Some clinical aspects of pernicious anaemia / by Herbert French.

  • French, Herbert Stanley, 1875-1951.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Some clinical aspects of pernicious anaemia / by Herbert French. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    in the skin, but also in the buccal mucosa. It is well known that Addison’s disease and pernicious ansemia may present such similar symptoms that it is sometimes difficult to be sure which malady the patient is suffering from. It was formerly a generally accepted opinion that the presence of pigmentary deposits beneath the buccal mucosa inside the lips or cheeks would be decisive in favour of Addison’s disease in such a case. Unfortunately this can no longer be maintained, for in the two following cases of pernicious anaemia, in which the diagnoses were confirmed hj post-mortem examination, at which the suprarenal glands were normal to the naked eye, there was well marked pigmentation of the buccal mucosa. The first of them was the one in which Dr. Hale WTiite himself observed the phenomenon ; the other is a hitherto unpublished case. Frederick V., aged 33, a shoemaker, first came under Dr. Hale White’s care in 1904, and was in the hospital from August 2nd to December 15th. There was a long and indefinite history of increasing weakness and unfitness for work, and upon examination the chief point that attracted attention was the colour of the skin. The man was not emaciated, though tall and spare; the lips were pale, but the skin, instead of being primrose or lemomyellow, was an unhealthy sallow tint, and upon closer inspection it became clear that there was an abnormal pigmentation in it, partly diffuse and partly in small localised dark l)rown freckle-like spots over the body. Addison’s disease at once suggested itself as a diagnosis, and at first sight this seemed to be confirmed by the presence of well marked scpia-coloured pigmented areas and streaks within the mouth, par- ticularly on the inner aspect of the cheeks, precisely as in Addison’s disease. The difficulty Avas rendered greater, perhaps, l)y the varia- tions in the colour index of the blood, which Avas sometimes Ioav and sometimes high. Dr. Hale White adhered to the diagnosis of pernicious anaemia, laying much more stress on the high colour indices than upon the Ioav ones. Arsenical treatment AV'as adopted, but Avithout great relief, and later suprarenal extract, iron, and bone marroAv Avere all tried. The patient Avent out a little better than Avhen he came in, but Avas tAvice re-admitted in 1905. He rallied again, and lingered on until 1907, Avhen he finally died, and t\\Q post-mortem examination shoAved that pernicious anaemia Avas the correct diagnosis, and not Addison’s disease.