As ill understood as the etiology of the disease is the actual condition of the blood. The microscopical appearances are well known, but the true chemical changes have almost entirely been neg lected. The blood in pernicious anmmia, contains a larger quantity of water than normal blood, a smaller quantity of solids, a higher proportion of chlorine, and a lower proportion of potassium, iron, and fat. There is not sufficient so dium to hold the chlorine fixed, and the potassium is also deficient. In various tissues the proportion of water was higher than normal in the heart, and lower in the liver, spleen, and brain. Treatment of pernicious anmmia with potassium carbonate, tartrate, and cit rate, in four cases, three of which were dying, resulted in recovery. Th. Rumpf (Berliner klin. Woch., May 6, 1901).
Two cases in which 5-milligramme in jections of sublimate daily for the space of two months were followed by rapid improvement. Patera (Rifornia Medico., May 23, '96).
Case in which death occurred from gradual asthenia. Entire absence of or ganic disease in all the organs examined; blood-count gave 1,600,000 red corpuscles per cubic millimetre (32 per cent.), while haemoglobin amounted to 16 per cent. J. II. Musser (University Med. Magazine, July, '93).
[A disproportion of this kind is cer tainly unusual in pernicious anaemia. F. P. HENRY, Assoc. Ed., Annual, '94.] A high degree of anaemia usually fol lows numerous predisposing causes. In some it tends to cause degenerative changes in vessels, leading, in turn, to capillary limmorrhages, conferring per nicious character. R. Stockman (Brit. Med. Jour., May 4, '95).
[I have for many years maintained that the arguments in favor of the "id.:o pathic" nature of pernicious anemia are very faulty. E. P. Assoc. Ed., Annual, '96.] Prognosis.—The mortality, from very nearly 100 per cent., has been greatly re duced since the introduction, by Byrom Bramwell, of Edinburgh, of arsenic. A guarded prognosis should always be given, however, relapses being exceed ingly common. About one-half of the fatal cases last from one to six months; the remaining seldom reach beyond the second year.
In attempting to reach a decision as to the efficacy of any plan pursued in the treatment of pernicious anaemia, it is to be borne in mind that periods of transitory improvement, of varying dura tion, are often a part of the natural course of the disease: so that too much importance mast not be attached to the favorable results that may follow the special line of medication employed.
Even if such improvement continue for a long time, the conclusion must not be too hastily reached that the disease is cured. Editorial i Sled. Pecord. Nov. 14. '96).
Treatment. — Arsenic cures the cur able cases and benefits the others. Iron is worse than useless, having shown it self injurious in several cases reported. Fowler's solution may be given in 3 minim doses three times a day, increased The disease may be due to some hitherto undiscovered organism.
The causes of the disease are of a complex nature. Some cases present no appreciable lesions.
by 1 minim daily until 30 minims are taken after each meal, provided the stomach does not rebel, which is seldom the case. The patient should be watched and the drug reduced or discontinued temporarily on the appearance of any of the physiological effects of arsenic: mdema of the lids, etc.
Arsenic is as much of a specific in per nicious =mina as mercury is in syphilis. Warfvinge (Transactions of the Eleventh International Medical Congress, '94).
Iron produces no permanent benefit.
Acid preparations of phosphorus exert a temporary tonic effect.
Intestinal antiseptics, advocated by Hunter, only of use in cases complicated by gastro-enteric fermentations.
Alcohol (that is, distilled liquors) does no good; malt liquors—ale or beer—if borne well, retard progress of disease.
Arsenic, when tolerated in heroic doses, is very beneficial, but no permanent cures have been authenticated. I. N. Danforth (Boston Med. and Surg. Jour., June 25, '96).
Case, which came under observation in 1892, of a man whose blood showed only 1,600,000 red corpuscles to the cubic millimetre. Under arsenic the red cor puscles rose to 4,000,000 and the man was practically well. In 1893 he re lapsed, and on ascending doses of Fow ler's solution he improved and went back to work as roller in a rolling-mill. In the following year he returned to the hospital in a worse condition than pre viously. Again, on arsenic he improved. Now, two years later, he is large and portly, weighing 250 pounds. His Inemo globin is 90 per cent. and blood-corpuscles 4.S00,000. M. H. Fussell (Boston Med. and Surg. Jour., June 25, '96).
Marked case (mentioned under PA THOLOGY) in which large doses of arsenic (for several days the patient took no less than from 50 to 60 minims of Fow ler's solution in the twenty-four hours) caused remarkably rapid recovery. The condition of the blood improved and the jaundice removed along with ether symp toms.