The appearance of patients afflicted with the severer grades of anemia may be difficult to distinguish from that associated with the final stages of cancer ; they have a waxy look, are incapable of any exertion, display a tendency to fainting-spells, stiffer from attacks of distressing vomiting, are unable to assimilate even the lightest foods, and are subject to haemorrhages •n the skin arid in the various internal organs. These symptoms indicate what is known as pernicious anminia.
It is to be hoped that this account has made it clear that a disease so varied in its aspects cannot be recognised as readily as the popular concep tion would lead one to believe, but that its type and its degree must be based on an intimate knowledge of the workings of the human body and of its requirements. The treatment, although considered a simple matter by the laity, is, on the contrary, surrounded by many difficulties. More is required than the administration of a universal " cure-all." The causes of the trouble must be definitely determined ; and, in the majority of cases, these must be removed and a complete change in the manner of living prescribed. From what has already been said, it is evident that there may be many remedies which may be attended by an apparently favourable result when applied to the treatment of this disease. They seem efficient because the latter presents extreme variations in form and degree and may be due to a great variety of causes. What is appropriate and effective in one case may produce harm in another, because it is not only necessary to treat the anaemia or the chlorosis, but the numerous contributing causes must be laid bare and removed ; and the treatment does not consist merely in the administration of iron, hannoglobin or pepsine, hydrotherapeutics, warm baths, mountain or sea air, nor of gastric lavage, or venesection. The choice of a course of treatment, and its details, depends on the circumstances associated with the individual case, and these can be ascertained only by careful and painstaking observations.
Many cases of anaemia require no specific treatment, it being merely necessary to remove certain harmful influences and then to prescribe rules for a more healthful manner of life. In some cases such measures as exercise, cold, fresh air, and forced nutrition, which are otherwise of value, may be productive of harm rather than of good. Above all, it should be borne in mind that it is not possible to accomplish by radical measures that which can only be secured by carefully building up the general strength ;' and where there is well-marked diminution of muscular power, complete rest is of the greatest importance to the patient. Persons affected with the severer
grades of anaemia must be treated at the first attack with as much considera tion as would be extended to a patient ill with fever ; and if a recurrence takes place, as occurs quite often, the manner of treatment should be like that given to an individual suffering from a constitutional or chronic disease. This means more or less continued rest in bed, or, during warm weather, the recumbent position in a place where the patient may be bathed by the rays of the sun, care being taken that the person is not clothed too lightly. Not until the strength has visibly improved is any recourse to be had to systematic muscular exercise.
The recurrence of the disease, of which we have just spoken, affords proof that even the milder degrees of aummia must be seriously considered and that the treatment must not be discontinued with the disappearance of symptoms which are plainly evident and the removal of which is considered by the laity to amount to a cure of the disease. A complete cure cannot be spoken of until the abnormal conditions of the blood and vascular system, which have been described, fail to reappear even when the patient must of necessity return to more unfavourable conditions of life and slit roundings.
ANESTHESIA.—The impairment or loss of sensibility, due to action on the sensory nervous system. Such anesthesia may be concerned with the sense of general sensibility of touch or of pain (analgesia) ; or it may refer to the loss of sense of heat or cold. It may refer also to loss of sensibility of a special sense : as anosntia, or loss of the sense of smell ; blindness, or loss of the sense of sight ; deafness, or loss of the sense of hearing ; ageustia, or loss of the sense of taste. These amesthesias, general or special, may be partial or complete ; if due to a wound of the external part of an organ of sense, the anaesthesia may be termed peripheral ; if the loss is in the brain centres, it is frequently termed a central anaesthesia. Anmsthesias may be functional, when due to hysteria, and are then not true aniesthesias ; or they may be clue to actual loss of nerve-substance. Their distribution is well localised and affords a fascinating problem for the nerve specialist. Agents are known that can bring about states of anaesthesia, which may be local or general. Thus, the use of cold, or of cocaine, may cause a local anaesthesia to pain ; while ether, chloroform, and similar agents may cause a general anaesthesia with unconsciousness.- See AN.ESTHETICS.