TREATMENT OF PERNICIOUS ANEMIA 255 



alternating every other day, may aid in reestablishing 

 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 reenforcement, 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,, im 

 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- 



