At least two years should elapse before a patient is reported cured. Patient who has been cured of pernicious for the space of two years by the use of arsenic pushed to the point of tolerance. The gentleman now en active business man. F. P. Henry (Boston Med. and Surg. Jour., June 25, '96).
There is no specific remedy for per nicious anwmia. Rest in bed is one of the first requisites, the assimilation of food must be stimulated. Lavage of the stomach, intestinal irrigation, and saline laxatives are useful. In rare cases with diarrhaia, calomel may first be given; later astringents, such as tannin. If the urine contain much indican intestinal antiseptics are indicated. Iron is of no value, and in the beginning is contra indicated. Arsenic is the best remedy; can be given with quinine. Inhalations of oxygen have been employed with ad vantage. Massage and gymnastic exer cises are often of service. After apparent recovery the patient must be carefully observed, as relapses are likely to occur, particularly if the hygienic and dietetic conditions are unfavorable. E. Crawitz (Berliner klin. Woeh., Aug. 15, '98).
When the gastric disorder, which is a usual symptom, prevents the admin istration of arsenic, the latter may be given subcutaneously, while the stomach is treated directly by lavage.
An excess of hydrochloric acid is not uncommonly found in the gastric secre tions. In such cases See recommends an almost exclusive diet of meat and other albuminous foods: raw meat to the extent of 10 to 12 ounces daily.
Bone-marrow sometimes proves cura tive.
Case successfully treated with bone marrow, uncooked, 3 ounces daily. In a case in which the prolonged administra tion of iron and arsenic in both medium and large doses was proved useless. Thomas R. Fraser (Brit. Med. Jour., June 2, '94).
The plain marrow cannot always be administered on account of the objection of the patients. The red marrow from the tibia of the calf, mixed with an equal quantity of glycerin and rubbed up in a mortar, results in a preparation of pleas ant taste and one that can be eaten with bread without disturbing the stomach. The preparation may be made more fluid by the addition of claret or port wine. Alfred Stengel (Therapeutic Gazette, No.
13, '96).
Severe case of pernicious anaemia, com plicated with oedema, ascites, and cardiac symptoms; 2 doses of fresh bone-marrow administered daily in soup or on bread. The patient was cured in two and a half months. Blumenau (Pediatrics, June 15, '97).
(See also ANneAL EXTRACTS.) In pernicious anxmia bone-marrow is not by any means of constant value. Such cases with large doses of iron and arsenic do very often improve. But herein lies the difference clinically be tween simple and malignant anaemia: in the former complete cure results, but with tendency to relapse, when the case is appropriately treated. In the latter. at the best some improvement occurs. The amount of haemoglobin increases, but does not attain the normal, and in no long time the patient is as bad as ever. T. G. Stewart (Clinical Journal. Sept. 14, '98).
Transfusion of blood should be re sorted to when improvement does not follow the administration of arsenic.
Transfusion of blood recommended. Blood a very indigestible substance. The practice of drinking it at slaughter houses is not to be commended. Laache (Wiener klin. Woc.b., Sept. 18, '89).
Case treated successfully by trans fusion of blood defibrinated and mingled ith a 2-per-cent. solution of phosphate of sodium in the proportion of 5 V: ounces of the former to 3 ounces of the latter. W. G. Evans (London Lancet, May 13, '94).
[Transfusion should never be omitted if improvement does not follow the free use of arsenic. The best method is that employed by Brakenridge, of Edinburgh (Edinburgh Med. Journal, Oct., '92). The blood is kept fluid by admixture with one-third part of its bulk of a 1-to 20 (5 per cent.) solution of phosphate of soda in distilled water kept at blood heat. John Duncan, who performed the transfusions in Brakenridge's eases, in sists upon the necessity of slowness in operating. He regards thirty minutes as the minimum time that should be occu pied in injecting S ounces of the fluid.— F. P. HENRY, Assoc. Ed., Annual. '94.] Defibrinated blood has been used cutaneously by Westphalen, with success. Subcutaneous injections of normal saline solution may replace transfusion.