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

  • Ceylon. Civil Medical Officer.
Date:
1887
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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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    and children, who cannot be restrained either by commands or punishments. St. Vel relates the case of a black child who, even with his strength failing in death, endeavoured to gratify the miserable craving.* 1 have not been able to satisfy myself that in geophagy there is any particular form of earth chosen, clay and black mould being consumed without distinction. The foot-paths and clay-walls supply very often the material. Some patients lick bricks and bite pieces out of them. That such a habit should conduce to the introduction of fresh parasites is easily understood, but it cannot be granted that geophagy is the primary, anchylostomiasis the secondary disease. Tiie first is rather a symptom of the second, and almost pathognomonic. Alterations and peculiarities of taste also occur in other diseases, as in hysteria and especially in chlorosis and pregnancy. Geophagy may be one of these, only this symptom is much too rare to alter iu any way the practical and important rule, founded on varied experience, viz., that wherever geophagy prevails in localities infested with the anchylostoma, the symptom is in the first place to be regarded as indicative of the presence of the parasite in the intestines. The parasite is only to be regarded as the indirect cause, the anaemic condition as the direct cause of the craving. As far as the geophagy of entire races is concerned {vide Humboldt's Travels j it seems this depends on other conditions, at least in a portion of the cases. The geophagy is limited to certain kinds of earth, and is not accompanied by any symptoms of disease. It is always interesting to know that earthy substances are not quite so disagreeable to the races of nature as they are to our refined palates. Also it would be worth while determining whether this peculiar kind of nourishment does not favour infection with parasites, and whether amongst many races only infected individuals eat earth, which in its turn would favour the idea of the presence of ancholystomiasis. It is most probable that in geophagy hunger plays an important part, as the patients are not always in a position to gratify the craving at all times. The idea of alteration of taste is not always to be overlooked, at least geophagy in other diseases accompanied by ravenous appetite, as for instance diabetes, which even occurs in children, has not, according to my knowledge, been observed. Next to symptorhs of dyspepsia, the most frequent functional disturbance is chronic constipation. This symptom is rarely absent in cases of ordinary intensity and duration, whilst mild and incipient cases show in this respect quite an ordinary function. This constipation is very obstinate, and not easily overcome by drugs, and leads very often to feecal accumulations, which patients often find distressing, and the removal of which gives great relief. Diarrhoea is much less seldom than constipation, and only occurs on the whole in one-third of the cases. Yet only acute attacks occur, and these otherwise common enough. The diarrhoea is of special interest when it occurs frequently, with intervals of constipation. The irregular intestinal function, diarrhoea alternating with constipation, is often observed in this disease. Long continued and intense chronic diarrhoea is extremely rare, and only occur in advanced cases. If some authors assert this as common, as for instance in the Gotthardt epidemic, the reason is that these came across very severe cases. For the organism diarrhoea is accompanied by severe consequences, inasmuch as it runs its course with loss of appetite, whilst chronic constipation is accompanied by an increase in this respect. The faeces, macroscopically, offer nothing characteristic. This is specially the case in the first stages of the disease. Later on they are either dry, or fluid, especially through mixture of undigested food, of mucus, and of blood. The discovery of large quantities of undigested food is the more striking, when a rather slow passage through the intestines must be supposed, as is really the case. In such a case we must suppose the bowels incapable of exhausting the nourishment from the food. Mucus is not only found covering the feeces, but it also occurs in larger and small masses throughout it, aud we are really obliged to suppose an increase of the mucous secretion in the upper parts of the intestines. Blood is either mixed in small quantities with the mucus, or the solid or fluid stools look dark like coffee-grounds, or large quantities of fluid blood may be evacuated, as in the abdominal hgemorrhages of typhoid fever. Hsemorrhages may be easily overlooked, but they betray them- selves when they occur repeatedly, or in large quantities, by the rapidly advancing anaemia. According to most authorities hfemorrhage is a rare occurrence ; yet, according to my experience in a fair number of cases, running a chronic course, but usually at long intervals. They are seldom observed in hospitals, on account of the short stay of the patient there. Patients who use latrines seldom notice the blood in the stools. It is the reverse with those who use the open field, who, either spontaneously, or on being questioned, report the passage of blood in their stools. Seven of the forty patients already referred to asserted that they passed blood during their entire illness, lasting most probably for several years. In three cases I found traces of blood : in one black, solid, or fluid evacuation ; in another cofi'ee-grounds, and in the last a real intestinal haamorrhage had occurred, with the evacuation of fluid blood. In some cases the haemorrhage was referred to haemorrhoids, but none such could be found to exist. Small quantities of blood effused into the upper portion of the intestines are not macroscopi- cally, and sometimes not even microscopically, discernible. Whether the presence of blood can be proved by chemical reagents, remains a matter for future investigation. I have still to mention another peculiarity, viz., the discovery of microscopic crystals of a characteristic form in the fffices. Perroncito was the first to observe these. In his treatise on the disease, he considers their occurrence as constant in anchylostomiasis. Baumler, who at an earlier date found them in the colon, spoke of them as Charcot's crystals. Later on they were noticed by other observers. * A oominon oueiirrence among labourers on the coffee estates u{ C&y\o\\.—Trams. [ .562 ]