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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    carriage. Her illness started eight months before her first admission to St. Thomas’s Hospital with an increasing general weakness. She had also noticed puffiness of her ankles and feet, especially on walking; loss of appetite; dyspepsia; and a ringing in her ears. On admission she was a typical case of pernicious anaemia. The heart was a little dilated, and there were generalised h^mic bruits and a bruit de diable in the neck. The liver came U inches below the ribs in the right nipple line. The spleen was not felt. There were no retinal haemorrhages. There was widespread pigmentation of the skin, both in specksj and spots and in bigger p;jtches, in addition to which there was decided pigmentation in or beneath the buccal mucosa on the inner aspects of the cheeks. This was confirmed at autopsy. The pigmentation was not known to have ante-dated arsenical treatment. The urine was high coloured, of specific gravity 1012 ; it contained neither albumen nor blood, but gave a well-marked urobilin band spectroscopically. The patient’s temperature was often 99° to 100° F. The pulse rate was 88 to 100 and the respiration rate 20 to 24. There were curious subjective sensations of paroesthesia, particularly in her thighs, which seemed to her at all times to feel “ too hot inside and too cold out,” in a way which struck her as being both abnormal, inconvenient, and different to her sensations in other parts of the body and limbs. The behaviour of the knee-jerks is noteworthy. They were present on admission to St. Thomas’s Hospital, but they had dis- appeared on December 21st, 1905, when liquor arsenicalis was being given in 9 minim doses. The medicine was stopped, and the knee- jerks had returned on December 27th. Liquor arsenicalis in 3 minim doses Avas again given and the knee-jerks Avere again absent on January 3rd, 1906. They had returned by the time of her admission to Guy’s Hospital in May. They Avere again absent in September, 1906. ToAvards the end pleurisy set in on the right side, and on November 11th, 1906, 3 pints of pleuritic fluid Avcre AvithdraAvn, folloAved on November 25th by another 4 pints. The patient collapsed, and died after the second aspiration. Post mortem.—Prominent inflammation of the alveolar sockets, Avith looseness of all the teeth Avere noted, also pigmentation of the inner aspect of the cheeks. Tliere Avere shallow circular ulcers of the skin around the left patella. Acute pleurisy had occurred on