SIMPLE ANEMIA 309 



The diagnosis of simple anemia, therefore, is often easily made from its 

 most manifest features. The careful physician will, however, make a blood ex- 

 amination, or at least a test for hemoglobin, even in cases where a glance is suf- 

 ficient to show that he is dealing with anemia. In this way alone can we 

 determine with certainty what part vasomotor influences play in shaping the 

 disease. This alone will assure us that the supposition of anemia is not un- 

 founded; and if the test shows a reduction we have then positive information 

 regarding the degree of anemia. Moreover, in every case of severe anemia, a 

 microscopic examination of a stained specimen of the blood is absolutely neces- 

 sary in order to make the important differential diagnosis between simple and 

 progressive pernicious anemia. 



The prognosis depends, in the first place, upon the cause of the disease. 

 If this can be removed there is a good prospect of a cure. Under such cir- 

 cumstances, even in the severest cases in which the hemoglobin and the number 

 of red corpuscles amount to only 10 per cent, of the normal, we have known 

 cases of simple anemia to terminate in complete recovery. 



The treatment of simple anemia must in the first place be directed to the 

 cause. In numerous cases in which the cause is found and removed, as, for 

 instance, continually recurring hemorrhages in the intestinal tract, worms, 

 improper hygienic conditions, etc., no special treatment of the anemia is neces- 

 sary after the removal of the cause ; for spontaneously the blood returns to its 

 normal state. 



When causal treatment is impossible, or when it fails to influence the 

 anemia beneflcially, attention must be paid to the symptoms of anemia as such. 

 In the great majority of cases, medication is far superior to any other mode 

 of treatment. Iron and arsenic, separately or combined, lend a powerful 

 stimulus to blood production, and after their rational administration, often 

 even in a few weeks, the morbid changes in the blood and in the general con- 

 dition disappear, and make way for a restoration to health. The choice of 

 the special preparation is essentially unimportant; the main point is to con- 

 tinue the treatment long enough, and to administer sufficiently large doses. 

 The general rule that 0.1 gram of iron is to be given pro die may serve as 

 a criterion for the administration of special iron preparations, organic or 

 inorganic. The dose of arsenic varies widely, and it must be determined by 

 the individual tolerance. TJsually we succeed best if we administer 3 to 5 milli- 

 grams of arsenious acid, divided' into several doses, properly diluted and given 

 on a full stomach. The drug should be continued for a long while, even after 

 the normal status has been reached. 



But there are other anemic conditions in which iron and arsenic give unsat- 

 isfactory results, or are of no use whatever. Here dietetic and physical therapy 

 must be resorted to. As the metabolism of anemia does not deviate from the 

 normal, the normal diet of healthy people may be allowed. Theoretically, pref- 

 erence has been given to food rich in iron (meat, yolk of egg, spmach, apples, 

 etc ). Often, however, owing to the special peculiarities of a given case (for 

 instance, in cases complicated with gastro-intestinal affections) special modifl- 

 cations of the diet must be made which cannot be here considered. _ 



Among the general auxiliary measures in the treatment of anemics, rest— 



