She complained of extreme feebleness, distaste for and inability to digest food, a great and constant difficulty in swallowing, shortness of breath, dropsy of the ankles if she walked or stood, hemorrhoids from which some bleeding often occurred, extreme constipation, constant chilliness, and frequent violent headaches.

Her appearance was that of a person with pernicious anaemia, a very yellow muddy skin, dry and harsh to the touch, and the hands and feet cold, almost to the point of pain.
On examination the spleen was decidedly large; the lower border of the stomach reached to the level of the umbilicus.

Two cardiac murmurs were present, the one a sharp and well-defined mitral regurgitant sound, confirmed by the dyspnoea and dropsy as organic, the other a loud musical murmur of haemic origin.

The trouble in deglutition proved to be due to an oesophageal narrowing.

The blood examination bore out the suggestion of probable pernicious anaemia, the red cells being only 1,500,000, haemoglobin 18 per cent.: the microscope showed microcytes, megaloblasts, nucleated red cells, and a large increase in white corpuscles.