THE ANEMIAS 



By P. EHRLICH and A. LAZARUS 



Frankfort-on-Main Charlottenburg (Berlin) 



In reviewing the earlier literature of anemia, very exact descriptions of 

 the general clinical symptoms may be found, while the changes in the blood 

 seem to have been somewhat overlooked. The object of this article is to 

 acquaint physicians with the advance in knowledge along these lines; points 

 which have long been established facts will be passed over rapidly, and the 

 special consideration of hematology will be our aim. 



Easy as it may be to distinguish the different forms of anemia, mistakes 

 in their recognition have sometimes occurred, and do still occur, chiefly through 

 a disregard of hematology. The fact that there can be no anemia without 

 changes in the blood seems to have been long ignored. Disturbances in the 

 circulation of the blood, especially, lead to incorrect diagnoses, because these 

 disturbances cause important clinical symptoms common also in anomalies in 

 the composition of the blood. Such symptoms are : Intense pallor of the skin 

 and mucous membranes, small pulse and its increased frequency, and among 

 subjective phenomena weakness and vertigo. These acute symptoms appear, 

 for instance, under such psychical influences as fear, terror, etc., or in acute 

 somatic disorders such as affections of the stomach, or from fatigue, or from 

 excesses in " Baccho et Venere." They may also be present in chronic condi- 

 tions, especially in neurasthenia, in gastric affections, and in heart disease. 

 Mistakes are therefore prone to occur, because in a few instances the symptoms 

 mentioned are also present in true anemia. 



The presence of anemia is, therefore, only positively established after 

 blood-changes have been proven. We never find that the blood deviates from 

 the normal in one respect only; in every case thorough examination shows a 

 group of changes. Still, a determination of the hemoglobin alone is sufficient 

 to demonstrate the existence or non-existence of an anemia. We say a person 

 is anemic if on testing his blood an amount of hemoglobin smaller than normal 

 is found, and we adhere to this designation even if other important properties 

 of the blood and the clinical symptoms appear entirely normal. On the con- 

 trary, when a patient has the general clinical symptoms of anemia while his 

 blood shows a normal percentage of hemoglobin, we do not call him anemic. 

 In practice, every case of anemia is identical with oligochromemia. 



The reduction of hemoglobin may be due to the fact either that too little 

 is formed or too much consumed. A formation of hemoglobin that does not 

 keep pace with the normal consumption may be either the expression of an 

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