308 THE ANEMIAS 



teristic. In one case we may find a normal number of their different varieties, 

 in another ease a marked neutrophilic hyperleukocytosis may be present, in a 

 third a hypoleukocytosis, or an increase in the number of lymph-cells, etc. So 

 many factors influence the condition of the leukocytes, that in the multitu- 

 dinous cases of simple anemia due to causes or complications differing from 

 one another, no uniform picture can be described. 



Summarizing, we may say that the most important and essential symptoms 

 of the blood-changes in simple anemia are a diminution in the hemoglobin 

 percentage and in the number of red blood-corpuscles, poikilocytosis, and the 

 changes in the staining reaction. By attending to these factors in each indi- 

 vidual case we can decide whether or not it belongs to the simple anemias, 

 and how grave the prognosis is. 



The general clinical symptomatology of anemic conditions exhibits a few 

 traits so characteristic as to make them in most cases readily recognizable even 

 without an examination of the blood. Owing to their wide distribution, they 

 are so well known to physicians that a brief reference to them will suffice. 



The pallor of the skin and of the mucous membranes is an obvious conse- 

 quence of the diminished hemoglobin percentage of the blood. It is often 

 intensified by a permanent constriction of the peripheral blood-vessels. The 

 same causes lead to a lessened capacity for muscular work, and readily produce 

 sensationft of weakness and fatigue. The most vital internal organs must also 

 suffer in consequence of a reduction in the value of the nutrition; and, in 

 severe cases, all physical and psychical functions are below par. 



It is surprising that, in anemic people, the general metabolism, even 

 the interchange of gases, is not, as a rule, reduced ; whereby we may conclude 

 that if, in some cases, these functions are abnormal, it is due not to the anemia, 

 but to some special cause or complication. 



Even in severe cases, the adipose tissue is well preserved unless a loss of 

 flesh follows in consequence of some special circumstances (as severe nutri- 

 tive disturbances). This is a striking phenomenon for which no satisfactory 

 explanation has been given ; it was formerly attributed to a" reduction in the 

 oxidation processes, but this is usually not present at all; and the reduction 

 in muscular activity and other functions is not sufiBicient cause. 



Eelated to this phenomenon is fatty degeneeation" of some of the organs, 

 especially of the muscles and the circulatory system. Patty degeneration and 

 fatty infiltration are chiefly found in the muscles of the heart, in the muscles 

 of the eye, and the intima of the blood-vessels. 



To the fatty degeneration of the endothelial cells of the blood-vessels may 

 be attributed the fact that in many anemic conditions a general hemorrhagic 

 diathesis develops, which not infrequently combines with the primary dis- 

 ease to form a vicious circle. By their localization in the organs of special 

 sense, hemorrhages of the eye and the ear are especially alarming, and lasting 

 injury with total destruction of sight and hearing has been observed in severe 

 cases of simple anemia. On this occasion we consider it our duty to differ 

 with the widespread opinion that the symptom of retinal hemorrhage in anemic 

 conditions belongs exclusively to progressive pernicious anemia. 



