An Address on Pernicious Anaemia, with Jaundice, and Cases Simulating it
Authors: J. S. Bristowe
Journal: BMJ (1888)

IN this paper I have no intention of attempting to throw any light on the etiology of pernicious anunmia, but I propose to my- self simply to give the clinical history of two cases of the disease that have been under my care, to compare themlwith certain other eases of disease to which they present some resemblance, and to make such comments as suggest themselves.It will be, perhaps, convenient that I begin by defining per- nicious anaBmia, as I understand] it, and enumerating its more important and characteristic symptoms.Pernicious anaemia is an affection in which, without any organic lesion that has hitherto been discovered sufficient to account for it, without any recog- nised malarious or similar influence, without any apparent climatic or dietetic default, the blood undergoes progressive' de- terioration, especially in regard to the number and quality of its corpuscles, and in which the symptoms the patient presents are mainly such as depend on gradual increasing bloodlessness.This definition, so far as I have gone with it, necessarily includes chlorosis or the ansemia of young women, which usually goes along with some derangement of the menstrual function, and which, almost without exceVtion, if not always, is curable by the judicious administration of iron; and I must conifess that it seems to me impossible at the present time to make any trustworthy distinction between the chlorosis of girls and pernicious anaemia save such as depends on the age and sex of the patients and on the effects of treatment.Chlorosis occurs among young women, and is curable by iron; pernicious animiam occurs,amongmen and women, usually above the age of 30, and iron is generally without beneficial influence.Nevertheless, I believe, as most physicians believe, that there is a fundamental difference between them;and, moreover, 1 suspect that the affections now.grouped together and labelled permious anaimia " will hereafter be found to be- long to several categories.Pernicious anaimia, for the most part, comes on gradually.The patient progressively loses the warm tint of health, until at length not only his cheeks, but his lips and tongue, the inIner surface of his eyelids, his ears, and his finger nails become almost white.Shortness of breath and liability to palpitation come on,.phenomena which at first are slight and observed only when he is ascending stairs or undergoing exertion, but afterwards become more or Less continuous, or at any rate induced by very slight causes.The action of the heart gets feeble, variable in rate, and sometimesirregular.A hsamic murmur usually develops over the pulmonic area.Venous bruits become recognisable in the veins of the neck.The patient complains of noises in the, ears, more espe- cially at 'night-time and when lying down.Dro.psical offusions tae .placemto the connective tissue, and.mainly in the lower ex- tremities.There is a marked tendency to haimorrhage from the nose, the mouth, the stomach, the bowels, on the surface and into the substance of internal organs, and beneath the 'skin.And especially haemorrhage takes place into or about the retinsi.The digestive-functions commonly suffer; the appetite usually fails; dyspeptic symptoms, with sickness ifter food, are of frequent occurrence; and, as a general rule, the bowels are constipated.The urine isfor the most part unaffected, but sometimes it pre- sents traces. of albumen.The patient gets more and more feeble, unable to bear exertion or exposure to cold; but usually there is no peat degree of emaciation.He becomes apathetic and for- getful, yet often irritable and fidgety; and if death ensues (as probably it doessooner or later) he sinks from exhaustion, not in- frequently preceded by coma, or from some intercurrent com- plication.