306 DISTURBANCES OF CIRCULATIOX 



have practically iioinial specilic gravity, while tlie decrease is chielly in the 

 serum. 54 



111 six cases of pernicious anemia Stiihlen ^r. found ahundant iron in the liver 

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

 Hunter '"J gives the following results of analysis of the liver, kidney, and spleen 

 for iron: 



Liver and 

 kidney. Spleen. 



Pernicious anemia, seven cases average . . . 0.360 per cent. 0.125 per cent. 

 Other conditions (with anemia), average . ". 0.079 " 0.3(52 " 



Healthy organs 0.084 " 0.090 



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

 in the spleon (\\'arthin) .57 



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

 quist 58 showed tliat there is a considerable destruction of tissue proteins, as 

 indicated 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. 5'<a in anemia due to liothriocephaliis quite 

 similar changes were observed. 



Hunter 59 describes the condition of the urine in pernicious anemia, particularly 

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

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

 in the urine in increased quantities. ^i 



Summary. — Putting together the above findings, we see that in 

 pernicious anemia we have every evidence that excessive hemolysis 

 is taking place, and the fact that continued poisoning by toln.ylendia- 

 mine *^- and other hemolytic poisons, such as that of Bofhrlocephalus, 

 may give rise to a condition resembling pernicious anemia ver^' closely, 

 indicates strongly that hemolytic poisons are the case of pernicious 

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

 says: "The hemolysis 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 tlie blood, probably 

 because the phagocytes pick up the corpuscles as soon as they have 

 been injured by the hemolytic poisons. In some instances choles- 

 terol administration improves the anemia, which suggests that the 

 poison attacks the lipoids of the corpuscles,"* as so many hemolytic 



54 Bonninger, Zcit. exp. Path., 1912 (11), 1. 



55 Deut. Arch. klin. Med., 1S95 (54), 248 (literature). 



58 Lancet, 1903 (i), 283; similar re.-;ults obtained bv Uvfl'i-l. .Tour. Path, and 

 Bact., 1910 (14), 411. 



57Amer. Jour. Med. Sci., 1902 (124), 074. 



58Zeit. klin. Me<l., 1903 (49), 193 (literature). See also :Min()t. Bull. .Johns 

 Hopkins Tlosp., 1914 (25), 338. 



581. Mcver and DnP.ois, Arcli. ln(. :\Ied., 191() (17). 90.'): (.'rate. Deut. Arcli. 

 klin. :Med., 1915 ( 1 18) , 148. 



5!) British Meil. Jour., 1890 (ii), 1 and 81. 



«f' See also Mott, Lancet, 189(» (i), 287; and Svllal)a, .\bst. in Volia lleiuatol.. 

 1904 (1), 283. 



"1 Kennerkneclit, Virchow'a Arch., 1911 f205). 89. Not conlirmed bv Q\ieckeii- 

 stedt, Zeit. klin. :\red., 1913 (79), 49; bildiography. 



«2Svllaba, Ihniter (lor. cit.) . 



•'4Sw Keicher, Berl. klin. Woch., 1908 (45), 1838. 



