Watson, Robert Henry

2018-01-31T11:39:50Z

2018-01-31T11:39:50Z

1898

So long as the aetiology is unknown it is impossible to claim any treatment as a rational cure for the disease, while the uniformly fatal issue up to the present time proves that empiric treatment has no permanent value.

All authorities agree that Iron alone is of no use whatever, seldom showing any improvement even temporarily.

From the use of Arsenic. alone or combined with Iron, from Bone-marrow and from Oxygen considerable benefit can always be obtained for a time, Koster claims complete recovery from advanced Splenic Anaemia in 3 months, from the administration of Arsenic and Quinine with 4 litres of Oxygen daily in a case previously going down under Arsenic and Quinine alone. Taylor, on the other hand, obtained only a temporary improvement from Arsenic and Iodides with as much as 30 litres of Oxygen daily.

While Arsenic is antiseptic, it also, like Iron and Bone-marrow, stimulates the growth of bone (the chief blood-forming tissue) and, according to Bins is a means of indirectly supplying oxygen to the tissues.

In severe cases a trial night he made of injection of arsenic or quinine into the spleen.

Transfusion of blood has been used with apparent temporary benefit , but , promising as were the early results, it has been, as far as I can gather, finally abandoned as a mode of treatment in primary anaemias.

Splenectomy has been tried in one or two cases with transitory benefit. Banti, Wells, Taylor & Gould have given their opinion in favour of this radical treatment of the splenomegaly. The danger of the operation is rapidly becoming less with improved technique, Spanton's mortality-tables showing already no more than 37$f of deaths. In the improvement after splenectomy there-'is perhaps some slight confirmation of the theory of microbic origin, from ' the fact that the main constitutional result of the removal of this organ is an increase of the bactericidal action of the blood and consequently a greater power of recovery from ineffective processes (Blunreich & Jacoby). Besides we must allow that whatever the nature of the cause of the disease of the spleen , so long as no change can be traced outside of that organ. removal of the spleen jna^mean remove 1 of the origo mali.

In regard to the treatment of my patient M, P. there are two details worthy of mention,

(1) The rise of Bourboule Water 3,3 an introduct¬ ion to the administration of Arsenic. It was taken with ease and benefit when very small doses of Arsenic in other forms were rejected. It is to be remambered that, apart from the Arsenic it contains, Bourboule Water is practically blood-serum.

(2) The very, large amount of Bone-marrow taken | without disturbance of digestion. As much as 6 oz, was taken daily for several weeka, twice as much as the largest dose I have read of, (Fraser & Barr) . It is of course true that the marrow usually administered consists of nothing but fat (Stockman.) but even fat is a stimulant to the blood-forming tissues (Passe etc.)

The treatment of Splenic Anaemia therefore must be conducted on general principles.

1. We can conserve the patient's energies by complete rest , better in. open air and sunshine when possible.

2. We can supply a light, nutritious, blood-forming mixed dint.

3. We can directly stimulate reformation of the blood "by the use of the drugs already named.

4. And in the last resort (or better, perhaps, at an early stage) splenectomy may be tried with a fair prospect of considerable tempor¬ ary improvement and a chance , remote it must be confessed, of permanent cure.

http://hdl.handle.net/1842/27626

The University of Edinburgh

Annexe Thesis Digitisation Project 2017 Block 16

Already catalogued

Splenic anaemia

Thesis or Dissertation

MD Doctor of Medicine