HYDROÆMIA. ANÆMIA OLIGÆMIA.
Definition. Causes: bleeding, watery repair, hydroæmia, repair of globules, changes in red globules, in bone marrow. Cause of chronicity; profuse secretions; moplasms; parasites; chronic exhausting diseases; defective diet or hygiene; diseases of jaws or throat; overwork; toxic substances. Symptoms: pallid mucosæ, weakness, perspiration, soft tissues, small pulse, palpitation, anæmic heart—arterial and venous murmurs, depilation, indigestion, costiveness, urine clear, abundant, emaciation. Lesions: blood poor in globules, embryonic, and other abnormal red globules, fatty degeneration, blood clot. Treatment: remove causes, diet, hygiene, sunshine.
Definition. Bloodlessness; Deficiency of blood; Lack of red blood globules. The last named is the condition to which the term is habitually applied.
Causes. Anæmia is not so much a disease, as a result of a great many debilitating and exhausting conditions. Hæmorrhage the most direct cause of anæmia determines at first an actual lack of blood (oligæmia) and of blood pressure, which may be sufficient to cause fainting and death. In case of survival the amount of blood is rapidly made up by absorption from all available sources of liquid in the economy, but the blood so restored is essentially hydroæmic having an excess of water and a lack of globules and dissolved solids. If however the loss has been moderate the quality may be restored in a few days. Buntzen found that after moderate bleeding the volume is restored in a few hours; after a profuse hæmorrhage in 24 to 48 hours. After bleeding to 1.1 to 4.4 per cent. of the body weight the increase of the red globules may be noticed after 24 hours, and is completed in 7 to 34 days. It is noteworthy that during this repair the bone marrow becomes much redder and more cellular, and that new red cells found in the blood are nucleated (Neumann) and contain less hæmoglobin (Ott). The absence of hæmoglobin is nearly in proportion to the amount of the hæmorrhage (Bizzozero, Salvioli). If the hæmorrhage is slow and continuous this repair is counterbalanced and the anæmia is much more persistent.
Profuse secretion as of milk (cows, goats, ewes, bitches, on poor feeding), of liquid fæces, urine, or pus often determine a marked and even dangerous anæmia.
The rapid growth of multiple tumors as of melanosis in gray horses has been noticed to cause profound anæmia (Bouley).
Perhaps no cause is more potent than the attacks of parasites and especially such as live by sucking the blood. The numerous strongyli of the lungs, stomach, and intestine, the tricocephalus, and allied round worms, the trematodes of the liver, and the cytodites of birds furnish striking examples of the bloodless and debilitated condition which they may produce. In man ankylostomata causes anæmia in Egypt, Italy (St. Gothard) and elsewhere, and bothriocephala in different countries.
Chronic exhausting diseases especially those which affect the digestive organs and mesenteric glands are prolific causes. So with Bright’s disease.
Connected with these are defects in diet or hygiene. Starvation, unsuitable, innutritions, or indigestible food, too laxative food, damp, dark, draughty or unventilated stables, and irregularity in feeding, watering and work are all potent factors in inducing anæmia.
Diseases of the masticatory apparatus (broken jaw, diseased teeth,) preventing the preparation of food, and pharyngeal troubles interfering with deglutition are other causes. Finally overwork is not to be forgotten.
Toxic anæmia may occur from the ingestion of lead, mercury, or arsenic.
Symptoms. These may be little marked at the outset in slowly developing cases. Extra pallor of the mucous membranes, fatigue and even breathlessness on slight exertion, a small, weak, pulse, with a tendency to become rapid, with violent heart beats, when excited.
At a more advanced stage the mucosæ, especially the buccal, are pale and thin, the muscles are soft, flabby and weak, fatigue and perspiration are easily induced, the feet are advanced more nearly in the median line of the body, and the toes strike on any obstacles, the pulse is weak, small and quick, and the heart easily excited even to palpitation, and with an occasional anæmic murmur with the first heart sound. Arterial and venous murmurs may be present. The hairs are easily detached. Appetite and digestion fail, there is costiveness, a full secretion of urine of a clear aspect, the subcutaneous fat disappears and the skin feels thin and limp (paper skin in sheep), the hair dry and lusterless, the wool flattened (clapped). The weakness and emaciation go on increasing and dropsies appear in the limbs, under the trunk and jaw and in the internal cavities.
Pathology. Lesions. Apart from the causes, the morbid conditions are mainly found in the blood. The watery state of the blood, the lack of red globules (even to but 2,000,000 per cubic millimeter), the absence of albumen (76 per 1000 in place of 83), the loose coagulum with excess of buffy coat, and the excess of serum are characteristic. The presence of large, nucleated (myelogenous) red cells, of spherical bodies smaller than the normal red cells (microcytes), and of irregularly shaped red cells (poikilocytes) is characteristic, the latter especially of pernicious anæmia. As the disease advances fatty degeneration of heart, liver, kidneys, and other organs are complications and tend to aggravate the disease, by counteracting repair of the globules—thus establishing a vicious circle. All the organs are pale and flaccid, the arteries empty, the veins contain a little blood, forming pale clots. In the cases considered, all the result of another disease, the lack of blood and of the solid and vital elements in that which remains, entails imperfect function in all the vital processes, including sanguification itself, and in this way an anæmia once established tends to perpetuate and aggravate itself.
Treatment. The anæmia above considered being largely symptomatic, or resultant from other diseases, the first consideration as regards both prevention and treatment is to prevent or cure such diseases. Where dietetic or hygienic, a liberal diet, and good hygiene will meet every demand in the early stages. In the warm season an open air life is most important. In case of a drain by over-secretion (milk) this must be judiciously checked. In bitches it will often be needful to wean several of the puppies. A rich and very digestible diet (oats, beans, linseed, oil meal, milk, gruel), in small compass, and suited to the genus and individual, with iron and bitters, and in the herbivora carminatives, will suit many cases. Muriate of iron, with strychnine or nux vomica; iron sulphate, sodium chloride and nux; or dialysed iron, or some other soluble ferruginous salt, with quinia, gentian, or some other bitter will serve a good purpose. For the dog saccharated carbonate of iron or citrate of iron and ammonia with quinia or strychnine, in pill form, is convenient. With poor digestion muriatic acid and pepsin may replace the iron at first. Beef teas may often be given with advantage, even to the herbivora, and injections of defibrinated ox blood night and morning have proved of service. In extreme anæmia, as from hæmorrhage, transfusion, or its equivalent, must be resorted to. A normal saline solution (0.6 per cent. NaCl), boiled, may be thrown into the peritoneum or subcutaneous connective tissue, or defibrinated blood, may be injected into the peritoneum. Transfusion is the dernier resort.