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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    blood corpuscles are constantly and greatly diminished in number. In various patients they were reduced to a quarter and to one-sixth the normal, and in one case of Bareggi they were reduced to two-seventeenths. As a rule, the reduction is oue-teiith. The hsemaglobin, as far as I can learn from the literature of the subject, seems to diminish in the same ratio, so that no peculiar ohgochromeemia occurs with the oligocythaeraia. The ratio between the white and red cor- puscles seems to persist for a long time, but ultimately the former become comparatively more numerous, without, however, any actual increase in their number, the actual number present being in fact considerably under the normal. No striking or characteristic changes in the sense of mikrocytose, or poikilocytose,* occur in the blood corpuscles in anchylostomiasis, but there is here a field for further study. Some authors describe flakes of pigment as met with in the blood, and I also have seen such, but in my cases a complication, viz., malaria, existed. As for the volume of the blood and of its individual constituents, further and prolonged examination is still required to determine the changes these undergo. The property of coagulability is retained even in the most advanced stages of the antemia. I must still mention one symptom connected with the circulation before leaving the subject—i.e., the occurrence of dropsy. This symptom occurs in a large number of the cases to a more or less degree, and serves as an index of the gravity of the case. The most frequent forms of this dropsy are oedema of the eyelids and of the cbeeks, as well as anasarca of the extremities. (Edema of the face appears early, and gives the patient a peculiarly characteristic appearance. In the more advanced form the impression of the teeth is visible on the mucoua membrane of the cheeks. (Edema of the eyelids occurs at the same time as that of the cheeks, and both eyelids add cheeks appear more swollen in the early morning. (Edema of the extremities appears principally on the dorsum of the hands and feet. Later on the calves of the legs become oedematous, then the abdominal walls, and finally the skin of the back and of the arms. The oedema remains as a rule moderate in amount, but in severe cases it may acquire great dimensions. In such cases the cavities of the body become dropsical, as the abdomen and thorax (ascites and hydrothorax). In rare cases symptoms supervene pointing to oedema of the brain. I must mention here yet a rare symptom, and one not hitherto pointed out, and which I look upon as localised dropsy, i.e., chemosis conjunctivje without any eye affection. This symp- tom occurred in three out of 250 cases seen by me. It affected specially the fold, and was constantly accompanied by oedema elsewhere. The remaining symptoms are all more or less the direct result of the anaemia itself. To this class belong the giddiness of which the patients so frequently complain, especially when they bend down, and which is accompanied by dimness of vision. Further, the patients complain of being wearied and sleepy. They are, as a rule, apathetic, &c., and inclined to shiver. To these may be added formication, numbness, &c., in the extremities. There is no change in the organs of respiration. The breathing keeps pace with the heart's action, and is more or less increased. The sliglitest exertion increases the frequency of the respiration, to a degree of dyspnoea, usually accompanied by palpitation. The temperature in mild cases remains normal : in severe cases it is somewhat abnormal, on an average about one-tenth of a degree. Authors mention, however, the occurrence of occasional rises of temperature, as in pernicious anfemia. This fever may be looked upon as anaemic fever, only when inflammatory processes in the bowels or lungs can be excluded. These feverish attacks, which occur most frequently during the night, account for the perspiration and thirst of which the patients occasionally complain. Otherwise the skin is dry as the sebaceous follicles, and sweat glands by normal temperature act but feebly. The quantity, colour, and specific gravity of the urine remain apparently normal. Albumen is met with only exceptionally, and then in very small quantities, but is usually absent even in the severest cases. Should the circulation begin to fail, the urine becomes small in quantity and dark in colour, as in valvular disease of the heart, where the compensation begins to give way. A high degree of anaemia leads, in men, to impotency, in women to amenorrhasa. Con- ception only takes place in mild forms, and pregnancy is always accompanied by danger. If carried to maturity, the children are poor and atrophic. If children suffer from anchylostomiasis for years, during the developmental period, this development is retarded, so much so that at twenty-five years of age they look like children of ten or twelve. The period of puberty is considerably delayed by several years. The development of tone is retarded, and the whole type remains that of a child. Although the disease in mild as well as in severe cases causes no disturbance of the general nutrition, yet long duration and advanced stages cause malnutrition, so that the patient begins to look emaciated. The panniculus adiposus begins to disappear, but only to a moderate degree, so long as the appetite is good, unless persistent diarrhoea sets in. Some sensations of pain are still to be mentioned, which are to be considered less as the symptoms of a local affection than as the result of the general condition. Of these, the headaches, of which most patients complain, take the first place. These headaches have nothing characteristic either in respect of locality, intensity, or duration. They are not to be explained in any other way than that they are the result of the anaemic condition. It is otherwise with certain forms of pain, occurring now here, now there, in the trunk and extremities, and which have been described, erroneously as I believe, by some authors as neuralgias * I have left these words as they stand in the original. Their derivation explains their meaning. Microcytose is derived from fiucpog kvtoq; poikilocytose ironi ttoikiKoq kvtos.— Trans. 77—87 ' [ 567 ]
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