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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    12. It was long suspected that beri-beri was due to a parasite. Sir Joseph Fayrer* suggests that a similar hEematozoon to the nematoid embryo found in the blood of persons suffering from chyluria might be the cause of beri-beri. Dr. H, Erni, in his contributions to the beri-beri question,! reports the results of post-mortem examinations made on the bodies of persons who died of beri-beri in Sumatra. The anchylostoma duodenale was found in the upper part of the alimentary canal, and the trichocephalus dispar in the ceecum and colon : he regards them as genuine parasites living at the expense of the blood of their host, and causing exten- sive lesions in the intestinal canal. He remarks :— In more than fifty post-mortem examinations of beri-beri I have never missed these intestinal lesions, whilst they do not occur in patients dead of other diseases. The parasites are indeed to be met with also in such, but without any lesion of the intestine. This makes me assert that beri-beri is helminthiasis, the cause of which is the destructive process in the intestinal canal caused by these parasites. Reflex symptoms arise from the lesions, whilst through the loss of blood and impaired digestion anaemia occurs. This chronic anaemia has, in its turn, a deleterious effect upon the different organs, and degenera- tion of the heart with atony, and dilatation of the blood vessels, particularly of the aorta, result. Finally dropsy supervenes, oedema of the ankles, feet, legs, and face, &c., as well as hydroperi- cardium, less seldom ascites; and death results from oedema of the lungs and paralysis of the heart. Should the patient survive the dropsical stage, general symptoms of atrophy, the atrophic stage, set in. 13. The influence of various intestinal parasites in the production of anaemia has recently claimed much attention ; and I believe it will be found a more successful field of investigation in this condition than the search after bacteria. Herr Runeberg ( Berliner, Klin, Wochenschrift, October 4, 1886) brought forward cases before the meeting of German scientists in support of the view, that the presence in the intestine of the bothriocephalus latus was a cause of pernicious anaemia, and was cured by the exhibition of anthelmintics. Hirsch (Geographical and Historical Pathology ) gives a quotation, that children sent home from Ceylon often have bothriocephali. This parasite is, I believe, unknown in the Colony, which is remarkable, as a large proportion of the population live on fish. 14. The trichocephalus dispar, known as the whip-worm, is found principally in the caecum, often in large numbers. Davaine calculated that one-half the Parisians were infested by it ;| but Oobbold remarks, that clinically its importance by no means corresponds with its prevalence. Mr. Gibson § gives a case of paralysis, with loss of speech, from the intestinal irritation of the trichocephalus dispar, in a female child aged six. After treatment she passed several chamber-vesselsful of trichocephali, with a gradual disappearance of the paralysis. This parasite is common in the bodies examined in Ceylon, and I am inclined to believe its influence in the production of disease has been on the whole under-estimated. 15. There can be no doubt about the deadly effects of the anchylostoma duodenale on the system, when present in large numbers. The disease known as Egyptian chlorosis and the anaemia of the workmen employed in the construction of the St. Gothardt tunnel, and in mines, are caused by the presence of this parasite ; and, in my opinion, anchylostomiasis and the beri-beri of Ceylon are absolutely identical : are, in fact, one and the same disease. |j 16. It is very probable that the benefit derived from the use of the preparations alluded to by Professors Aitken and Maclean, under the names of Oleum Nigrum and Treak Farrook (and of purgatives), in the treatment of beri-beri, is due to their anthelmintic properties, both containing turpentine or some similar drug. ] 7. Anchylostomiasis is the only disease in Ceylon which meets the descriptions of beri- beri. The definitions and description of beri-beri given by Sir Joseph Fayrer in Quain's Dictionary, by Professor Aitken in his Practice of Medicine, and in the classical lectures of Professor Maclean, stand for anchylostomiasis, the word paresis, feebleness or weakness, being substituted for paralysis; and as regards the symptoms, the elaborate treatise of Lutz, translated by Dr. Macdonald (annexed to this report), should leave no doubt in the minds of the most sceptical. 18. Both are most prevalent in the tropics, but may and do develop beyond these regions : both prevail most extensively in seasons characterised by a high degree of atmospheric moisture and temperature : both are most prevalent on the sea-coast and along the banks of great rivers, dampness, wetness, or swampiness being the characteristics of the soil; but there is no connection with malaria. The areas or centres where both prevail are often narrowly circumscribed, while adjoining districts with the same climatic influences escape : both attack bodies of men collected together under bad hygienic conditions, and those of strong physique are equally liable to be attacked with the weak, but those living on innutritions food, or food not corresponding to the metabolisms'and blood-making, or to the needs of the body, such as rice and dried fish,1f suffer the most severely : both are due to the use of bad drinking-water, and both recover if the anaemia has not advanced too far, on leaving the focus of the disease and changing the mode of living, particularly by the use of nutritious blood-forming food : both attack at all ages, but adults and males are more frequently affected than females or very young children ; but the latter frequently suffer when crowded in schools or reformatories with bad sanitary arrangements. In * Beri-beri in Quain's Dictionary of Medicine, page 104. t Berliner U ochenschrift, No. 37, of September 13, 1886. Translated in Appendix. j Quain's Dictionary of Medicine : article on Trichocephalus, by Dr. Cobbold, page 1659. § Lancet, vol. ii. for 1862, page 139. IJ The outbreak of acute ansemic dropsy in Mauritius, reported upon by Dr. Davidson in the Edinburgh Medical Journal for August, 1881 ; and the outbreak of the New disease in Calcutta, recorded by Dr. Macleod in the Indian Medical Gazette, were no doubt anchylostomiasis, or the dropsical form of beri-beri, or the beri- beri of Ceylon. T[ Hirsch's Handbook of Geographical and Historical Pathology, vol. ii. New Sydenham Society edition. [541]