310 THE ANEMIAS 



physical, mental and iDsychical — must be accorded the first place. In this con- 

 nection, certainty in diagnosis will aid materially in the choice of treatment; 

 for instance, the pale neurasthenic, not really anemic, needs considerable phys- 

 ical exercise; while the muscular activity of a true anemic must be limited 

 as much as possible. 



Modern hydrotherapy has gradually acquired a prominent place in the 

 treatment of anemia; but we must always bear in mind that the withdrawal 

 of too much bodily heat is to be avoided, because all anemics are sensitive to 

 cold. Cold applications, such as cold ablutions with friction, or partial 

 douches of short duration, are best given in the morning immediately on ris- 

 ing — for then the redilatation of the cutaneous blood-vessels takes place pleas- 

 antly and actively after the patient returns to his bed. Here, too, we must 

 remember the distinction between the treatment of anemics and of pseudo- 

 anemics; the latter have a perfectly normal composition of the blood, and 

 only suffer from an abnormal contraction of the peripheral blood-vessels. 



In protracted cases, a change of climate is frequently very beneiicial, and, 

 particularly in excessive anemia, a sojourn in the mountains of medium alti- 

 tude. More robust patients may be sent with advantage even to high moun- 

 tainous regions, which often powerfully stimulates the regeneration of the 

 blood. 



In most cases of severe anemia, a sojourn at the seashore is not to be 

 advised; in moderately severe cases it is to be recommended. Great caution 

 must be exercised in the use of sea-baths, as they sometimes aggravate anemia. 



PROGRESSIVE PERNICIOUS ANEMIA 



Pbogeessive pernicious anejiia must be distinguished from other anemic 

 conditions because in blood-regeneration it presents a most striking peculiar- 

 ity. In opposition to the process in simple anemia, in progressive pernicious 

 anemia blood-regeneration in larger or smaller regions of the bone-marrow 

 takes place in a manner different from the physiological. In the blood-form- 

 ing organs and in the circulating blood cells ive note cells which are never 

 found in the healthy adult organism. Since these cells are found physio- 

 logically in the embryonal life of man, we speak of a "reversion of blood- 

 formation to the embryonal type." 



Before accurate study of the changes in the blood and in the bone-marrow 

 had been made possible, the consideration of this particular form of anemia 

 as a special type was based upon a more negative foundation. If the symp- 

 toms of severe anemia were found without a distinctly palpable cause, the 

 disease was considered idiopathic, and was designated progressive pernicious 

 anemia. Almost always in such eases we observed in the blood the changes 

 alluded to, which are to be accurately described later on, and thus these posi- 

 tive signs, particularly as they are regarded as the expression of marked trans- 

 formation in the body, are almost universally recognized as the important 

 differential diagnostic points. 



The theory of the " primary " nature of progressive pernicious anemia was 

 shattered in the course of time by numerous experiences, and this aided us 



