Her appearance was that of a person with pernicious
anaemia, a very yellow muddy skin, dry and harsh to the touch, and the
hands and feet cold, almost to the point of pain.
On examination the spleen was decidedly large; the lower border of the
stomach reached to the level of the umbilicus. Two cardiac murmurs were
present, the one a sharp and well-defined mitral regurgitant sound,
confirmed by the dyspnoea and dropsy as organic, the other a loud
musical murmur of haemic origin. The trouble in deglutition proved to be
due to an oesophageal narrowing. The blood examination bore out the
suggestion of probable pernicious anaemia, the red cells being only
1,500,000, haemoglobin 18 per cent.: the microscope showed microcytes,
megaloblasts, nucleated red cells, and a large increase in white
corpuscles. In order to study the effect of massage alone upon the blood
no other treatment was used, though of course the patient was kept at
"absolute rest." No drugs were given, electricity was not used, and
extra food was omitted, as the irritability of the oesophagus made her
unwilling to attempt the exertion and annoyance of frequent feeding.
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