Clinical Lecture on Progressive Pernicious Anaemia with Spinal Symptoms: Delivered in St. Bartholomew's Hospital
Authors: D. Duckworth
Journal: BMJ (1900)

the Prince of Wales.GENTLEMEN,-The case furnishing the text for this lecture is one of so-called pernicious aniemia which has afforded us much thought recently.It supplies us with many of the typical features of such cases which we have to consider in detail.The whole subject of pernicious anaemia is a large and still a vexed one.Its recognition as a distinct malady is due to .Dr.Addison of Guy's Hospital, who first described its peculiar nature some half-century ago, when he also, as he stated, " stumbled upon " the peculiar disease of the adrenal bodies which now bears his name.He termed this disease "1 idiopathicansemia,"andthis is still a synonym of the disorder.Since the period referred to much work has been bestowed on the subject, and much has come to light by means of modern methods of research which were unknown in Addison's days.But, even now, I meet, in the best textbook we possess, with the following statement from a former distinguished pupil of this school, Dr. Rolleston, which may sufficiently indicate to you the difficulties which still invest the study of this disease: "Our ideas," he declares, "of pernicious aneemia are but a mass of shifting hypotheses."A similar statement might, indeed, have often been made respecting the knowledge of the time concerning various diseases about whose nature we feel certain to-day.It would have rejoiced the heart of Addison to know all that is now ascertained about pernicious anaemia, and who can doubt that ere the next half century is completed its pathogeny and treatment will be fully understood?Our patient was twice under care in Matthew Ward.His first sojourn lasted two months.The following notes relate to the earlier history: E. P., aged 36, an engine driver, admitted to Matthew Ward, December soth, I898.History.-He had been ailing from December, I8i7, when he began to have attacks of vomiting coming on immediately after food.Later, the attacks of vomiting were accompanied bv diarrheea, lasting about three days.These attacks occurred about once a fortnight.He continued at his work up to December 3rd, I898, when he had an attack of sickness and diarrheea worse than usual, followed by a fainting fit.He stated that he had been losing flesh lately and getting paler, and complained of tired and languid feelings.He had had rheumatism ten years earlier, but no other illness.His father was living, aged 84 his mother was dead.He had three healthy brothers and sisters.Condition on Admission.-Hewas a thin, sallow-looking man, and very aniemic.The skin had a peculiar yellowish, almost bronzed colour.His mannerwas languid.The tongue was clean.There was no pigmentation of the buccal mucous membranes, which were rather pale.The pupils were equal and dilated.The temperature was normal.There were no physical signs in the chest.The pulse was 120, and there was a bruit de diable in the neck.The abdomen was natural.Pulsation was visible in the middle line; no viscera were felt.There was slight cedema of the shins.The urine, of specific gravity I020, contained neither albumen nor sugar.Ophthalmoscopic examination revealed nothing abnormal.December i6th.Blood count: Red corpuscles, 31.8 per cent., 1,594,000.White, 40coo.Hiemoglobin, 36 Per cent.There was a relative eosinophile and coarsely granular leucocytosis.Poikilocytes were present, but there were no nucleated red corpuscles.December 20th.Some improvement in general condition.Hnemoglobin, 27 per cent.January ioth.Blood count: Red corpuscles, 4,300,000.HaemoglobiD, 42 to 45 per cent.No poikilocytes.Improvement maintained, gaining weight.