PROGRESSIVE PERNICIOUS ANEMIA 317 



Therefore, in spite of many uncertainties, we are warranted in stating that 

 the condition which most distinctively stamps progressive pernicious anemia 

 may be described as follows : Pbogeessive pernicious anemia is not an ex- 

 tremely MARKED degree OF ANEMIA, BUT A DISTINCTIVE TYPE OF THE DISEASE 

 CHARACTERIZED BY A PECULIAR MODE OF BLOOD-FORMATION. 



THE COURSE OF THE DISEASE 



The course of progressive pernicious anemia presents some remarkable and 

 characteristic features, which are more pronounced than in any other disease. 

 Only occasionally does the disease run a continuously i^rogressive and fatal 

 course; usually the morbid condition is relieved once or several times by a 

 state lasting for weeks or months that may simulate almost perfect health. 

 These " remissions " often follow stages of the disease so severe that they seem 

 to be the immediate precursors of death ; during extreme prostration, a change 

 suddenly sets in — spontaneously or under the influence of medication — a 

 change that within a few weeks often leads to apparently perfect recovery. 

 Eemissions such as these, as many as five or more, have repeatedly been noticed 

 in the same individual. 



The duration of ihe disease varies from a few weeks to five or ten years; 

 but by far the majority of patients succumb in a year or a year and a half 

 after the symptoms have distinctly developed. 



The prognosis of the disease is exceedingly grave; the so-called recoveries 

 have probably been only the beginning of the remissions, which delay, but 

 cannot avert, the fatal issue. According to our present knowledge, the disease 

 must be considered incurable and fatal. [In the vast majority of eases, in- 

 eluding most of those published as " cures," death follows within three years, 

 but there are a few well-authenticated cases still alive at the end of ten years. 

 Perhaps 1 in 100 may recover. — Ed.] 



Bothriocephalus anemia is a striking exception to this rule. This form of 

 the affection is often entirely cured by the expulsion of the worm, even though 

 symptoms of progressive pernicious anemia have already developed to the full- 

 est extent, and the anemia has attained a high degree. We recognize from 

 this that the mere presence in the blood of megaloblasts and megalocytes — i. e., 

 the megaloblastic degeneration of the bone-marrow— does not in itself make 

 the prognosis absolutely unfavorable, but that even with this the disease may 

 lose its progressive character if we can succeed in removing its cause from the 

 organism. So long as we are ignorant of the origin of progressive pernicious 

 anemia, so long are the prospects of a cure decidedly unfavorable. 



The most important point in the diagnosis is the differentiation between 

 simple and progressive pernicious anemia. In well-marked cases of the latter, 

 the general clinical picture enables us to make the diagnosis. The peculiar 

 pallor, the extreme weakness, the tired expression, the marked development 

 of heart symptoms, the retinal hemorrhages, the striking contrast between the 

 asthenia and the well-preserved adipose tissue— all these combine to form a 

 picture that clearly stamps the disease after a merely superficial examination. 



