(BURNS’ ANEMIA)
Costogenic Anemia is a result of functional disuse-atrophy of
the hematopoietic organs, there being an insufficient supply of
erythrocytes to meet the demands of the metabolism of the body. It
results from insufficient opportunity for nutrition and drainage of the
red marrow of the ribs, and gives the clinical picture of an anemia due
to too slow production of erythrocytes.
=Etiology.=—The condition is predisposed to by any factor which tends
to limit the action and nutrition of the ribs. We are too prone to
forget that the function of the ribs is to produce erythrocytes; it
is really a matter of secondary importance that they make up part
of the thoracic wall. The change from the horizontal to the upright
position has tended to a drooping of the whole chest from gravity. The
human animal seldom develops the free hinge rib motion as often seen
in quadrupeds. The passage of both arterial and venous blood, is not
normally free and copious, and as a consequence the tissue supplied
functions less efficiently. This function of the red marrow is to
produce erythrocytes. Any structural lesion of the dorsal vertebral
column, or its costal articulations, which interferes with the free
motion of the rib thus interferes directly with the efficient function
of these particular ribs. The severity of the condition varies with the
number of ribs affected and the impedance to nutrition and drainage.
=Diagnosis.=—The condition may be of gradual onset, and may be
associated or coincident with some other condition leading to a loss
of tone or opportunity for free rib action. The systemic symptoms are
due to a deficient oxygenation of all tissues as a result of the above
disuse. The thorax is usually rigid—forced respiration requires unusual
effort without proportionate thorax expansion. The type of breathing
tends toward diaphragmatic. The quantities of tidal and supplemental
air are both markedly decreased. The lack of tissue oxidation renders
elimination less active, hence constipation. Gas accumulation,
weakness, insomnia, with slightly increased amount of urine, and low in
total solids, is the rule.
“The blood itself is rather characteristic. Coagulation time is
increased; specific gravity and viscidity diminished; red cell count
normal or only slightly diminished; hemoglobin 6 to 10 grams per
100 c. c. of blood (Meischer); 40% to 80% (Dare). The red cells are
small, pale, vacuolated, sometimes nucleated. The white cell count is
normal, slightly increased or slightly diminished. The hyaline cells
are normal, or slightly relatively increased. (These, being formed
in lymph nodes, tonsils, etc., are not affected by rib changes.) The
mononuclear neutrophiles are relatively increased. The nuclear average
of the polymorphonuclear neutrophile is low. Vacuolated and atypical
neutrophiles are often found. Basophiles, myelocytes and amphophiles
may be found in considerable numbers. Nuclei in all granular forms
present evidences of immaturity or degeneration—they may be swollen,
vacuolated, extruded, ragged, or with variable staining reaction”
(Clinical Osteopathy).
=Treatment.=—The treatment is to obtain a normal function in the
inactive tissues. This is done by getting better rib hygiene. Whatever
is interfering with rib function and metabolism is to be removed.
Breathing exercises are given not only to “ventilate the thorax, but to
exercise its walls”. Carefully selected horizontal bar work is often of
great value. The diet should be of such nature as to supply material
for manufacture of erythrocytes and for loading them with hemoglobin as
well. Hence the foods with high chlorophyl or hemoglobin content should
be emphasized.
=Prognosis.=—This depends on patient’s desire for improvement of his
condition. He can be improved by correction of whatever lesions there
may be interfering with his freedom of thoracic motion. He can be
benefited by manipulations which adjust the ribs, but his cooperation
is essential. Lack of cooperation on the part of the patient, which
would tend to increase the mobility and metabolism of the ribs, renders
him more liable to any of the intercurrent pulmonary infections, as a
result of his deficient thoracic ventilation.
Encourage free thoracic respiration especially when in school, or when
under conditions which ordinarily would tend to slovenly habits of
breathing.