PERNICIOUS ANEMIA OF PREGNANCY.
It was not until 1871, when Gusserow published his first observations, that the pernicious anemia of pregnant and puerperal women was really demonstrated. It has been studied by different authors, but in reality it is a rare disease, as the small number of observations collected up to date proves. Batut has only been able to collect a dozen well-authenti cated cases.
Etiology.—The abode of the woman, the manner of living and even the climate are said to be causes; but the real causes are pregnancy, and the functional disturbances which accompany the condition of child-bear ing; also hemorrhages—in a word, all the causes which tend to depress the pregnant woman, which are summed up in the expression physiologi cal distress.
Symptoms.—At the outset it is generally insidious; and it is only in consequence of excessive fatigue, of a departure from the usual manner of living, that the patient experiences a general weakness, which, increas ing rapidly, confines her in bed. At other times, it is on account of some debilitating cause, abortion, uncontrollable vomiting, diarrhcea, that anemia dec/ares itself, and this especially from the sixth or seventh month of. pregnancy. Sometimes, as in the cases of pernicious anemia of Thierry, of Lauth, of Stoltz, it is only after labor that the disease appe,ars, which is characterized by two great symptoms or phenomena, i.e., the absence of albumin in the urine, and a considerable diminution of the solid constituents of the blood, and particularly of the luemoglobin, which falls as low as 10 in 1000.
Then the face becomes colorless, slightly puffy, the tongue is dry but not coat,ed, and fever soon appears, which is accompanied with a cer tain amount of emaciation, but always leaves the patient in a fair con dition, which persists in spite of a certain amount of digestive trouble not slow in showing itself.
We are always impressed with the general feebleness of the patient, which renders all movement difficult and painful, and this is accompa nied by headache, dizziness, vertigo and sleeplessness, more or less com plete, and above all by violent palpitations and dyspmea, with a tendency to syncope on the least effort or exertion. The syncope increases in severity and duration according as the disease increases. It may even become fatal.
On auscultation, the heart presents a systolic souffle more or less strong, which is transmitted into the vessels of the neck. The seat of the souffle is not fixed; sometimes at the apex of the heart, sometimes it is percep tible over the whole cardiac area; as a rule it is heard at the base of the heart. As the disease advances, the souffle becomes dull, and, at the
same time, the dyspncea becomes worse, and there are disturbances of vision, the conjunctiva loses its color, and becomes extremely pale.
This condition is accompanied by dropsy, at first localized in the cellu lar tissue and lower extremities. It soon becomes general, and invades the serous cavities, pleura, pericardium, peritoneum, and always without albumin in the urine. Quinquaud has noticed some retinal hemorrhages, but they are rare.
The hemorrhages which frequently appear are epistaxis and bleeding from the gums; and, at the same time, patients are tormented by neural gic pains, usually facial neuralgias.
As to the digestive tract we observe all sorts of possible troubles, pyro sis, nausea, vomiting, cramps, and complete anorexia. Then the patient becomes prostrated, more or less completely, the pulse is feeble, the heart slow and feeble, and she dies exhausted. In certain cases, in place of this rapid and progressive course, the aux mia becomes chronic, so to spclik, with intermissions and remissions, more or less marked. These are deceitful because they inspire the hope of recovery which rarely comes.
Pathological Anatomy.— On. autopsy nothing characteristic is found, for the lesions described by some authors are met with in other morbid conditions. • Treatinent.—It consists, above all, in regulating the diet, but this is not easy to do, considering the difficulty of nourishing and sustaining the patient. Tonics, iron, etc., have been used. Oxygen has been re commended, and, finally, Gusserow has used transfusion, as also has Fer rand. It has failed in four cases. [In this pernicious anemia, arsenic frequently serves a better purpose than iron. Further, the bin-oxide of manganese, an excellent blood regenerator, might be tried. —Ed.] Considering the severity of the disease, is one authorized to induce pretnature labor or abortion? This question wo answer in the affirmative; the interest of the mother precedes all other considerations. We should not interfere too soon or too late, and it is the condition of the mother alone which can indicate -the proper time to interfere. This will not always save the patient, for, in a number of cases, the pernicious anemia began after confinement. We must look to the future to settle this grave question.