The treatment of anaemia and chlorosis by the chief iron preparations commonly in use / by Andrew Smart.

Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of anaemia and chlorosis by the chief iron preparations commonly in use / by Andrew Smart. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    99 the recovery of these cases is longer delayed than in those of symptomatic anaemia, and besides this there is observed in the red globules a decided proclivity to undergo morphological de- generation. These special differences lead us to regard chlorosis pathologically as a graver type of anajmia than symptomatic an£emia, although at the same time it specifically differs from the pernicious type. 14. I would here again revert to the very severe type of anaemia referred to at the outset as being put under treatment by hydro- chloric acid as the sole therapeutic remedy. I am not aware of this treatment having previously been tried.^ Many anaemias doubtless originate in defects of the primary gastric digestion caused by either deficiency or complete absence of free hydro- chloric acid in the stomach, the consequence of which is that the proteids, not undergoing normal metamorphosis, are largely thrown out of the system as waste, and lost. This method of treatment by hydrochloric acid can only be of use in cases in which there is present that condition of atonic dyspepsia in which the hydro- chloric acid is, as I have said, markedly deficient or entirely absent. This type of dyspepsia, however, is characteristic of a large number of anaemias at the commencement of as well as through- out their entire course. The result of the trial by hydrochloric acid will be seen by referring to Case 13. During the forty-two days the patient was under this treatment the red corpuscles in- creased from 2,500,000 to 4,200,000 per cmm., and during that long period the haemoglobin only rose from 30 to 36 per cent. The patient at this stage of incomplete treatment left the hospital of her own accord. It was evident, however, that whilst longer continued treatment would have raised the corpuscles to 5,000,000 per cmm., it would not have materially increased the haemoglobin from the low standard at which it had apparently become stationary. The result of this clinical experiment, as that of every other, proves that iron in some form is absolutely indispensable in the treatment of chlorosis as well as of symptomatic anaemia to effect complete recovery. 15. In each of the anaemias here reported there co-existed chronic constipation, and the urine in each case yielded the roseate colour with nitric acid, referred to by M'Munn in his Chemistry of the Urine, as an indication of the destruction of red blood-cor- puscles. To what extent, if at all, this colour reaction indicates blood destruction through the agency of reabsorbed toxic materials from the prima via, as Sir Andrew Clark suggested, remains to be determined by further investigation. The following anatomical and pathological distinctions have been suggested in the course of these trials as marking off diag- nostic differences between the three grades of anaemia:—(1.) In symptomatic anaemia there exists a constant proportionate relation , 1 See footnote, page 14,
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