PROGRESSIVE PERNICIOUS ANEMIA. 817 



[CHAPTER IV. 



PROGRESSIVE PERNICIOUS ANAEMIA. 



THE old names of " essential," " idiopathic," " fatal anaemia," 

 etc., probably referred to the disease now called " progressive per- 

 nicious anaemia." Little is known of the causes of this gradually 

 progressing disease, which is nearly always fatal. It is most fre- 

 quent in middle age, but occurs later, as well as in childhood. It is 

 more frequent in females, especially after confinement or during 

 pregnancy, in which case it is apt to induce miscarriage, followed 

 quickly by death. Sometimes the disease can be ascribed to no 

 cause ; at others it may be referred to bad nourishment, repeated 

 losses of blood, diarrhoea, etc. The onset is usually insidious, with 

 great paleness of the skin and mucous membranes ; if there is no 

 fever, the nutritive condition of the patient may be little disturbed. 

 The patients are very feeble, with great tendency to faintness, 

 dyspnoea, palpitation, blood-murmurs, and gastric disturbances, 

 vomiting being very common. The spleen and lymphatic glands 

 are not swollen, wherein it differs from leuchaemia, nor does the 

 skin have the brownish color of Addison's disease. There is no 

 regular fever curve ; indeed, there is no fever till the disease is far 

 advanced ; autopsy has revealed no sufficient cause for the fever. 



Often, especially late in the disease, there may be epistaxis, pe- 

 techiae, ecchymoses on the legs, and haemorrhages from the female 

 genitals, from the stomach, air-passages, etc., or into the tissue of 

 the heart, the pericardium, dura mater, brain, retina, etc. ; the lat- 

 ter are said to be quite frequently discoverable on ophthalmoscopic 

 examination of the region of the papilla as reddish spots or radiat- 

 ing striae ; it is said that these spots are characterized by peculiar 

 gray or white specks. These haemorrhages are not, however, lim- 

 ited to this disease ; they may occur in various other forms of anae- 

 mia ; they may be due to the retinal vessels being diseased and 

 being ruptured by vomiting. 



As pernicious anaemia begins very gradually, and is not at first 

 detected, its duration cannot be determined ; it may prove fatal 

 within a few weeks from the time of its discovery, but usually runs 

 on for months or even years. All cases do not prove fatal. 



The diagnosis is difficult in the commencement. It is said that 

 even in the early stages some of the blood-corpuscles are very small, 

 but this is a disputed point. The anaemic symptoms cause it to re- 

 semble leuchaemia, but in the latter there is marked increase of the 



