PERNICIOUS ANEMIA 305 



number of red corpuscles. The r;ii)id improvement in the condition 

 that follows the administration of iron would seem to indicate that a 

 deficient supply of iron is the cause of chlorosis, but numerous ob- 

 jections exist to this hypothesis. Bunge advanced the idea that in 

 chlorosis the iron taken with the ordinary food is precipitated in the 

 intestines b}^ sulphides or other products of intestinal putrefaction, 

 and hence there results a deficiency in the amount of iron absorbed and 

 available for the manufacture of hemoglobin. ]\Iany objections have 

 been raised to tliis hypothesis, however, for competent observers have 

 failed to find any abnormal putrefaction in chlorosis, and others 

 have found that sulphide of iron itself gives good results in the treat- 

 ment of chlorosis, wdiile bismuth and other sulphur-binding substances 

 are without effect. Furthermore, Bunge's contention that iron ad- 

 ministered in medicinal form is not absorbed seems to have been 

 completelj'- disproved by several experiments.^^ 



As a consequence of all these conflicting data we are at present 

 completely in the dark as to the reason for that failure properly to 

 manufacture hemoglobin which seems to be at the bottom of chlorosis. 

 The hypothesis that iron and arsenic favor recovery by stimulating 

 the hemogenetic tissues, which is urged by v. Noorden and others, is 

 unsatisfactory in the extreme, and explains nothing. There is abso- 

 lutely no question that administration of iron restores the composi- 

 tion of the blood to normal, usually quite rapidly, and this seems to 

 leave as most probable the explanation that in some way an iron 

 starvation is the fundamental cause of chlorosis. How^ever, as Ewing 

 says, any theory must be inadequate that fails to take into account 

 the age of puberty, the female sex, and the function of menstruation. ''° 



Pernicious Anemia. 



In contrast to chlorosis many evidences of hematolysis may be 

 found in pernicious anemia, particularly the increased amounts of 

 iron in the liver, spleen, and kidneys; hemoglobinemia and hemoglo- 

 binuria, increase in urobilin, and not infrequently icterus. 



Chemical Changes."' — Erben's'- analysis of the blood in pernicious anemia 

 gave the following results: The proteins are decreased, both in the serum'^ and 

 in the blood as a whole; particularly in the latter, because of the great decrease in 

 the number of corpuscles. The quantity of proteins in the individual corpuscles 

 is increased, corresponding to their increased size. Fibrin is decreased in total 

 amount, but is relatively normal as compared with the total proteins; albumin 



" Full review with bibliographv bv E. Mever, Ergebnisse Physiol., 1905 (5), 

 698; Meinertz, Cent. Phvsiol. u. Path.' Stoffwech.. 1907 (2), 652. 



^»von Jagic (Med. Klin., 1915 (11), 69) states that in chlorosis the Abder- 

 halden test is positive with uterine and ovarian tissue. 



" Review and bibliography by Squier, Jour. Lab. Clin. Med., 1917 (2), 552. 



" Zeit. klin. Med., 1900 (40), 266. Beumer and Biirger, Zeit. exp. Path., 1913 

 (13), 343. 



"' See also Heudorfer, Zeit. klin. Med., 1913 (79), 103. 



20 



