Symptoms. — The main symptom of this condition is an abnormal pallor of the skin and mucous membranes, which varies in different cases from yellow to absolute whiteness. The finger-nails also show, by their whiteness, the general condition present. The pallor is asso ciated with various phenomena indicat ing involvement of the nervous system. Marked depression of physical and men tal powers is evident; there is tendency to inertia or indolence, especially during digestion. Inordinate palpitations are frequent, this condition causing, in the patients, a state of continuous fear as regards the presence of heart disease and anxiety concerning their general health. Shortness of breath on exertion, head ache, and, in women, menstrual disturb ances, amenorrhoea especially, and con stipation, are also complained of. The surface of the body is cool and the extremities are usually cold. Sensitive ness to the variations of temperature is the rule.
The urine has a low specific gravity through deficiency of urea. The globes of the eyes may appear blue, owing to semitransparency of the conjunctiva.
Auscultation over the vessels of the neck reveals a venous hum; this symp tom is often absent in mild cases, how ever. A systolic bellows-murmur is also frequently heard over the carotid ies. A systolic murmur is occasionally heard over the aorta and the pulmonary artery. These are valuable guides when the effects of treatment are to be closely watched, their intensity varying with that of the degree of anemia present.
Alterations in the size of the heart in anmmic subjects. Dilatation is com monly met with, and sometimes, espe cially in chlorosis, elevation of the diaphragm displaces the heart upward and an apparent dilatation is found. Anxmic dilatation is to be considered true idiopathic dilatation resulting from overstrain. None of the usual symptoms are present; gastralgia alone is com plained of. Wybauw (Jour. Med. de
Bruxelles, Mar. 15, 1900).
Armmic dysprnea is mainly due to vasomotor failure; the disease is preva lent in the female sex, whose vasomotor system is more unstable than that of the male; it usually occurs at puberty, when this system is unusually active. J. Hen 1– ton White (Birmingham Med. Rev., Oct., 1900).
Case of simple am:culla in a young mu latto in which the disease followed preg nancy. On admission, examination of the blood showed 12 per cent. of hxmo globin, 750,000 blood-cells, and 33,000 white cells. The case is classed as one of simple anminia because of the rapidity and degree of the recovery. Floyd and Gies (Med. Record, Apr. 27, 1901).
Case in a woman, aged 38 years, who had suffered from anminia for twelve years, attended by repeated nasal dis charge of blood and pus. Examination of the blood showed 23 per cent. of hmn oglobin, 475,000 red blood-corpuscles, 1400 white corpuscles, color index of 2.40, and the presence of nucleated red cells, both normoblasts and megalo blasts. Under treatment a great im provement resulted, but a recurrence of the blood-disorder took place and death resulted. The case is thought to have been one of secondary anmmia which had passed into pernicious anwinia. W. Edgecombe (Brit. Med. Jour., May 4, 1901).
Differential Diagnosis. — The symp tomatic evidence is such, in the majority of cases, as to readily suggest the true nature of the disease. It is to be dif ferentiated from the more severe forms: chlorosis, pernicious anaemia, leucocy thmmia, and pseudoleucocythmmia.
CHLOnOSrS. — The greenish pallor of this disease is quite characteristic. The reduction of hemoglobin is dispropor tionate as compared to the number of red cells, which is not, as a rule, greatly reduced.