Anatomical Changes, Symptoms. (^Q5 



changes as in severe simple anemia. The bone marrow appears 

 to be replaced by a raspberry-like mass or sometimes resembles 

 embryonic bone marrow; it contains fat cells sparingly, but 

 on the other hand numerous different kinds of red blood cor- 

 puscles with one or two nuclei, which are either very small or 

 very large (Babes, Eindfleisch). Not infrequently a relatively 

 large layer of fat is conspicuous under the skin and surrounding 

 the internal organs. 



Grohe found iron in large quantities in the spleen and the liver, Quincke in 

 the spleen and in the kidneys; it was demonstrable by ammonium sulphide, and 

 probably resulted from the great destruction of red blood corpuscles. Quincke 

 found 2.1% of iron in the ash. 



Symptoms. The disease always commences insidiously. 

 Ready fatigue, somewhat disturbed appetite, and as a result 

 a failing of the nutrition as well as a decrease of the circum- 

 ference of the abdomen, first direct attention to its presence. 

 At the same time the paleness of the mucous membranes con- 

 tinually increases. Difficulty of respiration appears during 

 work or even during slow walking. The heart's action is ac- 

 celerated, now and then throbbing, the pulse is later thread- 

 like, the heart sounds sometimes appear indistinct. 



The blood is pale red in color, sometimes with a yellowish 

 tint, it coagulates slowly, its specific gravity, as well as its 

 hemoglobin content, is lower (Lindquist found in one case the 

 hemoglobin content diminished to 60-80%, Friedberger to 

 60%). In affected man the hemoglobin content of the blood 

 is always found to be too high in proportion to the existing 

 number of red blood corpuscles. The number of red blood 

 corpuscles diminishes considerably, and they show changes in 

 form. First of all their non-uniformity in size is conspicuous, 

 inasmuch as some appear much larger and at the same time 

 are frequently pale (macrocytes, gigantocytes), others again are 

 very small, and of an intensely yellow-red color (microcytes) ; 

 in addition, a variable number of nucleated red blood corpuscles 

 may be seen (erythroblasts). At the same time the red blood 

 corpuscles form small money-roll-like groups and some appear 

 peculiarly wasted, angular, elongated, containing one or more 

 projections, club or biscuit-shaped, and sometimes entirely 

 shrunken (poikilocytosis). Friedberger observed in one case 

 an increase of white blood corpuscles and blood plaquelets. In 

 blood of affected man large or sometimes nucleated red blood 

 corpuscles are sometimes found, the diameter of which may 

 reach up to 20 '^, and the presence of which is, according to 

 Ehrlich, supposed to possess a high diagnostic value; this is 

 however disputed by some authors. As the pernicious anemia 

 of man and animal's should not show any marked differences 

 in the blood findings, more attention should be attributed to 

 the presence of gigantocytes or gigantoblasts in the diagnosis 

 of pernicious anemia in animals, and also to the relation be- 



