing in the southern states of the Union, in Louisiana (Chalbert, 1820 ; Duncan, 1840), in Alabama and Georgia (Lyell, 1849). Numerous reports at various times prove its occurrence in the Large and Small Antilles, as well as in British, French, and Dutch Guiana. Further, we meet with it in North Peru, at Maranon (Castelnan), and in east Bolivia (Salt, 1872). It is very widely spread in Brazil outside the towns, and has been recognised for a long time. The German colonies of Santa Catharina is the most southern point of distribution known to me. I have convinced myself personally of the frequent occurrence of the disease, at the present day, in the provinces of Rio and Sao Paulo. As is seen from the foregoing, the parasite has a wide dis- tribution. If it seems to fail in large stretches of tropical countries, this partly depends on the fact that the disease has not been properly looked for, and mild sporadic cases are easily over- looked, whilst great epidemics are usually attributed to bad hygienic conditions, which are not always present. It seems very improbable that whilst the Appenine peninsula has been infected, that the Pyrenees and Balkan peninsula should be spared ; that Morocco, Algiers, Tunis, Tripolis, Syria, Persia, and Arabia should remain free of it, while countries of the same zone were infected, can scarcely be credited. In India and Japan, which countries appear to have an immunity from the disease, the parasite has been recently proved to exist, and in the latter seems to be very common.* Post-mortem examination, and careful inspection of the fasces among the j^oorer classes of the agricultural population giving negative results, can alone be looked on as evidence of the absence of the parasite, whilst the disease then sets a girdle almost around the earth, it becomes more limited the further we advance from tropical and sub-tropical countries towards the pole. Beyond the latitude 46° N. and 30° S. the disease only occurs under exceptional con- ditions. This proves its connection with climate. On account of the immense intercourse between the countries of the world in modern times, the spread of the disease wherever favourable conditions exist for its development, is an accomplished, or an almost accomplished fact. Among the numerous Italian road workers and vagrants the parasite was not a rarity, and it is most probable that it found its way to Gotthardt through them. Strangers living along time in infected localities probably carry the parasite home with them, and by the distribution of the ova give rise to local epidemics. Fortunately, cold climates afford considerable protection, and good hygienic conditions cut short the disease in many localities. It seems to be diminishing in Egypt, and also in Italy (Gotthardt epidemic excepted), especially in Milan. On the contrary, I have repeatedly observed an advance in the province of Sao Paulo, and that was due to the import of slaves from the northern provinces. * It certainly prevails to an enormous extent in Ceylon, and must have done so for generations. —7'rons. [ 556 ]

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

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