Observations on the Treatment of Pernicious Anaemia Based on a Study of its Causation, with Notes of a Case
Authors: W. Hunter
Journal: BMJ (1890)

A CASE. THE patient, a man, aged 59, in good.circumstances, came under my observation on May 9th, 1889, suffering from anaemia and profound weakness, which had already confined him to his bed for three months.Previous Life History.-With the exception of an attack of ague which he had had as a youth while studying on the Continent, and some gastric affection for which he was under treatment for a short time about six years previously, his health had up to the onset of his present illness been exceptionally good.His present illness dated from the autumn of 1886.During a holiday in the country he was exposed for a time to unhealthy sanitary condi- tions in the house in which he stayed, and he suffered at the time from sore throat and diarrhcea.From that time onward he never entirely regained his former health.He continued to suffer at times from an inflammatory condition of throat and tongue, and his strength began gradually to fail, so much so that late in 1887 he was induced to seek medical advice.In January, 1888, aniemia was already very marked, but, with the exception of some congestion of the throat and certain pale red spots on the tongue, there was nothing further objective to be made out.'At times there were retching and vomiting, especially in the morning.Although still able to go about, his condition at this time was such as to occasion anxiety to his friends.A month later the number of corpuscles was found reduced to 860,000 per cubic centimetre (17 per cent.), and the corpuscles themselves showed all varieties of change both in form and size.Under treatment he recovered considerably during the spring and summer of that year.I had an opportunity of seeing him in June, 1888.He complained much of great weakness and ex- haustion on the slightest exertion.There was no emaciation, but the pallor was marked, without any trace of lemon tint, or of jaundice of conjunctivae.The condition of his tongue troubled him much.Great tenderness on mastication, especially when hot or stimulating food or drinks of any kind were taken.The tenderness on swallowing he described as extending down the throat to the stomach.Tongue extremely raw and flabby, deeply indented by the teeth, presenting a red and fiery appearance, witrn here and there scattered patches of a more inflamed character, the intervening portions of mucous membrane being smooth as if devoid of papille.The inflammatory redness extended to the anterior pillars of the fauces.There was no uneasine3s or tender- ness of, nor any symptoms connected with, the stomach itself.Number of red corpuscles at this time 3,200,000 per cubic milli- metre, with 56 per cent. of haemoglobin, the corpuscles showing no specially marked changes, either as regards their size or shape.This condition of the blood represented, therefore, a considerable improvement on that found four months previously.fle went to the country for a time, and returned early in August somewhat improved in health.The improvement however, was more apparent than real.The condition of the blood on his return