Show simple item record

dc.contributor.authorBanton, Arnold Howarden
dc.date.accessioned2018-01-31T11:16:57Z
dc.date.available2018-01-31T11:16:57Z
dc.date.issued1948en
dc.identifier.urihttp://hdl.handle.net/1842/26220
dc.description.abstracten
dc.description.abstractThis study of Mediterranean Anaemia was made between July 1946 and March 1947, while I was serving as a Graded Physician in the R.A.M.C. in Cyprus. By way of introduction some features of conditions in Cyprus will be discussed, so that the problem there may be viewed in its natural perspective.en
dc.description.abstractThe existence of Mediterranean Anaemia in Cyprus has only been recognised in recent years. Arabantinos (1936) mentioned that he had seen cases from Cyprus, and two of the children described by Caffey (1937) were of Cypriot parentage. But in the island itself Fawdry, a District Medical Officer in the Colonial Government Medical Services, was the first to draw attention to the condition. He published a report on the subject in 1944. Up till then the condition had always been regarded as chronic malaria, despite the absence of parasites in the blood films and the failure of quinine therapy. The local medical practitioners are mostly Greek trained and, as pointed out later in this thesis, the Greek medical schools have been strong protagonists of malaria as the etiological factor. From conversation with local doctors it was clear that many still held these views. In the main, however, the Government Medical Department has enlightened medical opinion throughout the island, and it is now realised that far from being a rarity, this disease is very common. It is interesting to record that a technician working in one of the Government hospitals told me that he frequently saw target cells when he was examining blood films, but that per se he did not regard them as abnormal. The technician in question was a most able and competent worker, but he was not familiar with the trait of the disease. In view of what is subsequently said about the trait, this is an example of the adage that 'familiarity breeds contempt.' I was first introduced to the condition by Fawdry, and I must acknowledge the encouragement and guidance I received from him when I embarked on investigating the condition myself.en
dc.description.abstractThe area of the island is 3,572 square miles, and the population is about 400,000 - roughly the same population as in Edinburgh. About three - quarters of the population are Greek Cypriots, and belong to the Greek Orthodox Church. About one -fifth are Turks of the Moslem faith. These are a remnant of the era when the Turks ruled Cyprus. There are also a few Armenians, a small British community, and scattered fatilies of other races, but all these comprise only a small percentage. The different sects live together quite harmoniously, though they keep much to themselves.en
dc.description.abstractMarriages between Greek and Turk are uncommon, but do take place. These points are important when one considers the hereditary aspect of Mediterranean Anaemia. Cyprus was an ideal place to study problems of heredity, since being a small island, relatives of patients were often quite easily available. In many cases whole families were located in the same village, and often in the same house. Life in Cyprus was very simple - in the country it had progressed little from Bible times - and the majority of the populace were subjected to the same environmental factors, and these had remained unchanged for very many generations.en
dc.description.abstractThe people themselves were friendly and co- operative. The Cypriots are a simple race, and though near the gateway of the East, are essentially European in their outlook. Their education is limited, and their intelligence below average judged by our standards. Often they did not know their own ages, and they would give different answers if questions were repeated. This made case, history taking difficult, and accordingly details of events, particularly those happening years previously, were unreliable. In particular, I found it difficult to obtain details of family histories. Mothers often could not remember how many children they had had, and remembering miscarriages was usually quite beyond them. They were also less observant of symptoms than mothers in this country, and they would pass as normal, children which most mothers here would recognise as unwell. They were, however, most co- operative in allowing me to make my investigations. Perhaps their generosity in this respect should be recognised even further, since it is a popular belief in the island that all blood examinaations have something to do with syphillis. Only in the third family which I recorded did I meet with opposition to my examining their blood. In this instance two sisters refused on the grounds that they were pregnant, and they believed that venepuncture would affect them adversely. I must acknowledge the enthusiasm and persuasive powers of my interpreter, whose helpwas invaluable. It was perhaps as well that I did not know some of the things he told my victims!en
dc.description.abstractCertain diseases peculiar to the island are worthy of mention. As a result of an energetic Anopheles Eradication Scheme by the Government Medical Department, malaria is no longer a major problem, and the decline in its incidence is likely to continue. Hydatid disease is common and must be considered in the differential diagnosis of any tumour. In my nine months stay in Cyprus I saw hydatids affecting the liver, spleen, lung, kidney, thyroid and a coronary artery. Typhoid fever is endemic, particularly in the villages where sanitation is poor. Bacillary dysentery is common, and shows a normal seasonal increase. It has, however, a lower incidence than elsewhere in the Middle East, probably because Cyprus is cleaner than the majority of places in that area. Amoebic dysentery is not seen.en
dc.description.abstract. Some interesting facts emerge regarding blood diseases other than Mediterranean Anaemia. Fawdry (1944) reviewed this problem, but other facts have come to light since his article was written. Idiopathic hypo - chromic anaemia, as we know it in this country, is never seen in Cyprus. In my stay there I never saw an example of koilonychia. Though the people are very poor, they live on the land, and apparently their diet is more adequate than that of the poorer classes in this country. The absence of this form of anaemia was fortunate in view of the similarities of the blood picture in this condition, and in Mediterranean Anaemia. In particular it would have complicated the detection of the trait of the disease. Fawdry records having seen cases of nutritional megalocytic anaemia, but I did not have the opportunity of seeing any such cases while I was on the island. A point of considerable interest is that he never saw a case of acholuric jaundice in all the seven years he was in Cyprus, despite the fact that specifically he was interested in blood disorders, and was on the look out for this condition. It may well be that since this disease, like Mediterranean Anaemia, is the result of a genetic mutation, the chance occurrence of one disease renders the other disease less likely. Haemolytic Anaemias of the allergic type are also seen. These result from sensitivity to certain beans. Cases are seen in the spring when there are flowers, and are presumably due to pollen sensitivity, and also in late summer when the beans have developed. I saw two cases in March 1947.en
dc.description.abstractThe investigations carried out in this study were essentially of the simplest nature. Technical assistance was limited and often had to be dispensed with owing to inaccuracy. No facilities were available for biochemical analysis. There are very many interesting problems connected with this disease which require the services of a biochemist. Such investigations may help to elucidate some of the obscure problems of iron metabolism, and also in the final issue, I feel that the etiology of Mediterranean Anaemia may have a biochemical basis.en
dc.description.abstractBefore describing cases of the disease a short introduction to the disease must first be given. It was first recognised by Cooley and Lee in 1925, though 1927 is usually accepted as the date when Cooley first described the condition as a clinical entity. He separated it from Von Jaksch's Anaemia with which it was originally confused. Cooley's name has often been associated with the condition, and there have been other synonyms. In view of the haematological response Cooley himself called the condition Erythroblastic Anaemia, but this term leads to confusion with other anaemias in which an erythroblastic reaction occurs. Whipple and Bradford (1936) called the condition Mediterranean Disease or Thalassaemia. This recognised that anaemia may be only one of the features of the disease and not the fundamental abnormality. Both the terms Mediterranean Disease and Mediterranean Anaemia are in common use.Thalassaemia has recently become popular, particularly in America. Lovel (1947) has pointed out that this is unfortunate, since ' Thalassa' is Greek for the sea and refers to the Mediterranean, and a literal translation means that the patient has the Mediterranean in his blood. This leaves the purists in no doubt as to why he should be anaemic! Damashek (1940) introduced the term Target Cell Anaemia, but this is unsatisfactory, since target cells are found in other conditions as well as in Mediterranean Anaemia.en
dc.description.abstractAn accurate definition of what constitutes the disease has not been given in the literature. There is in fact a gradual gradation from the trait not showing any anaemia, through the mild form of the disease, compatible with adult life, to the severe form of the disease, fatal in infancy. Clearly any distinction between one form and another is purely arbitrary. The terms Thalassaemia major and minor have been used to differentiate between the severe and mild forms of the disease. Classification is considered in greater detail under the heading of symptomatology.en
dc.description.abstractIn this thesis the following plan has been adopted. Fourteen cases of Mediterranean Anaemia together with haematological studies of their relatives are recorded. Examples of the trait of the disease are given and then the symptomatology and haematology of both the disease and the trait are discussed. A separate section is devoted to the radiological appearances. The results of investigations to determine the incidence of the trait of the disease in Cyprus are then recorded, and their significance is discussed. The results of a village survey are given to show how the trait may affect an isolated community. Various aspects of the etiology are next considered: the incidence of the disease in Cyprus, the defect in the erythrocyte, the development of the disease and finally the possible causes of the condition. The hereditary problem is considered in detail. Diagnosis, treatment and prognosis are dealt with in general terms, and a summary of the essential points concludes the thesis.en
dc.publisherThe University of Edinburghen
dc.relation.isreferencedbyen
dc.subjectAnnexe Thesis Digitisation Project 2017 Block 15en
dc.titleStudy of Mediterranean anaemiaen
dc.typeThesis or Dissertationen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnameMD Doctor of Medicineen


Files in this item

This item appears in the following Collection(s)

Show simple item record