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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![which is followed by complete and permanent recovery, as the only successful and suitable treatment. Malaria is another complication frequently met with. Both diseases are connected with water or moist soil, and very often the same district contains the germs of both diseases. Anchylostomiasis has been, in consequence, often mistaken for malaria cachexia, although neither the symptoms nor the local distributioa correspond. In Brazil I had occasion to treat successfully with quinine some cases of intermittent fever in patients suffering at the same time from anchylostomiasis. Should such patients be seen during the acme of the fever, pallor, otherwise very marked, may escape notice. The frequency of coincidence of the two diseases was not striking, considering the wide distribution of malaria. Struma is a much more frequent complication. Apart from the occurrence of anchylosto- miasis in a strumous individual, it often seemed to occur in an endemic form in the same localities. Complications with other intestinal parasites are frequently observed. These compli- cations were frequent in Italy by the presence of the ascaris, trichocephalus, and the rhabdomena (anguillula) of man. I observed the same thing in Brazil, where in fifty cases of anchylostoma only ten were found free from other parasites. In the remaining forty cases trichocephalus were found in eighteen, rhabdomena strongyloides in twenty-five, and ascaris in thirty. The whole four were found present in six cases. The ascaris and trichocephalus were numerically much smaller than the anchylostoma. This does not apply to the rhabdomena. The two last complications are usually of no consequence to the patient, and are as amenable to treatment as if these alone were present. Further observations are required to describe exactly the third group of complications. I mention a few, which probably belong to the group. In the first place, a frequent catarrh of the respiratory organs, with a tendency to chronicity ; it might be regarded as the result of dis- ordered circulation, and be placed under the first category. In the second place, I mention pulmonary tuberculosis, the frequent occurrence of which in anchylostomiasis has been noted by several authors. The anaemia is most probably here the predisposing cause. In one very pro- nounced case of my own, the lung process came to a standstill after the expulsion of the parasite, and apparent recovery took place. Farther, I frequently observed attacks of epilepsy occurring in anchylostomiasis, and it seems to me the latter predisposes to the former. By expulsion of the worms and removal of the anaemia the attacks became less and less rare, yet there was no definite cure. I also soon lost sight of the patients. In some cases ulcers, chronic in character, and with a tendency to spread, healed up rapidly after expulsion of the worm, followed by suitable internal remedies. The fourth group of complications extends over the whole field of pathology. Of interest, however, are specially the processes which are distinguished by frequency, similarity with the disease itself, or by running a modified course. Hitherto, few of those have been observed, as sero-fibrinous pleuritis in Turin, with three cases of death (Bozzolo), and among the Gotthardt labourers frequently anthracosis pulmonum, and a limited number of cases of pellagra. From my own observations I can mention t.wo cases of arthritis rheumatica, the one acute and easily cured, the other more chronic and accompanied by changes in the heart, which were more probably to be ascribed to the complication than to the disease itself. In another case, carcinoma of the uterus existed with the anchylostomiasis, which alone sufficiently accounted for the anaemia. The patient, a negress, complained of nothing locally, and the cancer was only found when the anaemia would not yield to ordinary treatment. Of other heemorrhages which naturally influence directly the course of the disease, I have often observed epistaxis in a young person with cardiac hypertrophy. Besides this, I have never noticed an increased tendency to haemorrhage. St. Vel asserts that in operations many ligatures are required, but this may be explained by existing cardiac hypertrophy. In an amputation below the elbow I found the hEemorrhage extremely small in a young person suffering from anchylostomiasis. In this case a high degree of anaemia existed, with a small fast pulse, but no heart enlargement. The case ran its course without fever, notwithstanding which small necroses appeared along the margins of the wound, which cicatrised very slowly. We may now discuss the differential diagnosis of anchylostomiasis shortly, as so much has already been said. It is true that there are many pathological processes which have the greatest resemblance to the several forms and stages of this disease, yet a careful examination will almost make a mistakeimpossible. Ifit be onlya question of purely local symptoms,then the microscopical examination of the faeces must decide the point; the presence or absence of the ascaris lumbri- coides can be shown at the same time, as the latter, when very numerous, cause similar symptoms. The history of the case will exclude chronic gastric catarrh (especially alcoholismus), ulcer, and carcinoma ventriculi, &c. When valvular insufficiency is present, the diagnosis between func- tional insuflSciency and defective valves may be difficult. Should the pulmonary and aortic valves be normal in a case with a high degree of anaemia, and should there be no history of polyarthritis rheumatica in particular, the assumption is in favour of functional disorder. Recovery decides the matter finally. Chlorosis and anchylostomiasis of an average degree have the greatest resemblance to each other, but have quite a different distribution. The former is rare in tropical climates (especially in Brazil), affects the more highly-cultivated localities and towns especially, and in these again females during the period of development, whilst anchylostomiasis affects the working 77—87 [ 671 ]](https://iiif.wellcomecollection.org/image/b23982305_0041.jp2/full/800%2C/0/default.jpg)
