PROGRESSIVE PERNICIOUS ANEMIA 313 



mil-nourished appearance of the patient is still more striking here than in 

 o Zr w' --pie anemias. There is hardly a diseaseln which "iS 

 so great a cachexia, the adipose tissue is so well preserved 

 littleTnnTf ^^-^^^^^^^o^^M in progressive pernicious anemia we have 

 httle knowledge. The increase of proteid decomposition, which has been 

 observed m some cases, must be due to some inconstant factor, for in other 

 cases there is no increase at all. The same is true of the oxidation processes 



Fever is present in almost all cases, if only transitorily, but it is bv no 

 means characteristic, and bears no relation to the intensity of the disease " Its 

 origin IS probably a ferment intoxication from the destruction of red blood- 

 corpuscles. 



The CAKDiAc SYMPTOMS are prominent. For a long time the disease was 

 considered to be merely a symptom of severe cardiac degeneration The sub- 

 jective disturbances which are very often troublesome to the patient consist of 

 (a) palpitation, brought about by the least exertion, which often leads to (&) 

 true precordial distress and (c) severe dyspnea. Auscultation of the heart 

 reveals over all the valve-areas a clear, soft, usually systolic, rarely diastolic 

 murmur. Percussion as a rule is normal. The heart symptoms are often so 

 intense that during life it is impossible to distinguish the condition from 

 genuine endocarditis. 



Nevertheless, we must state with emphasis that well-defined severe cases 

 of progressive pernicious anemia have been observed in which the heart showed 

 neither subjective nor objective morbid phenomena. 



The weakness of the heart action is best indicated by the character of the 

 PULSE, which usually is of low tension, small, and frequent. [Very frequent 

 and very interesting in this disease is the violent pulsation of the elastic 

 peripheral arteries which often equals that seen in aortic regurgitation. 

 Edwards^ has recently reported a case of pernicious anemia in which the 

 abdominal aorta- was so expansile and pulsated so forcibly that aneurism 

 seemed the only explanation. The carotids flap loosely.— Ed.J 



On the part of the digestive organs, marked anorexia, persistent nausea, 

 belching and vomiting, and also unconquerable repugnance to certain foods' 

 for instance, meat, are often noticed. Examination of the gastric contents 

 m the living has not infrequently revealed a complete suspension of the gastric 

 secretion — " achylia gastrica." The abdomen, as a rule, is everywhere soft 

 and not sensitive upon pressure. 



The motor capacity of the intestine, the power of absorption, and the 

 secretion of the intestinal glands seem, as a rule, normal. 



The spleen is generally normal or only slightly decreased in size, but 

 there are positive cases recorded in which extraordinarily large splenic tumors 

 complicated the clinical picture. 



Some disturbances of the central neevous system may be noticed, 

 though in comparatively rare instances. The mind may be in a condition of 

 deep depression or marked exaltation, and the one may repeatedly alternate 

 with the other. Toward the end, disturbances of consciousness and deep coma 



1 Trans, of the Assn. of American Physicians, 1903. 



