Vol. 60, 1909 - University of North Carolina at Chapel Hill

4,^0
THE CHARLOTTE MEDICAL JOURNAL.
Pernicious Anaemia.—Taylor, in The In the second or anaemic stage, the pains
London Practitioner, reports 10 cases of reached a high degree of severity, so as to
this disease and makes the following ob- prevent the patient altogether from moving
servations: the extremity; the gentlest contact of the
It is clear that the symptoms of pernic- soft parts gave rise to intolerable pain. In
ious angemia may be many and varied; in the third stage, when the gangrenous proone
case a gastro-intestinal disorder may be cess was already well under way, complete
simulated; in another the patient may ap- ansesthesia appeared in the gangrenous
parently have a nervous disorder, or again portions, together with a small hypersesthere
may be complaints of nothing except thetic area at the boundary of the healthy
weakness, loss of breath and oedema, which tissues. This was the point of origin of the
might be due merely to chlorosis.
pains, which appeared from time to time in
By the examination of the blood alone periodical attacks. Finally, in the fourth
can'the diagnosis be at once settled, and, stage, when the gangrenous tissues were
for the sake of cases of pernicious ansemia, already completely mummified, it again
the author would urge that more frequent became possible to determine pain by means
routine blood examinations should be un- of pressure. This state of afTairs caused
dertaken; many, of course, would show the patient herself and her friends to hope
nothing abnormal, but, at any rate, as a that the gangrenous portions of the exresult,
many more patients with pernicious tremity would recover. The color of the
anaemia would have their disease recogiiiz- skin coverings of the extremity likewis
ed earlier, and appropriate treatment start- varied considerably; it was deathly white
ed, and possibly harmful treatment avoid- during the first few days, then took a mared,
for if the case were thought to be chlo- ble tint, changing to a dark purple, and
rosis, and iron administered, it would be finally to a bright red, in the stage of mumone
of the worst possible things for pernic- mification (changes of the haemoglobin?),
ious antemia.
Unfortunately, the patient could not be kept
The recognition of idiopathic pernicious under observation until the end of the disancemia,
in any case with obscure symp- ease. The conservative treatment (rest,
toms, rests on the following blood changes warmth, analgesic remedies) adopted in
—reduction in the number of red corpuscles, the hospital did not satisfy the friends of
with a high color index, and leukopenia, the patient, who desired more energetic
The presence of megalocytes in large num- measures, such us massage, and the patient
hers, and of normo and megaloblasts. was removed from the hospital against the
Among the white corpuscles a lymphocy- advice of the physicians The outcome of
tosis, usually of over 40 per cent., and a the case is unknown.
not greater percentage than four of eosino- Upon the basis of his personal observa-
pliils. tion as well as the statements in the litera-.,
„^ „ ... . „ . . ture, the author believes himself justified im
The CompSicat.on ol Typho.d Fever
^j^^ following conclusions;
with Gangrene of the Extremities.-
^ The immediate cause of gangrene o?
Biron (Wiener Khu. Wchschrft). Thecase the extremities in tvphoid fever is the obreported
by the author concerned a young struction of the afferent vessels (arteries),f
woman, 21 years of age, who was admitted sometimes of the efferent vessels (veins).^
to the Obuchow Hospital for Women, in in certain cases the interruption of the cir-
St. Petersburg, suffering from an attack of culation mav be due to causes of a functyphoid
fever. In the beginning of the tional character ( spasm of the vessels
third week of an illness of moderate sever-
ity, when the temperature was already re- Treatment lor Intestinal Worms.—SavillTj
turning to normal, there appeared an un- in The London Practitioner, points out that
favorable complication in the shape ofgan- intestinal worms mav give rise to no sympgrene
of the right foot and leg. This gan- toms at all. These worms are most fregrene
was preceded by a stage of severe quentlv met with in children, and mav re- !
pain in the extremity, the cause of which main undiscovered until they are found in i
was not very clear. One and a half days the stools. The symptoms are verv indefilater
appeared manifestations of well- nite, and consist of vague and persistent, ^
marked local aneemia, followed by a pur- though often paroxysmal, pains in the abdo- ;
plish discoloration and loss of sensation, men; capricious and sometimes ravenous
etc., in the tissues, pointing to the true appetite, in spite of which the child be- \
character of the disease. In the first or comes thin and sallow, grinding of the teeth 3
prodromal stage, which lasted about one at night, picking of the nose, and other re- ||
and a half days, the pains in the extremity flax phenomena; irregularity of the bowels, |
were entirely spontaneous, without depend- or diarrhoea; threadworms produce intense i
in g upon movements, pressure and so forth, itching of the anus, and consequently i'
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