NOTE ON PERNICIOUS ANEMIA AND CHLOROSIS 
IN THE NEGRO. 
By J. H. Musser, M.D., 
Assistant Professor of Clinical Medicine, University of Pennsylvania. 
As far as the writer’s knowledge goes, cases of the above diseases 
in the black race have not thus far been reported. Cn account of their 
rarity, therefore, the following notes are presented : 
Case of Pernicious Anemia in the Negro.—E. D., aged 50, a 
widow, cook by occupation, black, was admitted to the medical wards 
of the Presbyterian Hospital, October 10, 1891. Her habits, as far as 
could be ascertained, had been good, and no cause could be found for 
her anemia. Her mother died of dropsy, and her father of an alleged 
slow poison, said to be due to work in chemicals. One sister died of 
cancer, another of phthisis, and a brother of acute intestinal disorder. 
The patient has had the usual children’s diseases and varioloid. 
At the age of 18 she had an attack of inflammatory rheumatism, and 
since then she has had three attacks at long intervals. She says she 
had malaria very severely during the past nine years. She had nine 
children in twelve years, and the menopause took place fifteen years 
ago. 
The patient has been feeling badly for a year. Her symptoms 
occurred at irregular intervals in exacerbations; shortness of breath, 
attacks of nausea and vomiting, neuralgic pains in the legs, and head- 
ache, were the most prominent. Her feet would swell, but the swell- 
ing would disappear on treatment. 
On examination the patient was much older in appearance than 
the age given. There is riot much loss of flesh. Her teeth were poor; 
the mucous membranes of the tongue and mouth particularly pale ; the 
sclerotics were very white, and conjunctivae extremely pallid. She 
suffers from extreme weakness and shortness of breath, on account of 
which she is in bed most of the time. The anemia and apparent cause- 
lessness of her disability led to careful examination of the abdominal 
organs, with the following results : The liver was of the normal size ; 
the abdomen slightly distended ; the functions of the gastro-intestinal 
tract appeared to be good. There was no evidence of any organic 
disease. The aorta pulsated very much, and was the cause of con- 
siderable distress. Indeed, the pulsation, and bruit with pain, caused 
one to suspect the presence of an aneurism. Examination of the lungs 
did not reveal anything of note. The apex of the heart was seen in 
the fifth interspace ; the impulse was diffused and strong. The upper J. H. Musser. 
2 
border of cardiac dulness began at third interspace, and the left border, 
in midclavicular line, fifth interspace. At the apex a loud systolic 
murmur was heard, transmitted into the axilla, and a faint murmur was 
heard at the second costal cartilage on the right, conducted into the 
carotids. A loud murmur was heard in the vessels of the neck. 
Carotid pulsation was marked; the jugular veins were not full. Patient 
remained in the hospital, growing weaker and weaker. On account 
of extra pressure of work, from a prevailing epidemic, the blood was 
not studied as it should have been. The count of the r. b. c. showed 
reduction of the same to 1,600,000, and several examinations for 
hemoglobin showed an average of 16 per cent. Death took place 
gradually from asthenia, during the term of service of my friend, Dr. 
Woods, to whom I am indebted for the privilege of reporting the case. 
The autopsy was made by the pathologist, Dr. Griffith. There 
was entire absence of organic disease in all the organs examined ; the 
tissues and fat were like those of pernicious anemia. The heart was 
markedly fatty, and showed the tabby-cat striation very distinctly. 
The marrow of the bones was very red. The liver and kidneys con- 
tained an excess of iron. Further report of the pathological features 
of the case will be made by Dr. Griffith.1. 
Case of Chlorosis in a Mulatto.—The patient was a young girl, 
aged 22, who had suffered for six months with all the severe symptoms 
of chlorosis, of which gastralgia, persistent throbbing headache, with 
palpitation and pulsation of the vessels, were the most marked. The 
symptoms were so striking that they led to an examination of the blood. 
Such examination showed the presence in a high degree of the changes 
found in chlorosis. The use of Blaud’s pills, as commonly advised in 
this affection, proved most satisfactory, and in a short time all the 
symptoms, for which the patient had been treated a long while, 
disappeared. 
1 See Trans. Col. of Phys., 1891.