PERNICIOUS ANAEMIA

Categories: Diseases of The Blood And Ductless Galnds

This is characterized by great decrease of the red
cells of the blood with a relatively high color index and the presence of

large number of germs. The causes are unknown.



Condition. The body is not emaciated. A lemon color of the skin is

usually present. The muscles are a dark red, but all the other organs are

pale and fatty. The heart is large and fatty. The liver and spleen are

normal in size, or only slightl enlarged with an excess of iron in the

pigment. The red cells may fall to one-fifth or less of the normal number.

The rich properties of the blood are fearfully decreased.



Symptoms. Stomach and bowels, dyspepsia, nausea and vomiting, or

constipation, may precede other symptoms or they may last throughout the

case. The onset is gradual and unknown, with gradually increasing weary

feeling, paleness and some difficulty in breathing and palpitation of the

heart on exertion. There is paleness of the skin and the mucous membranes,

the lips look pale, no color. The paleness becomes extreme, the skin often

having a lemon yellow tint. The muscles are flabby; the ankles are

swollen, you can see the arteries beat. Hemorrhages may occur into the

skin, mucous membrane and retina of the eye. Nervous symptoms are not

common. The pallor and weakness become extreme, sometimes with intervals

of improvement and death usually occurs. The following is Addison's

description given by Dr. Osler:



[BLOOD AND DUCTLESS GLANDS 251]



It makes its approach in so slow and insidious a manner that the patient

can hardly fix a date to the earliest feeling of that languor which is

shortly to become extreme. The countenance gets pale, and white of the

eyes become pearly, the general frame flabby rather than wasted. The pulse

perhaps larger, but remarkably soft and compressible, and occasionally

with a slight jerk, especially under the slightest excitement. There is an

increasing indisposition to exertion, with an uncomfortable feeling of

faintness or breathlessness in attempting it; the heart is readily made to

palpitate; the whole surface of the body presents a blanched, smooth and

waxy appearance; the lips, gums and tongue seem bloodless, the flabbiness

of the solid increases, the appetite fails, extreme languor and faintness

supervene, breathlessness and palpitation are produced by the most

trifling exertion, or emotion; some slight oedema (swelling) is probably

perceived about the ankles; the debility becomes extreme. The patient can

no longer rise from the bed; the mind occasionally wanders; he falls into

a prostrate and half torpid state and at length expires; nevertheless, to

the very last, and after a sickness of several months' duration, the

bulkiness of the general frame and the obesity (fat) often present a most

striking contrast to the failure and exhaustion observable in every other

respect. The disease is usually fatal.



Treatment. The patient should remain in bed and should use a light

nourishing diet, taking food in small amounts and at stated intervals.

Rest in bed is essential. Dr. Osler treated a case in the following way: I

usually begin with three minims (drops) of Fowler's solution of arsenic

three times a day and increase the dose to five drops at the end of the

first week; to ten at the end of the second week; to fifteen at the end of

the third week, and if necessary go up to twenty or twenty-five. Symptoms

of an overdose are rare; vomiting and diarrhea occur. Then the medicine

must be discontinued for a few days.