PERNICIOUS ANEMIA 307 



Hunter** gives the following results of analysis of the liver, kidney, and spleen 

 for iron: 



Liver and 



kidney. Spleen. 



Pernicious anemia, seven cases average 0.300 per cent. 0. 12;'> per cent. 



Other conditions (with anemia), average 0.079 per cent. 0.362 per cent. 



Health}' organs 0.084 per cent. 0.090 per cent. 



Iron is also found in the hemolymph glands, sometimes more abundantly than in 

 the spleen (Warthin).*^ 



Extensive studies on the protein metabolism of pernicious anemia by Rosen- 

 quist'" showed that there is a considerable destruction of tissue proteins, as indi- 

 cated by nitrogen loss, but that at times nitrogen may be stored up for brief 

 periods. At times there may also be an excessive elimination of purine nitrogen, 

 indicating destruction of nuclear elements. Calorimetric studies show the metab- 

 olism to be slightly above normal.^' In anemia due to Bothriocephalus quite 

 similar changes were observed. 



Hunter^- describes the condition of the urine in pernicious anemia, particularly 

 with reference to the elimination of much ''pathological urobilin,"^' which seems 

 to be produced by intracellular destruction of hemoglobin. Iron may also appear 

 in the urine in increased quantities." There is an increased elimination of oxy- 

 proteic acid nitrogen, other urinar}' nitrogen constituents being normal (Kahn 

 and Barsky)."^ No constant metabolic changes follow splenectomy in pernicious 

 anemia.'^ 



Summary.^*^ — Putting together the above findings, we see tliat in 

 pernicious anemia we have everj^ evidence that excessive hemolysis 

 is taking place, and the fact that continued poisoning by toluylendia- 

 mine^^ and other hemolytic poisons, such as that of Bothriocephalus ,^^ 

 may give rise to a condition resembling pernicious anemia very closely, 

 indicates strongly that hemolytic poisons are the cause of pernicious 

 anemia. Histological studies show the same thing, and, as Warthin^^ 

 says: "The hemolj^sis of pernicious anemia does not differ in kind 

 from that occurring normally or in certain diseased conditions; the 

 difference is one of degree only." The hemolysis seems to go on chiefly 

 inside of phagocytic cells instead of in the blood, probably because the 

 phagoc3'tes pick up the corpuscles as soon as they have been injured 



8« Lancet, 1903 (i), 283; similar results obtained bv Evffel, Jour. Path, and 

 Bact., 1910 (14), 411. 



89 .\mer. Jour. Med. Sci., 1902 (124), 674. 



90 Zeit. klin. Med., 1903 (49), 193 (literature). See also Minot, Bull. Johns 

 Hopkias Hosp., 1914 (25), 338. 



91 Mever and DuBois, Arch. Int. Med., 1916 (17), ^65; Grafe, Peut. Arch, 

 klin. Med., 1915 (118), 148. See also Tompkias et al., Arch. Int. Med.. 1919 

 (23), 441. 



92 British Med. Jour., 1890 (ii), 1 and 81. 



93 See also Mott, Lancet, 1890 (1), 287; and Syllaba, Abst. in FoUa Hematol., 

 1904 (1), 283. 



9^ Keunerknecht, Virchow's Arch., 1911 (205), 89. Not confirmed by Quecken- 

 stedt. Zeit. klin. Med., 1913 (79\ 49; bibliography. 



95 Denis, Arch. Int. Med., 1917 (20), 79. 



9^ Review on etiology of pernicious anemia given bv Vogel, Jour. Amer. Med. 

 Assoc, 1916 (66), 1012. 



9" Syllaba," Hunter** (loc. cit.). 



9* In horses a condition resembling pernicious anemia seems to be produced 

 by a toxic product of the larva; of a fly. Oestrus cqui, which is found in the walls 

 of the stomach of anemic horses (Seyderhelm, Arch. exp. Path. u. Pharm., 1914 

 (76), 149). 



