Etiology:—Under this head are included acute and subacute anemia from hemorrhage, or those forms which result from causes induced in the system by other diseases. There is not only a reduction of the amount of hemoglobin in each red corpuscle, in most of these cases, but there is also a reduction in the number of red cells. The destruction of the red blood corpuscles may result directly from the breathing of vitiated air; this is immediate and profound in the presence of the vapor of nitric acid; other vapors are slower and many are insidious in their influence upon the red corpuscles. Imperfect food, insufficient food, especially a lack of those principles which assist in the making of red blood, faults in the appropriation of food, either due to imperfect functional activity or to the presence of abnormal growths or cancer of the organs, are all contributing causes.
When the condition is due to a hemorrhage the impression upon the system is in proportion to the amount of blood lost. From an injury or during a surgical operation, or from the rupture of a blood vessel, or in post partem hemorrhage, the hemorrhage may produce immediate prostration, or syncope, or it may prove fatal. In hemorrhage from ulceration during the progress of some serious disease there is not only a loss of the total constituents of the blood, but the constituents may be seriously impaired and toxic elements may be added to the blood. Direct loss may extend over a long period, a small quantity of blood being lost daily, as in metrorrhagia, hemorrhoids, nosebleed, and in certain ulcerative disorders, as gastric ulcer.
This form of anemia also follows other chronic diseases, such as malaria, syphilis, tuberculosis, scarlet fever and diphtheria, and the various toxemias. It also results from the various mineral poisons. It occurs when there is a serious drain upon the albuminous constituents of the blood, as during chronic diarrhea, chronic nephritis, general pyemia and from prolonged excessive mucous discharges. Mothers will occasionally reduce the vital constituents of the body by prolonged lactation and from this, anemia is apt to follow. The condition may arise also from parasites.
Symptomatology:—The indications of this disease are few, but characteristic. The face, lips and mucous membranes generally become pale, the patient is breathless, inclined to faint, subject to vertigo, nausea, palpitation or irregular heart action, with transient and irregular shooting pains. There is loss of appetite, extreme weakness, headache, often of a bursting character, and constipation. The skin is cool, often clammy, and usually flabby. The pulse is weak and is apt to be persistently irregular. There may be dilatation of the heart and distinct valvular murmurs, usually from dilatation of the left ventricle. A systolic hemic murmur transmitted to the axilla may be heard over the entire chest.
Considerable difficulty of breathing is often present, with the shortness of breath and sighing respiration, especially on exertion. This may induce an occasional hacking cough or there may be some degree of cough constantly present.
Anemic headache is an especially trying complication. It is usually of a bursting character, and is located across the top of the head. Extreme frontal headache is not uncommon, and when the anemia induces, or is accompanied with nervous prostration, there may be a severe occipital headache which may extend down the spinal column and may later induce spinal tenderness, or the occipital headache and the characteristic anemic headache may coexist. Mental exertion is almost impossible and forgetfulness and mental apathy usually follow. These patients are troubled with insomnia and complain of hot flashes, especially during the night. While they are often sleepy and dull, the sleep is broken and irregular, and does not produce rest and restoration.
There is often a slight effusion into the cellular tissues, especially of the face and of the ankles. The pallor of the skin makes the edema of the eyelids more conspicuous. In females the menstrual irregularity is common. There is deficient quantity of blood and this soon becomes pale and watery and if restoration is not effected will cease entirely.
Diagnosis:—The diagnosis depends upon the knowledge of the loss of blood, as in hemorrhage, or upon the character of the blood, as observed under the microscope in obscure cases. The conditions of this disease being understood, there is usually but little, if any, difficulty in diagnosis.
Prognosis:—The prognosis is usually good but depends upon the character and severity of the causes.
Treatment:—All hemorrhages should be immediately arrested. All local or remote troubles which are apt to induce hemorrhage should be corrected. The system should be restored by the use of the very best tonics. I am convinced that in this form of anemia more can be accomplished by encouraging nutrition and the appropriation of good food than is accomplished with blood making remedies. The food is sufficiently active in blood making properties if the patient be relieved from physical labor and anxiety, and will rest during the course of the restorative process, taking exercise in the sunshine, always short of exhaustion. The administration of iron and other of the more direct blood making remedies will yield good results in nearly all cases and should not be neglected.