Morbid Anatomy.—In anemia, the blood may be merely deficient in amount (olig,emia), but it is usually found that there is also a deficiency in the hemoglobin (aglobulosis). It is not often that actual diminution in the number of the red Corpuscles occurs in ordinary symptomatic anemia un less, indeed, the impoverishment result from severe hemorrhage ; but these bodies are said to be considerably reduced in size, and in certain forms of anemia it is common to find many corpuscles with a diameter greatly below the average. The blood is paler than natural, for in con sequence of the decrease in the hemoglobin it is deficient in iron. Its specific gravity is also lower, and it coagulates slowly into a loose clot.
As a result of the imperfect nutrition of the tissues which is the con sequence of the deteriorated quality of the circulating fluid, a degree of fatty degeneration may be found in the heart, the liver, the kidneys, and even in the walls of the blood-vessels ; also in the voluntary muscles, and the glands of the stomach and intestines.
In idiopathic anaemia fatty degeneration of organs is also commonly observed. There are, moreover, ecchymoses of serous membranes, the re tina,. etc. The blood is not only diminished in quantity, but the red blood corpuscles are also greatly reduced in number, being, according to M. Lepine, one-fourth, one-sixth, or even one-tenth of. their normal pro portions. The white corpuscles are not more numerous than natural, at least they are not increased to anything like the degree observed in leu khfflmia. In some cases of pernicious anaemia minute red corpuscles have been noticed Measuring only one-fourth of their natural size, and wanting the characteristic bi-conate shape. These bodies, however, appear not to be present in every case.
Symptoms.—Poorness of the blood implies an imperfect state of the general nutrition. This is especially the case in young subjects whose blood, as has been already explained, can only carry on its functions effi ciently on the condition that it is continually reinforced by a regular inflow of properly elaborated nutritive material. Consequently, in addition to a general pallor, the muscles of such subjects are small and flabby, their strength is reduced, and their spirits may perhaps be depressed. Languor and indisposition to exercise are not, however, constant symptoms of anaemia in childhood. Boys suffer in this respect much less than girls, and when free from actual pain or discomfort such patients are often lively, and join with as much alacrity in boisterous games as if they were perfectly well. Indeed, this cheerfulness and activity may in some cases be an important aid to diagnosis (see Tuberculosis).
The tint of the skin may be a clear, transparent whiteness. Often, however, it is dull and pasty ; or may have a faint greenish cast similar to the hue of chlorosis, and the lower eyelid may be livid and purplish. The
mucous membranes are also pallid. Coldness of the extremities is a familiar feature of this condition. In anaemic little girls we are often told that the feet and legs are never warm, and the hands feel cold and clammy to the touch. Slight edema is often met with. It may affect the lower eyelid, but less commonly than in the adult. Usually it is noticed in the feet and ankles, and if the anaemia be great, may involve also the hands and arms. In rare cases there may be moderate ascites.
Breathlessness and palpitation on slight exertion sufficiently pronounced to cause distress are not common symptoms of encomia in the child, but they are sometimes present. The appetite is often poor, discomfort be complained of after food, and the bowels are usually confined. As this condition of the blood is in many cases a consequence of gastric derange ment, all the symptoms which are elsewhere enumerated under the head ing of gastric catarrh are often to be noticed. Flatulence, especially, is a common phenomenon, and faintness or actual syncope may occur from pressure upwards against the heart of a suddenly distended colon. The temperature is seldom elevated in an uncomplicated case of simple anaemia. Pyrexia may, however, be present as a consequence of the cause to which the impoverishment of the blood is owing, or to some accidental complica tion, such as teething, catarrh, etc.
Children, the subjects of anaemia, are usually very nervous and excit able, and on examination of the chest we often find the heart acting violently, can notice a strong pulsation in the neck, and with the hand placed upon the praecordial region can feel a well-marked systolic thrill. As the violence of the cardiac action subsides the thrill ceases, and the carotid pulsations diminish or disappear. The sounds may then be heard to be ill-accen tuated, or perhaps murmurish. Although anaemic cardiac murmurs are said to be uncommon in young subjects, it is not rare in cases of pro nounced anaemia to detect a murmur which ceases to be heard as the patient improves. The murmur may be at the apex of the heart and is— sometimes at least—accompanied by displacement of the apex-beat upwards and to the left, as if from dilatation of the left ventricle. Basic murmurs are, however, the more common phenomena. At the base of the heart the least pressure upon the pulmonary artery from enlarged bronchial glands will give rise to a loud systolic murmur in that vessel. In many cases we can hear a venous hum in the jugular vein in the neck, sometimes, also, in the left innominate vein, behind the upper part of the sternum.