TREATMENT OF PERNICIOUS ANEMIA 255 
alternating every other day, may aid in reéstablishing 
the activity of the blood-making processes. In nearly 
every case, in my experience, some form of the iodides, 
usually as syrup of hydriodic acid, has been of great 
adjunct value. 
Since many cases of pernicious anemia are in need of 
digestive assistance, the administration of diluted hy- 
drochloric acid and essence of pepsin in large doses 
should be persistently continued until the stomach is 
capable of resuming its normal function. Hemoglobin, 
with suitable endocrine reénforcement, is a very suc- 
cessful aid, and it should be pushed to the physiological 
limit. It is well to cease entirely with the organother- 
apy for five or ten days, and then push again as before. 
During all of this time if the patient is kept in bed, in 
the fresh air and sunshine when possible, the results 
are very much more satisfactory, as even a small 
amount of muscular exercise seems to destroy the re- 
sults that are so hard to obtain. It has been found 
that frequent relapses occur after exercise, that do not 
occur with a prolonged rest in bed until the cells are 
well above three million and the hemoglobin above 65 
per cent. 
Tonics, aids to digestion, and, in fact, all supportive 
measures as, for example, diet for the building up of 
tissue and hygiene for the prevention of toxemia, will 
be of great assistance and will give the patient the up- 
lift that is so much needed. 
That the benefit obtained from this line of treatment 
will last indefinitely is, of course, problematical. Clini- 
cal cases remaining well for from three to six years, 
and who are still going on with their usual occupations 
with no relapses in that time, offer a degree of encour- 
agement that no other treatment affords. Provided the 
source of infection is satisfactorily removed and the 
system is thoroughly stimulated and immunized by the 
serum and built up by the means before indicated, re- 
