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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    tantus dolar non adsit. Turn etiam vox aliqaando ita impeditur, ut aeger vix articulate loqui possit: qaod mihi ipsi accidit, dum hoc morbo laboranti vocis sonus per integrum mensem tarn exilis esset ut me vel proxime assidentes vix intelligerent.* 8. It will be seen that the Ceylon disease and that described by Bontius are different, the leading symptoms of the latter being paralysis or tremor: in the beri-beri of Ceylon there is no true paralysis nor tremor that I have seen. There are numbness and feebleness of the limbs, and a disinclination to move,—a paresis, or slackening of strength,—but no more : the patient seems to be constantly saying, Let me alone, and I shall be satisfied. And I have no doubt he thinks so. The term beri-beri of Bontius is of Malay origin, and the paralytic symptoms described by him and by Marshallf attacked the Malay soldiers. It is therefore very probable that these men in Ceylon used the word beri-beri as they did in their own country, and it became confused with the beri of the Sinhalese expression of weakness. Herklots, who wrote on the disease in India, derived the term from the Hindustani word bharbari, meaning cedema- tous swelling. 9. On reading descriptions of beri in other countries (the Straits, Japan, Brazil) after the time of Bontius, and comparing them with the Ceylon and Indian disease, the only essential difference is the prominence given to the paralytic symptoms. In the beri-beri of Ceylon, as I have previously stated above, while there is paresis and difficulty of locomotion from weakness and the oedematous condition of the feet and legs, there is no true paralysis. This shall be alluded to again. Dr. Aitkens gives a classification of Dr. Paterson, of Bahia (Brazil), where the disease is prevalent, in which three forms are given :— (1) Where dropsy is the prominent symptom. (2) Where paralysis is the leading feature. (3) The mixed form, where dropsy and paralysis are equally prominent. In Japan, where the disease is known as kake, a distinction is drawn between the dry, or paralytic, and the dropsical, or wet. The latter is essentially the same as the Ceylon disease, and we now know its cause ; but affections in this country where true paralytic symptoms are present, can be resolved into well-known forms of cerebral, spinal, or peripheral paralyses, and I cannot help expressing the belief that the same will be found to be the case in other countries, after careful investigation. 10. The winds known in Ceylon as the long-shore and land wind, which are very dry and disagreeable, and probably at certain times charged with malaria, give rise to rheumatic attacks with partial and temporary loss of power. This was alluded to by Dr. Lind, as quoted by Marshall in his account of the diseases incidental to strangers in different parts of the world. He says :— Barbiers (evidently beri-beri) is a species of palsy, a disease most frequent in India. It distresses chiefly the lower class of Europeans who, when intoxicated with liquor, frequently sleep in the open air exposed to the land winds. Its attack is generally sudden, and entirely deprives the limbs of their motion : sometimes all the extremities of the body are affected; sometimes only part of them. Dr. Macdonald informs me that when he was Port Surgeon of Colombo, sailors frequently complained of similar attacks after sleeping in the open air on deck ; and I was also informed that in our prisons, before the introduction of cots, when the prisoners slept on the cold ground, such attacks were not infrequent. 11. There are at least two principal forms of anaemia included under descriptions of the beri-beri of Ceylon :— (1) That form which is the result of malarial poisoning. There is in such cases a distinct history of attacks of malarial fever, or of residence in a malarial district where such attacks are common in persons using improper or innutritions food. The symptoms are extreme debility, impoverishment of the blood, invariably accompanied by enlargement of the spleen, often followed by dropsy, and rarely by paralysis, which apparently depends on functional disturbance of the spinal cord, is rapidly developed, is intermittent, and quickly disappears by removal from the malarial district and by the administration of anti-malarial remedies. (2) That form with which this paper is mainly concerned, and which depends on the presence in the intestinal canal of parasites, mainly of the anchylostoma duodenale and possibly of the trichocephalus dispar, both nematoid worms, the former occupying the duodenum and upper part of the jegunum, the latter the colon and caecum, both being conveyed into the system by impure drinking-water. The form of anaemia is an oligo-cythaemia, or an oligochromo- cyth^mia, the result of loss of blood. * Jacobi Bontii in Indiis Archiatri de iMedicina Indorum, edito ultima. Parisiis, mdcxlv. (Cap. I.—De paralyseos quadam specie quam Indigenae Beri-Berii vocant.) The tollowinn; will express what Bontius meant :—Men here are afiected with a certain painful disease, called by the natives beri-beri (a word that means sheep). I fancy it is so named from the fact that those it affects walk like sheep, staggering on their knees and raising their thighs. This is a sort of palsy, or rather tremor, for it impairs the moving and feeling powers, not only in the hands and feet, but even sometimes in the whole body, and it occasions trembling The invasion of this malady is in most cases gradual : yet sometimes its attack is sudden Now, the symptoms of this malady are easily observable. First, a sudden sense of weariness comes over the whole body : the power of motion in the hands and feet is impaired, and the sense of feeling blunted, and a tickling sensation is experienced, not unlike to, but less sharp than, the pain felt in our cold climute during winter time in the fingers of both hands and feet ; and lastly, the speaking organs become so impeded, that the patient can hartlly articulate. This happened to myself when suflering with this disease : my voice was so feeble that it could hardly be heard by persons sitting nearby. t Op. cit., page 161, chap. iii. (Of a particular kind of Palsy.) [ 640]