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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    On careful examination these pains are found to be situated in the muscles, especially the muscles of the extremities, and the lumbar and intercostal muscles. They occur after any exertion, and are transient in character, even in high degrees of the disease. I consider them, therefore, as mere expressions of exhaustion. In two extreme cases I found the bones painful on palpation and percussion. This symptom occurs also in pernicious anaemia. With this I conclude the description of the symptoms peculiar to the disease. In this respect, however, much remains yet to be done. On the whole, these agree with the pathological changes, and give us some insight into this many-sided disease. The symptoms of anchlostomiasis have been discussed one by one, and we may now attempt to explain their origin and mode of onset. It must be clearly understood that the disease varies extraordinarily in the duration of its development, the degree to which it may attain, and the extent of its effects, whilst the organism attacked shows varying degrees of resistance according to age, constitution, and other conditions, chiefly the state of nutrition. On this account the course is always irregular atypical, and it requires a careful observer to distinguish the more accidental variations from the results of suitable treatment. In general, we may divide the disease into two forms, one more or less acute, and the other more or less chronic. The term acute is certainly to be applied here, not in the same sense as in the infectious diseases. Acute cases are those in which the disease has run through its several stages in the course of some months, without, during that time, becoming stationary at any one period or showing any distinct remissions. Chronic cases, on the other hand, are cases in which the disease has extended ever several years (sometimes from ten to twenty years). In such cases the disease frequently shows remissions and exacerbations, and occasionally becomes stationary. The Gotthardt tunnel epidemic ran a tolerably acute course ; some cases were very acute. E. Parona mentions a case in which the patient acquired 1,250 anchylostoraa within two months. Many of these cases, it is true, became afterwards chronic. Among the natives of the locality, on the other hand, the disease on an average runs a chronic course. Twenty cases are exactly recorded, in which the average duration from the first appearance of grave symptoms was four years. From this may be explained many symptoms which I frequently observed, but which were rare in the Gotthardt epidemic. Should the patient on exposure to infection be slow in acquiring the disease, the number of the anchylostoma may, for a considerable time, be limited, and their presence give rise to do symptom whatever. I have often found in the faeces of children the ova of anchylostoma, whilst searching for those of the ascaris, without any suspicion of the presence of the former. This discovery was rare in adults. In other case the presence of the anchylostoma was Buspected from the local symptoms alone, whilst as yet no general symptoms were observable. As the disease advanced the local symptoms became more pronounced. Yet there are cases in which the patients complained of nothing locally, even in advanced stages of the disease. Should the patient be weakened by other causes, the general symptoms appear comparatively early, and which are not due to the parasite alone. It may be said that adults, in the absence of any com- plication, and in whom the disease runs a tolerably quick and uniform course, do not begin to show symptoms until the number of anchylostoma passes into the hundreds, so that when pronounced general symptoms are present three to five hundred parasites may be set down as present in the duodenum. In severe cases I have not found them over a thousand present, but in the Gotthardt epidemic two and even three thousand were found. Of the general symptoms, the first to appear are palpitation and a feeling of weariness, often comparatively early before any trace of anajmia is observable. Yet these symptoms must be referred to impoverished blood, as can be proved by careful examination of the latter. Inspection alone detects changes in the blood only when these have already attained to a high degree. The constituents of the blood principally affected are the red blood corpuscles, the regeneration of which first ceases to keep pace with the constant small losses occurring in the duodenum. Although there is no direct proof, yet clinical facts speak in favour of the regeneration of the plasma occurring much more easily, and remaining much longer in a satisfactory condition. We have, therefore, to do in the first place with pure oligocy- thsemia or oligochromocythaemia. (The average duration of life of each individual blood corpuscle is lowered, and it may be reasonably inferred from that that the haemoglobin is diminished in quantity, and that a com- parative oligochromsemia must exist. There is no satisfactory proof of this as yet; on the contrary, the observations hitherto made speak against the occurrence of higher degrees.) So long as the disease remains at this stage, it has the greatest resemblance to chlorosis, on which account it has received the name Egyptian, or Tropical, chlorosis ; and as in chlorosis, in spite of the extreme discoloration, mostly neither deep-lying lesions nor threatening symptoms are present, so also in this disease the pallor may become extreme without the patient becoming bedridden. It is true that every exertion of the patient causes palpitation, dyspnoea, and lassitude. Giddiness and fainting-fits have been observed, but, with the exception of the gastric symptoms, the patient scarcely suffers, and his nutrition continues fairly satisfactory. Should the blood losses still continue, the regeneration of the blood plasma begins finally to sulfer ('principally in consequence of diminished absorption), and a certain degree of hydrtemia appears. The latter is betrayed by the occurrence of oedema, without the occurrence of any cardiac anomaly, except increased action. In cases running a more chronic course, striking changes are frequently met with in the heart, as hypertrophy and dilatation. A causation for the development of these changes seems to me to be found in the fact that individuals so affected were strong, and the anajmia developed itself slowly, attaining even a moderate degree after a comparatively long period, and allowing [ 568 ]
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