(3) Complete Anamia or Exsanguil$ity, characterised by the diminution of the blood in the body, in some instances to such an extent that on pricking the finger no blood flows from the wound. This condition is usually brought about by the sudden loss of a large amount of blood, or is due to long continued, severe illness.
(4) Local Anarteia or Depletion, a condition of abnormal distribution of the blood in some particular region of the body.
(5) Lcitcocytha'»tia, a disease which, in addition to other changes, is characterised by an often enormous- increase of the white blood-cells, and in the severe cases accompanied by a diminution in the number, and a change in the shape, of the red cells. Although the well-marked paleness which is present in this disease may at first lead to confusion with ordinary anemia, the true nature of the condition soon becomes evident, as the patho logical processes in the blood-forming organs, the spleen, the lymphatic system, and the marrow of the bones, lead to well-defined enlargement of the various lymphatic glands.
The facts that pale persons may be neither chlorotic nor anzemic, that anemia of a mild degree may not always be evidenced by a pale complexion, and that several processes may be concerned in the production of this class of diseases, make it clear that an exact diagnosis of the complaint cannot be made from the mere impression afforded by the colour of the skin. It is always essential to make a careful chemical and microscopical examination of the blood of each patient. When in any given case it has been deter mined that some change in the blood is the basis for the symptoms of which the patient complains, and after it has been decided which of the organs concerned with the formation of the blood is diseased, it still remains to remove the cause of the disturbances before any definite indications for the treatment can be formulated. It is necessary, therefore, in every case to determine whether the therapeutic measures shall be directed to any one organ which may happen to be diseased, or whether and unhygienic conditions are alone at fault and must accordingly be corrected.
It is evident that the faculty of inspection, however acutely it may be developed in the physician, does not offer any royal road to correct diag nosis in the domain of blood-disorders. The generally accepted opinion of the laity in reference to the ease with which anaemia may be cured, and that the administration of iron is the great panacea, may well be met with ridicule by those who are acquainted with the complex constitution of the blood and the many and varied causes which may underlie changes in its compo sition. The mistaken conception, that anxmia is due entirely to the lack
of a sufficient quantity of iron in the blood, may he traced, as in numerous other instances, to a confusion of the effect and the cause. It is true. that iron is lacking in the blood, but only so because the blood-forming organs, and among these must he included the digestive system, arc not acting properly. The blood-cells become diseased because these organs interfere with the absorption of the iron present in the food ; and also because they do not develop in sufficient amounts other constituents which are necessary components of the blood. In the majority of cases, therefore, a lack of iron is not the cause of the illness, but the latter is the immediate result of a weakness of certain organs.
The more important causes of blood-disorders must be definitely known if it is intended to overcome them. In the first place they may consist of sonic constitutional failure ; that is to say, the blood circulatory system of some individuals may be afflicted with a certain predisposition to these dis orders, just as a person may squint from the time of birth, or present crooked limbs. Then, again, the cause may arise during subsequent development. It is known that the transition from childhood to puberty is marked by many changes. In the female, as the time of puberty is reached, there occur numerous changes in the circulatory system associated with the develop ment of sexual activity, and for this reason girls, during certain years of their lives, are more apt than boys to become afflicted with disorders of the blood, especially if their surroundings are unfavourable. But even where the conditions are more favourable, the transition may sometimes be accom panied by changes involving the entire system, which may persist for a long time and even extend through life, unless this period of development is permitted to go forward under the most careful prophylactic measures. During this time girls should not be permitted to indulge in over-exertion involving either the body or the mind, and their nutrition should be carefully looked after. Boys should receive similar care during this period of develop ment, for they also exhibit general changes as well as particular ones in the circulatory system, but in a less marked degree than girls. It is incorrect, therefore, to associate anemia with the female sex entirely.