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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![we may obtain, according to E. Parona, the same results by means of small doses, although much slower, such mode of treatment is recommended in severe cases. Strong remedies are more dangerous for such patients than even the continued loss of blood through the parasite. Cases in which the parasite must be immediately expelled are not frequent, and always of uncertain prognosis ; besides, it is to be hoped that these will become rarer in time. It seems that, except in the worst cases, two and a half drachms may be given at once, or in two doses with an interval of two hours. By this procedure less indeed of the drug will be absorbed than by a greater sub-division, as in large doses it causes local irritation and diarrhcea, and is in a great measure carried off in the faeces, which then acquires its peculiar odour. At all events, it is better, in the case of a remedy with such irritating properties, and which, besides, is said to affect the deeper parts of the intestines, to limit the absorption as much as possible.* Whether the drug be given pure or diluted, is indifferent. A mild aperient is given the preceding day. Patients should fast the same evening, and the remedy should be taken on an empty stomach next morning, as in the treatment of tape-worm. In case of failure the treatment may be repeated a few days later. A further repetition is said, in case the drug is good, to be unnecessary as a rule. In the cure with small doses, from one-half to one drachm are given daily on an empty stomach. A special diet is not necessary : only the bowels should move regularly. A good preparation has the advantage of surer success by a tolerably easy mode of use, and even small children may be induced to take it, although with difficulty. The second remedy with which the parasite was completely expelled, is thymol (acidum thymolicum). This was first used by Bozzolo, but again abandoned, because the desired effect was not produced. Later on he resumed the use of the drug, giving it in the following manner. The thymol was powdered, and in from three to six doses, a total quantity of from 30 to 150 grains being given in the day. Some time after taking the medicine a little diluted brandy was given to the patient. By this mode of treatment he was able as early as the beginning of 1881 to report six cases, in which the remedy, without exception, expelled numerous anchylostoma. Soon after this he published a case in which, after the first dose of thymol, 650 worms passed, and the ova disappeared from the stools ; besides, male and female trichocephali were also expelled in two cases. Later on, the cure was so formulated that on the preceding day an aperient was given, and nourishment limited as much as possible. Next day the patient received on the whole 180 grains in six doses, at intervals of two hours, with a little wine or diluted brandy after each dose. This process was repeated after an interval of a few days, and as often as necessary. In 1882 Graziadei, Bozzolo's assistant, was able to publish forty-five cases, in which, by means of thymol, the ova had disappeared from the faeces. Of these, twenty-nine were exclu- sively treated with large doses of thymol. I myself adopted this mode of treatment as soon as I heard of it, and obtained results agreeing in all particulars with those of Graziadei. In all cases where the treatment could be continued long enough a complete elimination of the parasites was effected. Only whilst this result was often obtained after the first— frequently after the second dose of 3 drachms—I was obliged in other cases to repeat the dose four or five times, almost exhausting thus the patience of the patients, and the more so as non- success had already followed other remedies. The severe diet which I then considered necessary forced some to resistance by sheer hunger. Besides, the whole treatment proved too complicated, and the more so as the patients belonged to the lowest ranks of society, and could neither read nor write. As also a certain degree of apathy and want of energy is peculiar to the disease, there was always the danger that the prescription would not be carried out properly, or not at all, endangering the success of the treatment and bringing discredit on the method. It then became necessary to find a surer and less complicated mode of treatment, and I placed the following questions before myself :— 1. Which of the given prescriptions can be omitted without endangering the result, or can be replaced by something more suitable ? 2. Upon what do the greater or less results depend ? 3. How is the cure to be effected at the cheapest rate possible with good results ? The following are the results of my experiments undertaken to solve the above, and which, on account of insufficient control over the patients, extended over two years. Many of these conclusions, the correctness of which I can vouch for, have in other publications found confir- mation :— 1. It did not seem necessary, nor particularly desirable, to favour the solution of the thymol by giving alcoholic fluids after each dose, as increased absorption increased only the subjective symjjtoms, not the therapeutic effects. The effect of the the thymol depended on each individual particle in the form of pulp, or rather suspended in fluid, than dissolved, coming into direct contact with the parasite. 3. Some absorption always takes place, probably in the form of the more easily soluble salts, but a great portion passes through, and in successful cases is not met with in the faaces in such quantities, and is so vf ell distributed that it prevents further development of the ova. 4. There is no reason to suppose that the effect takes place from any portion which has been absorbed. * A valuable addition to our knowledge of the physiological effects of the extract of male fern. But too little stress is laid on this in our textbooks on Materia Medics, iu the handling of such a dangerous drug.—Trans. [ 574 ]](https://iiif.wellcomecollection.org/image/b23982305_0044.jp2/full/800%2C/0/default.jpg)
