PERNICIOUS ANa3IIA.—In this affec tion the skin is more yellow than green ish. Blood-examination shows a relative increase of hmmoglobin and the pres ence of gigantoblasts; there is also marked oligocythmmia. LEUCOCYTELEMIA. — The microscope shows the characteristic increase of white corpuscles, their ratio to the red cor puscles becoming sometimes 1 to 30 in stead of 1 to GOO, the usual proportion.
LEUKtESIIA.—The facial discoloration is much less marked and the lips are red, instead of pale as in chlorosis. HODGKIN'S DISEASE.—In this affec tion the glandular enlargement is more or less marked, and serves to easily dif ferentiate it from chlorosis, in which the lymphatic glands do not play a special role in the general dyscrasia.
Warning against hasty diagnosis of chlorosis from mere inspection. There are various deceptive features, including, certain anresthesias and analgesias, com parable to those of hysteria, but not to he confounded with stieh. Asthma is a common symptom. The disease has been growing more infrequent, owing to the better hygienie conditions of our time. l'otain (1.'Union -Mt-A., Dec. 23, :30, '90).
Examination of the fundus frequently elicits a lustreless, dull, and grayish ap pearance of the optic nerve, when the hmmoglobin is greatly reduced. Inflam mation of the optic nerve is occasionally observed.
1.:1111111/1S1S 1)11 the statement that there is in chlorosis a greater tendency to in flammation of the optic nerve and retina than in pernicious anremia, while the tendency to retinal limmorrhage is con siderably less. The latter fact is notori ous, but the former is not so generally recognized. Stephen „Ilackenzie (Clinical Jour., Jan. 10, '94).
A ease in a girl. aged 21, in which optic neuritis occurred in the course of eldorosis. Dieballa (1)ent. med. 1Voch., july 9, '90).
AVhile examination of the fundus often gives indications of anminia, it does not always do so, especially in cases of anremia of moderate degree. ln rosis ocular manifestations are more fre quent than was commonly supposed, for, in nearly every ease in which the hmino globin is markedly reduced, changes in the fundus may be found. The most
common change is a dull,lmitreless. gray ish appearance of the nerve. ln per nicious anreinia clinicians have observed retinal hremorrliages, but they are not so uniformly present as some have sup posed. As a ride, they occur in the ad vanced stage. In initial amemia from loss of quantity of blood there are seldom ocular changes unless some other factor than loss of blood exists. IV. C. Posey (N. '57. Med. flee., July 10, '97).
Marked case of ehlorosis in which the fundus was examined: The siirface of the disc was of mottled yellowish white. Ds edges were hazy and at places NITI'e almost indiscernible. The fibre-layer of the retina. which itself was visible to a more or less degree throughout the f11111.111S, WaS thickened, opaque. and in tensely striated. The underlying choroid, so unlike that which is so common in the negro raee, was but sparingly and ir regularly pigmented. The retinal veins and arteries, particularly the former, were pallid, with a thickening. and pro nounced opacification in many places of their lymph-sheath walls. To the nasal side of the disc two faintly-marked lymplemassings could be dimly seen. (See co/ored platr, Fig. I.) The fields of vision for white and red, especially the former, a.s shown in sketch 2, were markedly contracted.
Careful testing and retesting of the urine failed to show any course disturb ance or evidence. of general dyserasia.
Exa:nination of the blood: The red cells amounted to but 1.008,000, and the white ones were deereased to 3490. The luemoglobi» eqnaled but 22 per cent. The red cells were quite irregular in size. both mieroeytes and macrocytes being present. A few nucleated red cells eould be seen, but there were some of all types. None of them could be determined to be in the process of cell-division.