SIMPLE ANEMIA 307 



The reduction in the hemoglobin value of the individual corpuscle is, in 

 some cases of simple anemia, very striking. This can be seen in fresh blood, 

 but better in the dry stained preparation, from the fact that a larger area 

 of the center remains unstained than would correspond to the physiological 

 depression of the corpuscle. In some forms only a ring of stained portion 

 may be seen (pessary forms). 



Furthermore, the red corpuscles often manifest under the microscope a 

 change in reaction to the usual stains. This change is known as "anemic 

 or polychromatopliilic degeneration." ^ It may be recognized from the fact 

 that the hemoglobin of the corpuscles does not assume the -pure color of the 

 stain (eosin, orange), but a mixed color (blue-red in the methylene-blue eosin 

 solutions, grayish-yellow with the triacid solutions). These changes are often 

 very pronounced even in the mildest degrees of simple anemia. 



A rare occurrence, which is probably characteristic only in especial forms 

 of simple anemia, is the presence of granular or punctiform deposits in the 

 protoplasm of the erythrocytes {"stippled erythrocytes") ; these are most 

 apparent when stained with methylene-blue. They are found especially in 

 lead anemias, even in the mild grades, and also in malarial anemias. In 

 simple anemias of other etiology, even in very grave cases, they are commonly 

 absent, so that to a certain extent specific significance may be attached to 

 them. [The universally applicable Eomanowsky stains, described and recom- 

 mended above, bring out the stippling beautifully. — Ed.J 



Of great importance in the diagnosis of the different kinds of anemia is 

 the fact that in the circulating blood nucleated red corpuscles of the same 

 kind as those found in the normal red marrow {" normoMasts ") sometimes 

 appear. Such cells are noted in comparatively few cases of simple anemia. 

 We find normoblasts with fair regularity, though usually only transitorily, in 

 post-hemorrhagic conditions, and sometimes, in these cases, in quite large 

 numbers. Their appearance proves an increase in intensity of the activity of 

 the bone-marrow, and in extent of marrow which is active; for the clinical 

 phenomenon corresponds anatomically to a more or less decided transformation 

 of quiescent fat marrow into functioning red marrow, and an especially marked 

 richness of these portions in normoblasts. We must emphasize the fact that 

 the appearance of normoblasts in the blood is in no relation to the severity 

 of the anemia; sometimes they are found in the mildest conditions, and are 

 often looked for in vain in the severest. Except in acute post-hemorrhagic 

 anemia their number is always small — so that only one nucleated corpuscle is 

 found to one thousand and more non-nucleated red blood-corpuscles. 



Besides the presence of normoblasts microblasts are sometimes noted. 



Other alterations in the properties of the blood are also found in simple 

 anemia, always in the direction of a reduction in the values. This is true of 

 the SPECIFIC GRAVITY OF THE BLOOD, its total soUds, and the amount of alhu- 

 min it contains; the reduction is the more pronounced the greater the devia- 

 tion of the hemoglobin from the normal. 



The WHITE CORPUSCLES in simple anemia present nothing that is charac- 



1 See article, " Blood and Blood Examination." 



