Tropical dysenteries are often responsible for anaemia and in liver abscess the patient becomes quite earthy in color, provided no operation is performed. In chyluria there is a marked drain on the patient.
The anaemia in liver abscess is not so great as the muddy complexion would indicate. The emaciation is greater than the anaemia.
Haemorrhages
The loss of blood through haemoglobinuria and haematuria has been taken up under the urine. The haemoglobinuria is the pathognomonic symptom of blackwater fever. There is also recognized a haemorrhagic form of pernicious malaria with epistaxis and alimentary tract haemorrhages. Moderate haemoglobinuria may be found in severe cases of malignant tertian infections.
Yellow Fever.—During the asthenic period of the disease, which sets in about the fourth day, we have, as a result of the damage to the endothelial lining of the capillaries, various haemorrhages.
Of these the best known and most dreaded is that from the stomach, black vomit. The bleeding from the gums is apt to appear before that from the stomach. Not only may bleeding occur from the intestines but from any mucosa, as that of the nose, conjunctiva or vagina.
In vesical and rectal bilharziasis the perforation of the terminal branches of the portal vein by the terminal or lateral spined eggs gives rise to haemorrhages.
In dengue we may have an epistaxis at the time of the crisis of the first febrile paroxysm.
In dysentery the blood-admixed mucous stools are of diagnostic importance.