CHAP. III.] THE BLOOD IN DISEASE. 155 



important organ, though in many cases fatty degenerations of heart, 

 liver, and kidneys changes which must be considered as mere 

 results of imperfect nutrition have been observed. 



The statements of authors who have described this remarkable 

 disease vary as to the changes which the blood undergoes. 



In several cases where an enumeration of the coloured corpuscles 

 has been effected, a very remarkable diminution has been found. 

 Thus in a case described by Lepine the coloured corpuscles sank 

 on the day preceding the death of the patient to 378,750 in 1 cubic 

 millimetre. In a case described by Ferrand the number of coloured 

 corpuscles was found to be 500,000 in 1 cubic millimetre, and the 

 amount of haemoglobin estimated by the colorific intensity had 

 sunk to one-tenth that of normal blood. 



Dr Hermann Eichhorst 1 has studied the anatomical changes 

 which the blood undergoes in certain cases of progressive pernicious 

 anaemia, and the following is a brief summary of his observations : 



1. The blood has a serous, amber-coloured appearance, with 

 scarcely a trace of red (?), and coagulates with difficulty. 



2. The colourless protoplasmic granules, which are always to be 

 found more or less distributed throughout healthy blood, are. com- 

 pletely absent. 



3. The colourless cells of the blood are extraordinarily few in 

 number. 



4. The coloured corpuscles of the blood are diminished in number. 

 Those which retain the form of normal corpuscles are observed to 

 be increased in size, having a diameter of 8 9//,, some being as 

 large as 9*5 //, and very few having a smaller diameter than 8 p. 



5. In addition to the ordinary corpuscles there occurs a second 

 class of corpuscles. These are much smaller than normal coloured 

 corpuscles, having a diameter varying between 3/u. and 3'5yLt or 4/<t; 

 they are not biconcave but globular, and are of a deeper red colour 

 than normal blood-corpuscles. In one case these smaller corpuscles 

 were in the ratio of 1 : 5 of the normal corpuscles. 



That cases of progressive pernicious anaemia occur in which the 

 changes which Eichhorst has described are not seen appears certain 

 from the observations which have already been published. He 

 himself admits thai there may be, and doubtless are, several 

 classes of cases, which have been, and which may be, grouped 

 under the term of Progressive Pernicious Anaemia, but he argues 

 that during the progress of the case a diagnosis is alone possible 

 where the changes which he has described are found to exist. 



The observations of Dr Byrom Bramwell 2 on several cases of 

 pernicious anaemia, whilst they in the main confirm Eichhorst's 

 statements in reference to the presence in the blood of small non- 



1 Eichhorst, Die progressive perniziose Andmie. Eine klinische und kritische 

 Untersuchung, p. 378. Leipzig, Verlag von Veit u. Comp. 1878. 



2 Byrom Bramwell, "Idiopathic or Progressive Pernicious Anaemia, with cases." 

 Edinburgh Medical Journal, Vol. xxin. (1877), p. 408. 



