Anaemia

“ The symptoms are those of a progressive anaemia, in which gastro-intestinal disturbance usually plays a large part, and nervous symptoms are common, and they become at last much more severe than those of any secondary anaemia. The patient may die in the first attack, but more usually, when things seem to be at their worst, improvement sets in, either spontaneously or as the result of treatment, and the patient slowly regains apparent health. ”

“ In acute anaemias, such as those associated with septicaemia, there is no doubt that blood destruction plays the principal part. But if the cause of anaemia is a chronic one, a gastric cancer, for instance, though there may possibly be an increased amount of destruction of corpuscles in some cases, and though there is often loss by haemorrhage, the cancer interferes with nutrition, the blood is impoverished and does not nourish the erythroblasts in the marrow sufficiently, and the new corpuscles which are turned out are few and poor in haemoglobin. ”

“ A whole category of female complaints is treated successfully with these waters. Indeed, anaemia from any source, as after fever or through loss of blood, and enlargements of the spleen, are benefited by them. ”

“ Malarial Cachexia.—Although the malignant tertian infection has the greatest tendency to produce anaemia yet any type may, when untreated, bring about the more or less profound anaemia with earthy skin, enlarged spleen, dyspnoea on slight exertion, and oedema of the ankles characteristic of malarial cachexia.
Oroya Fever.—In this disease we have what might well be termed a fulminating pernicious anaemia. The rod-shaped protozoon which attacks the red cells seems to be peculiarly active in the bone marrow, excruciating bone pains being quite a feature of the disease. ”

“ The evidence of destruction has often to be sought for in other organs, or in secretions or excretions.
Of the so-called primary anaemias the most common is chlorosis, an anaemia which occurs only in the female sex, between the ages of fifteen and twenty-five as a rule. Its symptoms are those caused by a diminution of haemoglobin, and though it is never directly fatal, and is extremely amenable to treatment with iron preparations, its subjects very frequently suffer from relapses at varying intervals after the first attack. ”

“ Practical experience teaches every clinician that, whatever the mode of action, iron is most valuable in anaemia, though in many cases, where there is well-marked toxaemia from absorption of the intestinal products, not only laxatives in combination with iron but intestinal antiseptics are necessary. That form of neuralgia which is associated with anaemia usually yields to iron. ”

“ Associated with the profound anaemia there may be oedema of legs and about joints and functional cardiac murmurs. The kidneys do not seem to be affected. There may be a diarrhoea in the later stages of the disease. There is no eruption in uncomplicated cases.
The most important findings in the disease are those in connection with the blood examination. The rod-shaped organisms, which are thought to be the cause of the disease, are somewhat difficult to observe in fresh blood preparations. They show definite motility within the red cells, particularly after warming the blood slide. ”

“ It also arises in the course of exhausting diseases, and through excessive study and insufficient physical exercise. One of the commonest causes of anaemia is indigestion, due to incomplete mastication of food caused by bad teeth, and by absorption of the discharges from rotten and decayed stumps.
Symptoms.—A pale appearance of the skin and mucous membranes; the lips and gums lose the rosy look of health, and become of a delicate pink colour; exertion is difficult, and going upstairs or climbing a height out of doors give rise to breathlessness. ”

“ The anaemia accompanying the disease is due partly to the leucocyte overgrowth, which takes up the space in the marrow belonging of right to red corpuscle formation and interferes with it.
(G. L. G.)
1 The suffix -phile, Greek φιλεῖν, to love, prefer, is in scientific terminology frequently applied to substances that exhibit such preference for particular stains or reagents, the names of which form the first part of the word. ”

“ The anaemia in liver abscess is not so great as the muddy complexion would indicate. The emaciation is greater than the anaemia.
Haemorrhages
The loss of blood through haemoglobinuria and haematuria has been taken up under the urine. The haemoglobinuria is the pathognomonic symptom of blackwater fever. There is also recognized a haemorrhagic form of pernicious malaria with epistaxis and alimentary tract haemorrhages. Moderate haemoglobinuria may be found in severe cases of malignant tertian infections. ”

“ It may therefore be considered certain that during sleep there is an anaemia, or partially bloodless condition, of the brain, and that the blood is drawn off to other organs, whilst at the same time this anaemic condition may be modified by changes in the circulation or in the respiratory mechanism caused by position, by sensory impressions or by sudden changes in the state of repose of the muscles. ”

“ In the absence of agglutination haemolysis never occurs. Only about one-fifth of agglutinating sera prove also haemolytic. Rarely a pernicious anaemia patient’s serum may agglutinate his own red cells. This auto-agglutination is regarded as an important test in acquired haemolytic jaundice. ”

“ Cases of anæmia in women with excess of flesh have to be managed in a somewhat similar fashion, but with the utmost care. In such persons we have a loss of red blood-globules, perhaps lessened hæmoglobin, weak heart, rapid pulse, and general feebleness, with too much fat, but not, or at least rarely, extreme obesity. ”

“ Iron is an inorganic substance and is necessary in making red blood corpuscles.
If, by some disturbance in the digestion, absorption, or assimilation of food, more [Pg 49] iron is excreted from the body than is made use of from the food, the blood making organs do not receive sufficient iron and the blood is lacking in red corpuscles. It becomes poor in hemoglobin and the individual becomes pale. This condition is known as Anaemia. ”

“ Anæmia may arise in consequence of low diet, or because the alimentary organs do not properly digest the food, or when there is not sufficient variety in the diet. No matter how anæmia is occasioned, whether by labor and expenditure, by hemorrhages, lead poisoning, prolonged exposure to miasmatic influences, deprivation of food, indigestion, imperfect assimilation, frequent child-bearing, or lactation, the number of the red corpuscles in the blood is materially diminished. ”

“ They are also very fatty and of acid reaction. They show a proteid loss as well as lack of fat absorption.
The Blood Findings.—There is a marked secondary anaemia with great reduction in red cells and Hb. percentage.
The color index averages higher than normal and with the poikilocytosis resembles the blood picture of an atypical pernicious anaemia. Nucleated reds are rarely found. The eosinophiles are reduced in percentage. The polymorphonuclears often show a great number of nodes, as 7 or 8 instead of the ordinary three. ”

“ Chemically speaking, they are mild waters; they are none the less very effective therapeutically. Some of the mildest mineral waters, both at home and abroad, are the most valuable.
And for what classes of complaints are the springs of Luxeuil especially indicated? There is no obscurity about the answer; and it will be an encouraging one to many sufferers.
The waters of Luxeuil are especially adapted to anaemia and to the complaints that arise from it; and especially to the nervous, as distinguished from the scrofulous, forms of anaemia. ”

“ After death the amount of blood sometimes seems to be increased, and sometimes, as in “pernicious anaemia,” it is certainly diminished. But the high counts of red corpuscles which are occasionally reported as evidence of plethora or increase of the total blood are really only indications of concentration of the fluid except in certain rare cases. It is necessary, therefore, in examining blood diseases, to confine ourselves to the study of the blood-unit, which is always taken as the cubic millimetre, without reference to the number of units in the body. ”

“ The amount of iron existing in the human blood is only 38 gr.; therefore, when an excess of iron is absorbed, part is excreted immediately by the bowel and kidneys, and part is stored in the liver and spleen.
Iron being a constituent part of the blood itself, there is a direct indication for the physician to prescribe it when the amount of haemoglobin in the blood is lowered or the red corpuscles are diminished. In certain forms of anaemia the administration of iron rapidly improves the blood in both respects. ”

“ Persons who gradually acquire tolerance go through the stage of anæmia without exhibiting any symptoms of colic or paresis, and without any treatment the hæmoglobin and the number of red cells gradually pass back to a more or less normal condition. During this period—that is, whilst the blood shows signs of a diminution in its corpuscular and colour content—basophile granules may always be found if sought for, but disappear as a rule when the blood-count has returned to about 4,000,000 per c.c. ”

“ In fatal cases the internal organs are found to be pale, and very often their cells contain an excessive amount of fat. In many anaemias there is a special tendency to haemorrhage. Most of the above symptoms and organic changes are directly due to diminished respiratory interchange from the loss of haemoglobin, and to its effect on the various organs involved. ”

“ Some observers state that many girls are anaemic about the age of 12 when they start work, and then again between 18 and 22; others declare that most girls suffer from anaemia at some time between the ages of 13 and 18. ”

“ The metabolism of the proteids is increased, as shown by the increased excretion of urea, and owing to defective exudation the decomposition of the fats is lessened; hence the retention of fat, or even increase, in anæmic persons. The influence of repeated small bleedings in hastening the fattening of cattle has been known since the time of Aristotle, and horse-dealers still affirm that there is nothing like bloodletting to put an animal into good condition.
CHLOROSIS
is a special form of anæmia distinguished by certain etiological and anatomical peculiarities. ”

“ Associated with progressive anemia is mal-assimilation, improper nutrition, ebbing of the nervous and vital forces and the lessening of the secretory, excretory and digestive powers. By the time the poor victim is weighing fifteen to twenty-five pounds less than he ought to the symptoms of ill-health are sufficiently alarming to compel the sufferer to seek medical aid for disease of the stomach, bowels, liver, kidneys, lungs, etc. ”

“ The rare and rapidly fatal anemia which has been described under the name of aplastic anemia is probably a variety of pernicious anemia. Absence of any attempt at blood regeneration explains the marked difference in the blood picture. Red corpuscles and hemoglobin are rapidly diminished to an extreme degree. The color index is normal or low. The leukocyte count is normal or low, with relative increase of lymphocytes. Stained smears show only slight variations in size, shape, and staining properties of the red cells. ”

“ Change of air and change of scene are of special importance in these cases and will frequently cure. The general condition of course must not be overlooked. The diet, exercise, bowels, habits, should receive careful attention. Iron should be continued for a number of months after all traces of the anemia have disappeared.
Pernicious Anemia.—For this condition arsenic is the one remedy needful. In all conditions of poor blood the most careful attention should be given to the general health. Colds must be guarded against. The patients should never get their feet or their clothes wet. ”

“ We must, therefore, always take this special duty into consideration, when the question of recuperation, convalescence, feeding, and the administration of blood foods and tonics comes up.
It is not necessary to specify the diseases from which a child may suffer and recover, in an anemic condition. Any disease may leave a child with temporarily poor blood. The conditions which most frequently produce anemia in childhood are improper feeding and unhealthy surroundings. It is not fully appreciated how seriously these conditions can affect the health of growing children. ”

“ The lesson is, that boys who are bleeders may marry, because they will most likely not transmit the disease; but girls who come from a hemophilic family, irrespective of whether they themselves are hemophilics or not, must not marry, because most likely they will transmit the disease.
Anemia
Anemia is a poor condition of the blood. The blood may contain an insufficient number of red blood cells or an insufficient percentage of the coloring matter of the blood, that is, hemoglobin. A special kind of anemia affecting young girls is called chlorosis. ”

“ It is a rare condition, and must be distinguished from hematuria, or blood in the urine, which is common. In both conditions chemic tests will show hemoglobin, but in the latter the microscope will reveal the presence of red corpuscles. Urines which contain notable amounts of hemoglobin have a reddish or brown color, and may deposit a sediment of brown, granular pigment.
Hemoglobinuria occurs when there is such extensive destruction of red blood-cells within the body that the liver cannot transform all the hemoglobin set free into bile-pigment. ”