SIMPLE ANEMIA 305 



affection of the hematopoietic organs, or in consequence of the fact that too 

 little material, or an inferior material, is at the disposal of these organs. 



An exaggerated consumption of hemoglobin takes place in hemorrhages 

 and, indirectly, also in wasting processes of all kinds. The processes of blood 

 regeneration and blood consumption are so intimately related that a disturb- 

 ance of one of these processes is likely to bring about a disturbance of the other. 



Often the blood regeneration is only relatively insufficient; that is, the 

 blood-forming organs, especially the bone-marrow, furnish less blood than is 

 required for the momentarily and abnormally increased demand. In these 

 cases it often occurs that the hematopoiesis is more considerable and more 

 energetic than in health, entire portions of the bone-marrow, physiologically 

 passive, now becoming active; the consumption of blood may, however, re- 

 main so great that even an increased production does not maintain the balance. 

 In these cases, whether the work of the blood-making organs is absolutely 

 increased or diminished, the amount only, not the manner, of blood formation 

 is changed. 



On the contrary, we see conditions in which the type of blood-formation 

 in larger or smaller regions of the bone-marrow has changed, and hemato- 

 poiesis has assumed a type which is abnormal in the adult organism. 



Those anemic conditions in which blood restitution talces place according 

 to a normal type are called simple anemias; and those in ivhich the process 

 is partially or wholly different from the normal type which loill he considered 

 more in detail later, are called pkogeessive pernicious anemias. [The old 

 term, " simple anemia," to which Ehrlich here reverts, does not seem to me 

 likely to come back into use. It seems most reasonable to retain our present 

 current term, " secondary or symptomatic anemia," for trouble of this type, 

 and to use the terms, " pernicious anemia " and " chlorosis," with the con- 

 sciousness that they, too, are secondary, but secondary to a cause which in most 

 cases is wholly unknown. — Ed.] 



SIMPLE ANEMIA 



As a result of extensive observations of the blood changes, and of supple- 

 mentary studies of the changes in the bone-marrow, we know that in by far 

 the larger number of cases of anemia the normal mode of blood regeneration 

 is preserved ; hence, these are classed as simple anemias. 



The causes of simple anemia are, first of all, acute, subacute, and chronic 

 posthemorrhagic conditions. The supervention of anemia in these instances 

 from the loss of considerable blood is readily understood. 



Many constitutional or organic diseases lead to simple anemia, either by 

 reducing the appetite, or by the loss of blood and tissue-juices, but especially 

 through suppuration and albuminuria. Poisons also play an important role. 

 Here the large group of autointoxications play a part and another damage is 

 done by toxic substances developed by bacteria and other parasites. We may 

 explain in two ways the effect which brings about the anemia without being 

 able, in the special instance, to determine with certainty which of the two 

 active causes, or whether, perhaps, both together, have been operative. Some 

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