Report on anaemia, or beri-beri, of Ceylon / by W.R. Kynsey.
- Ceylon. Civil Medical Officer.
- Date:
- 1887
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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![the patient to go about his daily duties. It is of coarse understood that the nourishment of the patient kept pace with the increasing requirements. I liave most frequently found these changes in strong adults, with a moderate degree of anaemia, and in boys, but never in small children. These symptoms are, at all events, the most striking symptoms of anchylostomiasis, and seem scarcely in unison with the facts hitherto observed. CausativeJy we can connect them at all events with the existing aneemic (or oligocythtemic) condition. The latter is the result of successive small blood losses ; and we are forced to the new but striking conclusion, that through these in fact hypertrophy is caused. On closer examination, however, these results lose somewhat, and cannot be reconciled with other well-known facts. This symptom seems to me to belong in the category of the so-called spontaneous cardiac hypertrophies, which occurs in mountain-climbers and in men engaged in heavy employments. Under the influence of strong exertion the heart must perform increased labour to satisfy the claims made on the blood circulation, and this finds expression in the strength and frequency of the contractions. This seldom occurs in the normal heart with a normal blood circulation, as slight hindrances scarcely cause increased activity ; but, on the other hand, under pathological conditions even slight exertions are followed by the same results as heavy exertions in the normal state. The blood need not lose its capacity to nourish the tissues, although its corpuscles are numerically diminished, but to attain the same effects with diminished corpuscles all the reserve power of the heart must be brought into play. The patient who continues to perform his ordinary work finds himself constantly in the position of a man who makes constant demands on the circulation, and it is this increased effort which, as daily experience teaches, leads to hypertrophy and dilatation. The inefficient closure of the valve, which is met with in almost the half of the more pro- nounced cases, is quite another symptom, and may occur in the apparently normal as well as in the hypertrophfed heart. It belongs usually to a later stage. Its mildest grades are well enough known in other ansemic conditions, and in chlorosis the higher grades have been sometimes observed. In the former cases, when onl}' a slight blowing sound is present, the effects on the circulation is scarcely noticeable. It is otherwise in those cases in which the murmurs are scarcely to be distinguished in quality from those of valvular inefficiency. Here the same secondary changes are observed as in valvular defects, only modified to a more or less extent by the existing anaemia. For instance, the cyanotic coloration is never so pronounced as when the blood is normal. On the other hand, the hypertrophy of the left ventricle and of the right half of the heart is developed often in atypical manner. The pulse assumes the same peculiarities as in mitral deficiency, and in time dropsy supervenes, when the anaemia is not so pronounced as to account for this symptom. The course and termination are the same as in genuine valvular diseases, and death may result from cardiac insufficiency, haemorrhagic infarcts, or dropsy. On the other hand, the affection is not only amenable to the same treatment, but also, the cause being once removed, complete recovery is possible. This recovery as well as the results of pathological anatomy prove that there is no loss of substance in the valves. There remain to us only two ways in which to explain the defective closure of the valve. The first and the more rational supposes a deficient contraction of the papillary muscles to exist in consequence of fatty or some otlier degeneration, and that in consequence the valves are not properly adjusted, but allow regurgitation into the auricle. The second supposes that in consequence of dilatation the valves are no longer able to close the orifice. This may indeed be the case in secondary tricuspid insufficiency. The symptoms of cardiac degeneration and insufficiency may appear without any previous functional valvular insufficiency. The causes seem to be advanced age, long duration, a high degree of anaemia, or the rapid occurrence of the highest degrees of same. Very often the premature appearance of the arcus senilis points to the existence of a similar process in the heart. With or without the existence of valvular insufficiency, a regular cardiac cachexia may set in accompanied by extreme emaciation and various functional disorders. The gastric catarrh, occurring constantly in the advanced stages of the disease, and leading in its train loss of appetite, diarrhoea, and imperfect absorption, helps to bring about emaciation. This symptom, as well as the chronic pulmonary catarrh which occasionally exists, and the still rarer albuminuria, are partly the results of passive engorgement of the tissues in question. We may now, after what has been said, decide anchylostomiasis into a number of forms and stages for the purposes of realising at once the condition of individual cases. Such a division has of course something artifical about it, as transition stages always exists. I.—Stage of Pukely Local Symptoms. (a) AcDTE FoEM.* I (b) Cheonic Foem.* II.—Stage of Simple Anemia, oe Oligocythemia. (Chlobotic Stage). (a) Acute Form. 1. —Slight Degree. Conjunctival vessels still visible. Nails and lips pale red. Pulse increased in frequency. No blowing murmurs over cardiac area. 2. —Higher Degree. Conjunctiva devoid of vessels. Nails whitish. Lips pale. Pulse frequency very much increased. No blowing murmurs. (&) Cheonic Fobm. Anaemia which has not reached the highest degree. In many cases distinct cardiac hypertrophy and dilatation ; ia other cases disordered valve closure, seldom both combined. Moderate increase of frequency of pulse. * The symptons are in both forms the same. The presence of the disease is only betrayed by pain and disordered digestion. There is no pallor, and the pulse is normal. [ 569 ]](https://iiif.wellcomecollection.org/image/b23982305_0039.jp2/full/800%2C/0/default.jpg)
