306 THE ANEMIAS 



of the poisons appear to destroy tKe blood directly; others to diminish or to 

 change the function of the hematopoietic organs. 



Excluding the diseases accompanied by suppuration, bleeding, and gan- 

 grene, a few others deserve especial mention as producing simple anemia. 

 Such, for instance, are chronic digestive disorders, malignant tumors, serofu- 

 losis, syphilis, malaria, and the different forms of helminthiasis. 



In addition to the symptoms of the diseases which, according to the old 

 terminology, were called " secondary anemia," the symptoms of simple anemia 

 may be found in cases which are apparently " idiopathic." They are the con- 

 sequence of faulty hygienic conditions, among which unsatisfactory nutrition 

 plays the greatest role, and it may here be remarked that food which leads 

 to a reduction in the percentage of hemoglobin need not necessarily be insuf3&- 

 cient in quantity but it is lacking in iron and albuminous substances. [That 

 faulty nutrition is a cause of anemia seems, of course, most plausible, but 

 definite evidence for it is so far wanting. — Ed.] 



But, whatever the cause of the anemia in individual cases may be, no dif- 

 ference is to be noted in its essential results, the changes in the blood, or in 

 their main clinical symptoms. 



The most important symptom is the eeduction in hemoglobin ; this not 

 only characterizes the disease as anemia, but also gives us information as to 

 the degree of the morbid changes. Cases vary greatly in this respect, and vary 

 without any apparent relation to the etiology. "We meet with cases of " simple 

 anemia " in which the values are but slightly below the normal. To this 

 class belong also cases which show 20, 15 and even only 10 per cent, of the 

 normal amount of hemoglobin. 



In the mild cases of simple anemia, the red Mood-corpuscles differ little 

 from those of normal blood. In cases somewhat more serious, deviations 

 from the normal number and morphological changes are observed. In ex- 

 treme cases the number of red cells may amount to less than 10 per cent, of 

 the normal; 50 per cent, is by no means rare. 



For the numerical relation between the percentage of liemoglohin and the 

 llood-corpuscles in simple anemia, the etiology seems to be, to some extent, a 

 determinative factor. Parallel deviations of both values from the normal are 

 often seen; for instance, a reduction of 30 per cent, in the amount of hemo- 

 globin corresponds to a reduction of 30 per cent, in the number of red corpus- 

 cles. After hemorrhages, however, we find that the amount of hemoglobin is 

 considerably less than the corresponding red corpuscle count; and in cases of 

 uncomplicated chlorosis, the parallel is disturbed in the sense that the number 

 of red corpuscles is often nearer the normal than the hemoglobin value. 



The morphological changes of the erythrocytes in simple anemia affect 

 their size and their shape. We find that the individual red corpuscles show 

 considerable difference in size; being mostly smaller than normal. Increase 

 in size is rare, and is then but slight. The. shape of the red corpuscles is fre- 

 quently more or less distorted and deformed. These conditions of deviation in 

 size and shape are designated " poilcilocytosis." Milder degrees of simple 

 anemia do not show it, but the degree of poikilocytosis corresponds to the 

 severity of the anemia. 



