Studies in Japanese "kakké" or beriberi / by Wallace Taylor.

  • Taylor, Wallace W.
Date:
1886
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Licence: Public Domain Mark

Credit: Studies in Japanese "kakké" or beriberi / by Wallace Taylor. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    deranged digestion or complicated with other blood impoverishing diseases. Marked anae- mia in cases of kakke not thus complicated are exceptional, but there is a slight degree of anaemia in most cases of kakke that have continued for some time. III.—Condition of the Circulation. The condition of the circulation is one of the most striking as well as the most important featm-es of kakke. However profound the mus- cular paralysis may be, there is no occasion for alarm so long as the respiratory and circulatory systems are not involved. But in most cases of marked muscular paralysis the respiratory muscles are somewhat weakened, and the cir- culatory system seriously affected. The phe- nomena of Shiyoshin *—which is liable to suddenly occur at any time in any case—is chiefly due to failure of the circulation and respiration, especially the former. I have wit- nessed but few cases of death from kakke where failure of the circulation was not the chief, and in many instances the sole, cause of death. Though these paroxysms of shii/oshin some- times unexpectedly and suddenly occur in mild cases, yet they are generally preceded by a gradual failure of the powers of circulation; and the judicious physician nmst look to the condition of the circulation for the first indica- tion of serious consequence to his patient. For the purpose of more fully studying the cardiac and vascular phenomena occurring in kakke I began a series of observationsf with the Sphygniograph,J and give herewith some * Shiyoshin.—This term as used by the Japan- ese has no pathological signification; they simply mean by it a metastasis of kakke to the chest. The paroxysms of ShiyosJiin bear some resemblance to an acute attack of A ngina ])ector 'm. There is great distress in the chest, accompanied by marked dysp- noea, and failure of the powers of circulation. The action of the heart is sometimes rapid and violent, and again it is calm and quiet. But whatever be the character of the heart's action, the increased fee- bleness of the pulse and increased blueness of the extremities show a marked diminution of circulatory power. These paroxysms are almost invariably the precursors of a fatal termination. The patient not infrequently dies in the first paroxysm; he may lin- ger, however, a few days, the paroxysms growing more and more frequent and severe till death ends the distressing scene. f A full report of these obserA'ations are published in the Toltei Medical Journal, 1885-6. I The tracings here given were taken with Marey's Sphygmograph, improved by Mahomed; and the rate of travel by the slide bearing the card was from II to 12 em. in 10 seconds. Pond's instrument, fur- nished me, exaggerated slight deviations from the normal, and could not be used where precision was required. The tracings taken with this instrument and here given are so designated. of the cases with the tracings taken during the summers of 1883 and 84. In the description given of these cases I confine myself to a statement of those symp- toms which have a bearing upon the circulation, 1.—Slight Cardiac Debility. Case 1. K.— Male, act. 31.* Patient is of strong constitution, has now been ill with kakke 40 days. He suffers chief- ly in the legs. He can squat and rise up with difficulty, and by an effort can stand on tip-toe. He can walk a short distance with comfort, but if he attempts to walk fast, or any distance, he suffers from palpitation of the heart and is compelled to stop. Condition of blood. Table III.—No. 45. Dynamometer, R.H. 110 (outer circle). L.H. 102 Resp..26. Pulse, 82. The pulse feels soft yet it is somewhat incompressil^le. and its stroke partakes somewhat of the water-hammer character. It is not weakened if the arm is elevated above the head. The aortic and pul- monary valve sounds are normal; so also are the other heart sounds. Tracing 1. (See tracings at end of book). These tracings were taken with the patient sitting by a table. Pressure of each, 2 oz. After the upper tracing was taken, the patient walked around the square, and came back short of breath, saying he was suffering from palpi- tation of the heart. The second tracing was at once taken, but shows but little change from the first. The dyspnoea and cardiac palpitation which this man suffered on slight exertion indicated some weakness of the heart, but the sphygmo- graphic tracings show that the heart is not seriously affected. Case 2. I.—T. Male, act. 35. This patient is of average constitution, and has been ill with kakke for 15 days. He has a pale, waxy countenance, with some pigmen- tation, and appears feeble, but says he is in no distress. He walks across the room imper- fectly with a staggering gait. He cannot squat down, nor rise up, nor stand on tip-toe, nor even raise his heels from the floor in the effort. Condition of blood, Table III.—No. 33. Dynm. R.H. 60, L.H. 50. Pulse, standing, 70; after walking acrosB the room, 80. Resp. 16. The pulse feels full * See Addenda,—Age.