146 THE BLOOD COKPUSCLES IN ANAEMIA. [BOOK I. 



This degree of diminution of the coloured corpuscles occurs under 

 the following circumstances; in feeble individuals of the so-called 

 lymphatic diathesis : under the influence of insufficient diet : in 

 persons inhabiting marshy districts : as the result of a copious blood- 

 letting : as a result of the persistent use of purgatives : in chronic 

 Bright's disease : after some days of an acute disease, such as a fever : 

 in the course of many chronic diseases, &c. 



Class B. Medium diminution (weight of dry blood-corpuscles 

 between 80 and 100 per 1000 of blood). 



This state of the blood is accompanied by a much more marked 

 debility of those subject to it. The skin is pale and slightly 

 yellowish. Bodily exertion is irksome. There exists palpitation, 

 and some dyspnoea may come on if the patient takes exercise. 

 There is a soft bellows murmur in the aorta and carotids, which is 

 rarely propagated along other arteries. 



The causes enumerated under Class A may, if continuing in 

 operation, lead to the case being classed under B. As special 

 causes are to be mentioned ; considerable losses of blood : continued 

 diarrhoea (or dysentery) : malarial cachexia : the cancerous cachexia : 

 lead poisoning: chronic Bright's disease : the last stage of chronic 

 diseases : lastly, and chiefly, chlorosis. 



Class C. Great diminution (weight of dry blood-corpuscles varying 

 between 40 and 80 per 1000 of blood). 



Cases belonging to this class are much rarer than the preceding. 

 The skin is pale, and may present a greenish hue, the strength is 

 diminished; sometimes the least movement occasions sensations of 

 painful weariness, muscular pains, dyspnoea and palpitation. Cephal- 

 algia, vertigo, tinnitus aurium and other nervous troubles appear, 

 in varying degrees of intensity. Syncope is readily induced; the 

 pulse is quick and dicrotic ; there is a murmur with the first sound 

 of the heart at the base. A very loud bellows murmur is heard in 

 the carotids, and usually there exists, especially in chlorosis, a more 

 or less loud venous murmur (bruit de diable). 



The following causes specially lead to the condition observed in 

 this class; great or frequently repeated hemorrhages: chlorosis: 

 malarial anaemia: the cancerous cachexia, especially where cancer 

 affects the stomach. 



If to the causes producing a diminution of the blood-corpuscles 

 enumerated by Becquerel and Rodier, we add abundant and long- 

 continued suppuration, scurvy, leucocythaemia and the affection 

 designated by the term 'pernicious anaemia' we shall have before 

 us a pretty complete catalogue of the various morbid states con- 

 nected with a diminution of the blood-corpuscles. 



As will be appreciated by the reader of the section in which the 

 determination of the weight of the coloured corpuscles is described, 

 the weight of the dry corpuscles as found by such a method as that 

 employed by Becquerel and Rodier does not admit of absolute accuracy. 

 For the purposes of the physician it would be better if we could express the 



