Is pernicious anaemia a special disease? / by William Hunter.

  • Hunter, William, 1861-1937.
Date:
[1888]
Catalogue details

Licence: Public Domain Mark

Credit: Is pernicious anaemia a special disease? / 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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    the blood. These conditions are however easily differentiated from pernicious ansemia. Where hcemorrliagcs have already occurred, the general question becomes more complicated, and the value to be assigned to the above figures may require modification. Each case must be discussed on its own merits, but we are not without general principles which aid us in arriving at a sound diagnosis. In the first place we must enquire whether the haemorrhages have been sufficient to account for the degree of oligocythemia present. It must here be kept in mind (1) that a diminution below 1,000,000 per cmm. is rare as a result of haemorrhage alone, unless it is repeated and copious; (2) that oligocythsemia result- ing from loss of blood is in most cases accompanied by a corre- sponding diminution in the percentage of haemoglobin ; (3) that in hcemogenic anaemias (and that resulting from haemorrhage may be so described) we do not usually find in the blood the small yellow microcyteS; perfectly spherical in form and deep in colour, which point to an anaemia of hceniolytic origin. Apart however from these changes in the blood, it is in such cases especially that we must in diagnosis have regard to the symptoms in their entirety and not to any one in particular. A profound aneemia due simply to haemorrhage, such as results, for instance, from long-continued metrorrhagia, though associated with intense pallor and debility, is not necessarily accompanied by the peculiar lemon tint, by the gastro-intestinal disturbance, by the jaundice, by the pyrexia, &c., which are generally associated with haemolytic or pernicious anaemia. Even in the presence of haemorrhage, therefore, the presence or absence of the latter group of symptoms will in general suffice to determine the question whether the anaemia with which we have to do is referable to the haemorrhage alone, or whether it must be classed as a manifestation of the special disease—pernicious anaemia.