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Causes and Treatment of the Main Primary and Secondary Forms
While modern improvements in hygiene and the standard of living have greatly reduced the frequency of this disease it has not been conquered. The various kinds and causes of anaemia are here enumerated the difficulties of diagnosis explained and methods of treatment outlined.
Anaemia is the name which is given to any impoverished condition of the blood. From its derivation it means "bloodlessness," and in the widest sence of the term anaemia is met with in numberless states of disease. It may be due to impaired formation of any of the constituents of the blood, to excessive blood destruction, to an alteration of the amount of fluid in the blood causing dilution or concentration of its cells, or to a combination of these factors. Thus it may be only a symptom of some other disease which is reducing the strength of the blood or it may be caused by some interference with the activity of the blood-forming tissues themselves.
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There are then two main groups of anaemia: (A) Secondary anaemia, which is a symptom of some diseased state (B) primary anaemia in which the blood-forming tissues are at fault.
The causes of secondary anaemia are :
( 1 ) Haemorrhage. After a large haemorrhage, or as a result of continued loss of small amounts of blood, there is a dimi- nution in the number of the corpuscles of the blood. A large loss of blood will result in the absorption into the blood vessels of water from the tissues, resulting in a diluted blood, which is paler than normal blood and does not carry ont its duties satisfactorily. In favourable cases after a haemorrhage the blood becomes normal again in a few weeks.
(2) Acute fever of any kind causes an increased destruction of the blood cells, due to circulation of toxins in the blood.
(3) Unhygienic conditions such as improper food or insufficiency of, fresh air and sunlight, result in anaemia.
(4) Certain chronic diseasea such as cancer, tuberculosis kidney disease syphilis malaria, and chronic infection of the mouth, tonsils, bowel or other organ may poison the blood and cause anaemia
(5) Some metallio poisons such as lead and mercury, may cause a degeneration of the bone marrow which produces some of the bloodcells.
(6) Among other causes it should be men- tioned that the strain of prolonged suckling may cause anaemia.
Amongst the primary anaemias or" blood dieeases the following, fully dealt with under their own headings, are the more important:
(1) Chlorosis or green sickness, an anaemia which affects the femalo sex almost exclusively between the ages of 16 and 20. Males are rarely affected. It is a disease of civilised races and is rapidly becoming less prevalent than it was even in very recent times. In chlorosis the pallor is of a greenish yellow tint, although at times the disease may be masked by redness of the cheeks. the body is usually well nouriehed, but the patient complains of lassitude and shortnees of breath. Dyspepsia is commonly present also amenorrhoea (q.v.).
(2) Pernicious or Addison's anaemia, an anaemia of insidious onset which attacks males more often than females, and which terminates usually in death, although there are periods of improvement.It is more often a disease of middle life. Its cause is as yet unknown, but it is possibly a deficiency disease, i.e. due to the want of some essentialfactor in the diet.The success of the modern treatment by liver extract points in this direction.
(3) Leukaemia, a disease of the blood characterised by an increase in the numbers of the white cells of the bloodThere are several varieties of the disease, but little is known of its causation. Men are more often attacked than women, while cases in children are not unknown.
(4) Hodgkin's disease, a disease characterised by enlargement of the epleenanaemia and progressive enlargement of the lymphatic glands of the body. Most cases occur in the young male subject or in early adult life. The cause is not known and the outlook is unfavourable.
(5) Splenic anaemia, a disease of unknown origit associated with enlargement of the splean The form of infantile anaemia known as Von Jakech's disease is a type of splenic anaemia.The radical cure is removal of the spleen.
(6) Haemophilia or bleeders' disease (q v.), a constitutional andhereditary disease which consists in a tendency to bleeding which is difficult to control. Death may result in such cases from the lose of blood from any small wound. In these cases the blood does not clot readily.
(7) Purpura; a condition of the blood which may result in markedanaemia It is characterised by bleeding into the skin, resulting in purple spotsbut there may also be bleeding from the gums, bowel lungs and kidneys.
(8) Scury, now a rare disease in England, causey by improperfood, deficient in vitamin C. It is classed with diseases of the blood, as it is charactzrised by a tendency to bleeding from the gume into the skin and elsewhere.The blood shows definite changes. Profound anaemia and death may result.The disease may attack infants who are improperly fed. Mild, unrecognized conditions of sourvy are fairly common in infants and adults.
ANAEMIA: BLOOD EXAMINATIONS IN VARIOUS FORMS OF THE DISEASE: 1. Normal blood showing the usual high proportion of red cells, with occasional white cells and minute blood platelets. 2. Blood from spleno-medullary leukaemia: numerous white cells of abnormal type present. 3. Blood from pernicious anaemia: here red cells are scanty varying in size and distorted. 4. Blood from lymphatic leukaemia: red cells are diminished, while white cells are more numerous, and of the form known as lymphocytes.
In all forms of anaemia, whether primary or secondary, the interference with the normal condition of the blood results in definite symptoms. The body is insufficiently aerated and inaufHciently supplied with nouri hment The symptoms that result are nu There may be at first shortness of breath with general lassitude and weakness, t.ben giddiness, palpitation, headache and even fainting. Dyspeptic symptoms, with nausea and vomiting, may occur, and diarrheoa is frequent.
Diagnosis and Treatment.
The diagnosis of a case must rest on a skilled medical oxamination, and on an examination of the blood itself. Pahor of the skin is not a safe guide to the diagnosis of anaem;a. It should always be remembered that in certain trades and in certain diseases there may be pallor but no anaemia. Pallor may be associated with perfect health, and yet rosy cheeks may exist in severe anaemia.
With regard to the treatment of anaemia, the first step is to diagnose with certainty the variety that exists. If it should be a secondary anaemia, the troatment must be directed towards removing the cause, when the natural processea of repair will restore the blood to normal. In the primary anaemias the diagnosis must be made as accurate as possible by skilled examination. In the graver forms of anaemia, arsenic often produces a temporary improvement. In chlorosis the administration of iron will nearly always cure. In pernicions anaemia large doses of hydrochloric acid have been given because it is found that these patients lack this acid in the gastric juice.
Treatment by feeding with about half a pound of liver raw and cooked, or better with concentrated liver extract each day, has given results which much surpass any hitherto obtained, and this treatment has undoubtedly saved many hitherto hopeless cases. It must be persisted long after apparent recovery. With this exception and that of anaemia due to scurvy the other types of secondary anaemia are very refractory to treatment.
Anaemla in Children
Primary blood diseases such as chlorosis and pernicious anaemia are of extreme rarity in childhood, but splenic anaemia may occur though it is generally of syphilitic origin.
Secondary anaemia may occur at any time in a child'a life. Rickets and syphilis may cause profound anaemia. Digestive disturbances, constipation and improper feeding are a frequent cause. After any attack of fever, such as pneumonia or measles, there is often a period during which the child a anaemic. Rheumatism is very often associated with anaemia. Other causes are worms, enlarged tonsils, and adenoids, and defective hygiene, particularly insufficient fresh air and exercise.
The symptoms of anaemia in the child are similar to those in the adult. The child becomes weak, pale, and easily tired. There is sometimes much sweating, which may raise the alarm of tuberculosis. Murmurs in the heart may develop and suggest the possibility of early heart disease. The spleen may enlarge in children even with a secondary anaemia so that great care and alcill are needed in diagnosis. The microscopic appearance of the blood also is often so abnormal even in a simple anaemia as to raise suspicions of a serious blood disease. Most cases of anaemia in childhood result in complete cure, when the cause is removed.
The cause of the anaemia must be determined as soon as possible and treated by appropriate remedies, but it is the discovery of the cause which may present the greatest difficulty. The child must then be placed under good hygienic conditions of food, clothing, housing and fresh air. rest in bed may be necessary, with exercises as improvement sets in. Simple nourishing diet is needed. Cod liver oil is an excellent remedy alone or combined with malt extract and iron. Arsenic in small doses often hastens improvement. Iron is usually well tolerated in the form of the syrup of phosphates of iron in half-teaspoonful doses in water three times a day after food. Sulphates of iron in half-grain doses may also be given, but constipation must be guarded against by laxatives.
Local Anaemia
It is also possible for a part only of the body to suffer from anaemia, in which case there is a condition of purely local anaemia Thus, the brain may suffer f om a local anaemia, and swooning results. This may happen as the result of an emotional stimulus, or as a result of severe pain. Other organs of the body also may suffer from this local anaemia., which causes a loss of activity. Certain arteries may, as a result of spasm of their walls, carry insufficiont blood to the organs or tissues. The "dead fingers" (q.v.) that some people suffer from are thus due to a spasm of the blood vessels to the fingers.
ANAEMIA: in Animals. General anaemia is usually classified as secondary or primary. Secondary anaemia is always symptomatic, whereas primary is essential.
Acute, secondary anaemia follows profuse bleeding. The symptoms depend on the severity of the bleeding and vary from paleness of the vieible mucous membranes, tumultuous heart action and quickened respirations to death in convulsions. Treatment consists in stoppage of the bleeding by surgical means. If the bleeding is internal, adrenalin should be given hypodermioally and large quantities of normal saline administered as an enema or subcutaneousl.
Chronic secondary anaemia is often seen in animals which are underfed, which are kept in insanitary conditions or which suffer from malignant or chronic diseases. The symptoms are not very obvious. The mucous membranes are pale, the animal is dull and easily tired, the appetite is poor, the coat staring and emaciation more or less pronounced. Treatment consists in attention to diet, the removal of the primary cause, if possible, and the use of iron-arsenic tonics.
A not infrequont form of anaemia is found in house-kept dogs. In most cases it is due to feeding on a diet of a too strictly biscuit nature. A complete cure is often effected by the addition of a small quantity of minced meat each day or on alternate days. Liver must not be given, as it is liable to cause diarrhoea, especially in the animal's weakened condition. The dog should be taken out as often as possible and cannot get too much sunlight. This last instruction may well be applied to all anaemic animals.
Primary anaemia is a specific disease as a rule, but is seldom seen in animals. Chlorosis of human beings does not exist in the lower animals: but pernicious ana.emia has been seen in cattle, sheep, pigs and dogs. It consists in a reduction in the number of red cells with many degenerate forms. The white cells are also reduced, but not to the same extent. The cause is unknown.
Infectious Anaemia in Horses
This disease, which is also caved swamp fever and equine pernicious anaemia, is a contagious malady of horses and mules due to an ultra-visible virus, and characterlsed by serious and progressive bloodlessness, with marked emaciation and debility. It occurs chiefly on the western seaboard of North America and in certain regions of France, Switzerland, Germany and Hungary, especially in swampy areas.
The virus is present in the blood stream of affected animals, and the natural method of spread is by contamination of food and water with blood or urine from a previous case. It is possible that it may also be spread through the agoney of a blood-sucking insect.
There are three types of the disease, acute, subacute and chronic, but in many instances they merge into each other in the same animal. In the acute type the animal becomes suddenly dull, unfit for work and greatly weakened. It loses appetite, develops a difficulty in breathing and a high temperature and shows dropsical swellings along the lower line of the abdomen. Inflammation of the bowels often occurs, associated with a blood-stained diarrhoea, and death occurs in from 7 to 15 days from the commencement.
In the subacute form the symptoms are similar to those shown in the acute, but are always less severe. Periodic remissions are common in which the horse apparently regains its normal health and may work well for weeks, but a relapse is sure to follow, each succeeding relapse being more severe than that immediately previous.
The chronic type is the typical anaemic form of the disease, and is commoner than the others. The disease begins in an insidious manner with dullness; irregularity of appetite, staring coat, yellowish diacoloration of the mucous membranes of eyes and mouth and pronounced weakness during work. Both horses and mules are easily exhausted, and if made to continue their work may fall to the ground and be unable to rise. A few cases recover with good nursing, but they are always a menace to other horses, for they act as carriers of the infection and can only be worked and housed by themselves.
All doubtful cases should be isolated until a definite diagnoais is establiahed. Animals with the disease should be destroyed at once and their carcases disposed of in a safe manner. Careful disinfection is necessary, both of the stable premisea and of any buildings which have been used by the sick. Affected horses should never be allowed access to running streams, as the dangers of contamination are great. Medicinal treatment of sick animals is useless.