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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![III.—Dkopsical Stage. (a) Acute Foem. (6) Chronic Form. A high degree of anaemia. Pulse small, much Symptons of cardiac defects with disturbed com- incrensed in frequency. No blowing murmurs. pensatinn, or of fatty degeneration. Distinct symp- CEdema of a hydremic character. tnms of c\anosis. I )ropsy of engorgement. Anaemia of varying intensity. Disordered nutrition. It depends on numerous conditions which stages of the disease are developed, and in what manner these succeed each other. Ceteris paribus, the number of parasites present give the indication. These may develop slowly or quickly, or almost remain stationary, the number thrown off being exactly replaced. Finally, the parasites may gradually or quickly diminish in numbers. Should a constant increase occur, the disease will run with a corresponding speed through all the stages of the acute or chronic form, and finally end in death. Should, on the other hand, the parasites gradually diminish in numbers, the disease will gradually disappear, and may cease in its manifestations before all the parasites are dead. This often occurs when the patient removes from the infected locality;—hence the much-praised effects of change of air mentioned by many authors. It were more correct to designate it change of water and employment. The same results are obtained under good hygienic conditions. Such spontaneous cures have been observed by various authors, and numerous examples have occurred in my own experience in Brazil. Inexact observers always ascribe these cases to some mode of treatment, although such treatment in very many cases has otherwise proved ineffectual. Such a process of recovery is however very slow, and may take many months, nay even years. Spontaneous cure may not, however, take place at all even after the parasites have all disappeared. This is specially true of the chronic cases of the disease, when the cardiac cachexia has set in, and the patient is already advanced in life. The cardiac degeneration and the chronic gastric catarrh have then become an independent disease, which, on account of disordered circu- lation and nutrition, prevent recovery. Such cases, in which the patients finally succumb to the disease, may on post-mortem examination show few or no parasites at all. Such cases are by no means rare, and have mostly contributed to make the etiological connection between the parasite and the disease obscure. It is therefore the more necessary to emphasise the occurrence of a cachexia as the resi- duum of an anchylostomiasis, which has run its course, as authors have only spoken of it hitherto indefinitely. It is characterised by the fact that there is never a question of simple anaemia, but that disordered nutrition and circulation are constantly present, and are often the most prominent symptoms. Should the number of parasites remain approximately the same, the stage of the disease may remain the same for a considerable time; still there is always a slow tendency for the worse, as soon as the first stages are passed, because the losses occur in an organism less and less able to tolerate them. On this account, after a comparatively sudden infection, notwithstanding removal from the infected locality, an increase of the symptoms has been observed for a con- siderable time, as, for instance, was the case in the Gotthardt epidemic. Here the number of the parasites may be considered as unchanged, inasmuch as the infection was probably caused by young and active worms. From what has been said, it follows that it is impossible from the stage of the disease to make any estimation of the number of parasites, especially if the disease has already existed for some time. Besides the various resistances, which diminish with increasing years, as well as the varying conditions of nutrition, there is yet a cause which has a prominent position in the disease, and that is the complications which are seldom long absent. The complications observed in anchylostomiasis may be brought under four categories : — (1) They are directly connected with the cause. (2) They originate under the influences of the same hygienic conditions. . (3) Their development is favoured by the existing disease. (4) Their coincidence with anchylostomiasis is purely accidental. Should important functions suffer under the influence of these complications, the disease becomes worse. Should the complication be curable and of short duration, the disease may gradually return again to its original state, which here is tantamount to complete reconvalescence. The changed conditions make, however, very often the restoration of the statu quo ante impossible, and the result is an increase of the symptoms of the disease. In severe and incurable affections the existing anchylostomiasis may be a secondary disease, or both may be so combined, forming a complete whole, that either the one or the other may elude the observer. It is of the utmost consequence here to recognise the anchylostomiasis, as it is usually easily cured, and leave the field clear for the treatment of the other. The first group of complications has been already partly mentioned with the symptoms, such as dilatation of the stomach and circumscribed peritonitis. I emphasise only two here, on account of their frequency and their injurious effects, viz., diarrhoea and enteric haemorrhage. Both increase the anfemia. Severe enterorrhagia does this in the most rapid manner, so that on any sudden increase of the anaamia this fact must be kept in view. Should the process cease spontaneously, or in consequence of suitable treatment, the ansemic condition rapidly im[)roves. Even favourable results are obtained with indifferent treatment. The experienced physi- cian knows that these sudden changes form a part of the disease, and he looks on the treatment [ 570]](https://iiif.wellcomecollection.org/image/b23982305_0040.jp2/full/800%2C/0/default.jpg)
