Observations on the treatment of pernicious anaemia based on a study of its causation : with notes of a case / by William Hunter.

  • Hunter, William, 1861-1937.
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the treatment of pernicious anaemia based on a study of its causation : with notes of a case / by William Hunter. 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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    thickening, due to increase of fibrous tissue, resulting from chronic inflammatory processes. The change involves in a special degree the vessels, the walls of which are greatly thickened; at parts, however, the process is more subacute in its character, the walls of the vessels being seen infiltrated with groups of proliferating con- nective tissue cells. In the pyloric portion of the mucous mem- brane the chief change is the increase in the interstitial connective tissue between the glands ; the more subacute and acute inflam- matory changes are absent. Small Intestine : Walls very thin. Mucous membrane of duodenum covered with a thin coating of slightly bile-stained mucus. No swelling or other obvious change. On microscopic examination nothing abnormal found. Pathology. During the last two months and a half of his illness the urine of this patient was made the subject of a daily series of observations relating to the nature (1) of the changes in the blood, (2) of the changes in the gastro-intestinal tract responsible for the extensive blood destruction, characteristic of the disease.* The former included observations on the excretion of urinary pigments, of blood-pigment, and of iron. The results obtained seemed to me of such interest and importance, both in their bear- ing on the pathology and diagnosis of the disease, that I have recorded them at length in a series of papers elsewhere.f 1. They showed, first, a largely increased excretion of urinary pigments, evidenced by an extremely high colour of the urine without any diminution in quantity, and with a low specific gravity. During the last three weeks of his illness, for example, when there was little intestinal disturbance and the whole of the urine could be obtained, the quantity varied from 40 to 52 ounces, with an average specific gravity of 1014. The reaction was at all times extremely acid. At no time were bile pigments found in the urine. Uro-erythrin appeared from time to time during the slight feverish attacks from which he suffered. The chief interest attached to the presence in large quantity of a urinaiy pigment, having all the characters (chemical and spectroscopic) of that * An investigation into the Pathology of Pernicious Anaemia, ' Lancet,' Tol. ii, 1888. t Observations on the Urine in Pernicious Anaemia, ' Practitioner,' September, November, December, 1889.