ANEMIA, PERNICIOUS.
Definition,—A form of anaemia which tends toward a fatal issue.
Symptoms.—The most evident symp tom is extreme pallor of the face and body, which gradually assume a lemon yellow tint. This yellowish color deep ens as the case progresses; it may appear suddenly, but in the majority of cases it develops gradually, following the insidi ous course of the disease.
There is great weakness with all its at tending symptoms: inordinate palpita tions and dyspncea on exertion, sighing, and slow delivery in speaking.
The pulse is regular, but rapid, in the majority of cases, more or less fever be ing usually present. The temperature is extremely irregular.
Cardiac murmurs are generally heard, and signs of fatty degeneration may be detected by auscultation, although there is usually no arterial degeneration or valvular disease. A loud venous hum can sometimes be detected in the vessels of the neck. (Edema of the ankles, face, and lungs and dropsical effusions may appear at any stage.
Retinal haemorrhage is a symptom of great value. There may also be Imn orrhages into the mucous membranes, epistaxis, menorrhagia, and purpuric eruptions in advanced eases.
Gastric and intestinal disorders are the rule, although the general nutrition is apparently preserved, the appetite be ing sometimes voracious, and the patient becoming obese. Dyspepsia, vomiting,
and diarrhoea usually prevail. The gas tric region is tender to pressure, and the tongue is pale and smooth.
Involvement of the osseous system is occasionally indicated by sensitiveness of the bones, especially those of the ster num.
Drowsiness is present in the majority of eases, but insomnia is occasionally observed.
Headache, vertigo, tinnitus, apoplec tiform attacks, delirium, and other dis orders of the nervous system, such as parvesthesia, neuralgia, and extensive paralyses, have been noted.
Absence of the knee-jerk is often pres ent, and is indicative of degeneration of the posterior columns of the cord.
Jaundice is occasionally met with.
The urine is dark and highly colored; it is of low specific gravity, and shows an increase of urea and uric acid and pathological urobilin.
When the end is approaching the temperature recedes markedly, and the patient enters into a torpid condition, ending in coma.
Diagnosis.—While pernicious anmmia possesses characteristics that readily dis tinguish it from other blood affections, —the color of the skin, the retinal ham orrhages, etc.,—the early stages are gen erally such as to suggest diseases that do not present the same degree of danger.