306 DISTURBANCES OF CIRCULATION 



is normal; serum globulin much decreased. The proportion of water is much 

 increased, both in the serum and in the corpuscles. Fat is present in normal 

 amounts; cholesterol is decreased, although in relatively normal quantities in 

 the corpuscles. Lecithin is decreased in the total blood, but increased propor- 

 tionately in the corpuscles. The total ash is increased, owing chiefly to an ex- 

 cessively large proportion of NaCl and a slight increase in calcium and magnesium; 

 potassium and phosphoric acid are decreased because of the small number of cor- 

 puscles; but the serum itself contains' more P2O5 and potassium than normal. 

 Although the total iron is, of course, much decreased, there is iron in the serum 

 (indicating hemolysis) and the proportion of iron in the corpuscles is increased; 

 but as the amount of iron in the corpuscles is even greater than corresponds to 

 the hemoglobin increase, it would seem that either the hemoglobin in pernicious 

 anemia is very rich in iron, or that the corpuscles contain iron bound in some form 

 other than hemoglobin. 



The analyses of Rumpf^^ agree quite closely with those of Erben, and, taken 

 jointly with other analyses in the literature, show the large proportion of water 

 in the blood, the small amount of solids, the large amount of NaCl, and the de- 

 crease in potassium and iron. Rumpf also examined the brain, liver, heart, and 

 spleen in one case. Water was found increased in the heart, decreased in the 

 other organs, the solids not being decreased in any of the organs. There was 

 little fat in any of the organs or in the blood, but NaCl was generally increased. 

 The liver contained four or five times as much iron as normal; the spleen three 

 or four times. Rumpf is inclined to lay great stress on the general povertj^ of 

 the body in potassium, and suggests its therapeutic application. By more modern 

 methods Bloor'^ found the blood lipoids about normal unless the red corpuscles 

 were below 50 per cent., when there appear high fat and low lecithin and choles- 

 teroF'^ in the plasma, but usually with normal corpuscular lipoid content. The 

 proportion of cholesterol free and as ester is normal. Syllaba''' found bilirubin 

 and also free hemoglobin in the blood of seven patients. Fowell'^ found a con- 

 siderable excess of iron in the blood over the amount combined with hemoglobin. 

 Schumm^^ could find no proteoses or other evidences of protein decomposition in 

 the blood in a case of pernicious anemia, but he did find free hematin.*" The 

 tendency to hemorrhage observed in this disease may depend on a slight decrease 

 in the prothrombin and a reduction in the number of platelets. ^1 



V. Jaksch and also v. Limbeck^^ have found some decrease in total alkalinity, 

 which probably depends on the loss of proteins and their fixed alkali.*^ The red 

 corpuscles are very susceptible to hemolysis by lowering of osmotic pressure 

 ("high isotonicity," equal to 0.54 per cent. NaCl — v. Limbeck). The specific 

 gravity of the whole blood is, of course, decreased, but the corpuscles themselves 

 have practically normal specific gravity, while the decrease is chiefly in the serum. *^ 

 Bile pigment is frequently found in the blood, but so bound that it does not escape 

 into the urine and it does not always cause evident jaundice. Bile salts may be 

 found in the blood, either with or without pigment (Blankenhorn).*^ There is a 

 marked increase in the urobilin output, corresponding in degree to the amount 

 of hemolysis. ^'^ 



In six cases of pernicious anemia Stiihlen^^ found abundant iron in the liver 

 and spleen microscopicallj^, and less constantly in the kidneys and bone-marrow. 



^* Berl. klin. Woch., 1901 (38), 477; !^ee also Kahn and Barsky, Arch. Int. Med., 

 1919 (23), 334, 



" Jour. Biol. Chem., 1917 (31), 79. 



^« Corroborated by Pacini, Amcr. Med., 1918 (13), 92. 



" Abst. in Folia Hematol., 1904 (1), 283 and 589. 



^8 Quart. Jour. Med., 1913 (6), 179. 



" Hofmeister's Beitr., 1903 (4), 453. 



soZeit. physiol. Chem., 1910 (97), 32. 



81 Drinker and Hurwitz, Arch. Int. Med., 1915 (15), 733. 



»'^"Klin. Pathol, des Blutes," Jena, 189(1, p. 311. 



83 See Brandenburg, Zeit. klin. Med., 1902 (45), 157. 



8" Bonninger, Zeit. exp. Path., 1912 (11), 1. 



85 Arch. Int. Med., 1917 (19), 344. 



8" See Ifansnuuui and Howard, Jour. Anier. Med. Assoc, 1919 (73), 1262. 



8^ Deut. Arch. klin. Med., 1895 (54), 248 (literature). 



