PROGRESSIVE PERNICIOUS ANEMIA 315 



in progressive pernicious anemia may be considered a proof of the invariably 

 concomitant increased destruction of red corpuscles. 



Fatty degeneration, the clinical consequences of which have already 

 been alluded to, is found quite often in the muscles of the extremities, of the 

 trunk, and conspicuously in the muscles of the eye. Almost always we find 

 the fatty degeneration of the heart muscle which is such a well-known charac- 

 teristic of the disease. The fatty degeneration of the arterioles and capillaries 

 is interesting because it occasions hemorrhages in the internal organs. 



Attention must be devoted to the digestive tract, because the achylia 

 gastrica sometimes present leads us to expect definite anatomical changes. In 

 fact a more or less marked atrophy of the gastric and intestinal glands has 

 been found repeatedly, yet the pathologico-anatomical changes at the autopsy 

 by no means always coincide with the symptoms during life; quite marked 

 degenerative changes have been found in cases where the functions of the 

 stomach and intestines had apparently been perfectly normal, while, on the 

 other hand, in cases in which achylia gastrica undoubtedly had been present 

 no anatomical changes were found. The relations of the gastro-intestinal 

 atrophy to progressive pernicious anemia have not as yet been sufficiently 

 demonstrated. It must be remembered that only comparatively few cases of 

 anemia, and those not always the most severe, show these changes; and fur- 

 thermore, that in a series of other changes nowise related to progressive per- 

 nicious anemia, atrophy of the gastro-intestinal glands has been found. The 

 supposition is reasonable that this atrophy and anemia have no causal relation 

 to each other, but that they represent the effects of a common cause. 



A few instances of progressive pernicious anemia have been reported in 

 which carcinoma of the stomach, in extent about the size of a hazel-nut, and 

 without ulceration or metastases, has been found. The small size of these 

 tumors prevents our recognizing in them the cause of the anemia; but if one 

 is not content to call it " coincidence " the supposition that progressive per- 

 nicious anemia has prepared the way for the formation of the tumors is not 

 altogether unreasonable. Of course, the cases in which advanced carcinosis is 

 found combined with progressive pernicious anemia must be judged quite dif- 

 ferently ; here it is probable that the carcinoma is the cause of the anemia. 



On account of the symptoms suggesting tabes and other diseases the cen- 

 tral NERVOUS SYSTEM has bccn made the subject of especially thorough re- 

 searches. Besides the hemorrhages which are most apt to occur in the brain 

 and spinal cord, we find focal and also diffuse degenerations of the nerve 

 fibers in the white substance of the spinal cord, with consecutive prolif- 

 eration of the connective tissue. These changes, which occur particularly in 

 the posterior columns, are without doubt the cause of the severe clinical 

 symptoms. 



The changes in the bone-maekow, especially those revealed by the micro- 

 scopical examination of the organ, are the most important of all, because we 

 find in them convincing proof of the necessity of classifying anemic conditions 

 according to the mode of blood-regeneration. If we consider only the macro- 

 scopical evidences, the classification of anemia appears impossible; for m 

 almost all cases we find a transformation of the yellow fat marrow mto red 



