THERAPY 319 



Marked improvement and even apparent cure has been repeatedly noticed 

 after the stomach and intestines had been thorougUy cleansed by laxatives 

 and irrigations. In such cases we are warranted in the interpretation of the 

 progressive pernicious anemia as an autointoxication from the gastro-intestinal 

 tract. 



Organotherapy, the treatment of the disease with bone-marrow, has thus 

 far given no results. 



On the contrary, some very surprising, though not always accountable, 

 results have been attained by the transfusion of small quantities (40-100 

 c.e.) of defibrinated human blood. In several cases transfusion has been 

 followed immediately by the onset of a complete remission of the disease and 

 life was prolonged for months, though when transfusion was again performed, 

 after a relapse, it was ineffectual. But if the patient's life is endangered, 

 and if coma has already set in, this operation is our last hope and resource, 

 and should at least be attempted. 



The most important and successful treatment is by arsenic. To this 

 remedy we are indebted for an extraordinarily large number of apparent cures, 

 and by its aid in some cases we succeed in bringing about remissions and in 

 delaying the imminent outbreak of a relapse. 



Nevertheless there can be no lasting cure, even with the aid of arsenic. 



This remedy is administered according to the generally observed rules : 

 Small doses in the beginning and gradually increased, long-continued use, 

 and a gradual decrease. The doses should be adapted to the individual sus- 

 ceptibility and reaction; as a rule, even during the acme of the treatment, 

 we find doses smaller than the maximal to be sufficient. During the remission, 

 when no symptoms are present, it is well to give the remedy from time to 

 time for several weeks. The best indication for a renewal of the treatment 

 is afforded by regular examinations of the blood, which may give warning of 

 a new outbreak before the clinical symptoms suggest it. 



An unfortunate idiosyncrasy for arsenic not infrequently develops in the 

 course of treatment, and may prove disastrous for the patient, inasmuch as the 

 proposed substitutes for this remedy have not yet borne the test of experience. 



As for general treatment, rest and comfort are of paramount importance. 

 The diet must be adapted to the individual susceptibility of the stomach and 

 intestine, as well as to the sometimes insurmountable repugnance of the 

 patient for meat. In view of the debility of the patient, hydrotherapeutic 

 treatment is not advisable, but sponge baths may be given without danger. 

 General massage is preferable to bathing. A change of climate may be indi- 

 cated during the remissions, and a sojourn in a mountainous region of mod- 

 erate altitude is more likely to prove beneficial than any other climatic change. 



LITERATURE 



The earlier literature of this subject, in all its details, is given by Ehrlich-Lazarus, 

 "Anemia," " Nothnagel's Handbuch," viii, Wien, 1900. More comprehensive works 

 which have appeared are: Strauss and Rohnstein, "The Composition of the Blood in 

 Different Anemias," Berlin, 1901; Schaum.ann, "Pernicious Anemia in the Light of 

 the Modern Toxin Hypothesis," Volkmann's Clinical Lectures, New Series, No. 287. 



