LEUKEMIA 307 



a^'eiits do. Ihthriotcphalus anemia, which so closely resembles the 

 "pernicious'' form, seems to be caused by a hemolytic lipoid,®^ pre- 

 sumably a ehoh'sterol ester of oleic acid, and there is a g^rowing tend- 

 ency to associate hemolytic lipins witli the etiology of pernicious 

 anemia."'' However, although in liemol^'tic anemias tliere is an in- 

 creased amount of unsaturated lipins in the blood, Medak "^ did not 

 find the isolated lipoids to be particularly hemolytic. (See Hemolysis, 

 Chapter viii.) The origin and the nature of the specific hypothetical 

 poisons have been sought in vain. Some authors have referred them 

 to infections of unknown nature, occurring perhaps in the mouth and 

 gastrointestinal tract (Hunter),''" or to hemolytic products of intes- 

 tinal putrefaction,"- or to faulty metabolism. Many others, with per- 

 haps the best of grounds, would ascribe pernicious anemia to a multi- 

 plicity of causes, which produce a protracted slight hemolysis that 

 continues until the hematogenetic organs give out, their exhaustion 

 being perhaps hastened by the influence of the toxic substances in the 

 blood; hematogenesis then becomes insufficient to replace the lost 

 corpuscles, and the picture of pernicious anemia is established.'^'* 



LEUKEMIA 



In leukemia the chemical changes in the red corpuscles take a less 

 prominent position, resembling either those of a secondary anemia 

 or chlorosis, while the enormous number of leucocytes is the prominent 

 feature and causes marked alterations in the composition of the blood. 

 Large quantities of nucleoproteins and also of the intracellular 

 en/ymes are introduced into the blood by the excessive leucocytes. As 

 the leucocytes are constantly breaking down, more or less of the 

 products of their decomposition are present in the blood and appear 

 in the urine. Because of the relatively slight metabolic activity of 

 the Ijonphocytes the various chemical alterations are all less marked 

 in IjTnphatic than in myelogenous leukemia.''" There is a notable re- 



65 Tallquist, Zeit. klin. Med., 1907 (61), 427: Arch. exp. Path. u. Pharm.. 100? 

 (57). 367. 



66 See Liidke and Fejes, Deut. Areh. klin. :Med., 1913 (109), 433. 

 63 Biochem. Zeit., 1914 (59), 419. 



67 Lancet, 1903 (1), 283. 



68 See Kiilhs (Arch. exp. Path. u. Pharm., 1906 (55), 73), who found tlie in- 

 testinal contents of patients with chronic intestinal disorders to contain lienio- 

 lytic substances of undetermined character. Hemolytic lipoids in tlie intestinal 

 contents have been described by Berber and Tsuchiga (Deut. Arch. klin. Med.. 

 1909 (96), 252) and Liidke and' Fejes, loc. cit.; but this observation failed of con- 

 firmation by Ewahl (Deut. med. Woch., 1913 (39), 1293). 



Herter (Jour. Biol. Chem., 1906 (2), 1) suggested a relation between intestinal 

 infection with B. aerogenes capsulatus, which produces hemolytic substances, and 

 pernicious anemia. 



69 See also Bunting. .Johns Hopkins Hosp. Bull., 1905 (16), 222; Pappenheim. 

 Folia Serologica. 1910 (10), 217. 



"0 Stern and Eppenstein have observed that the striking proteolytic power of 

 the leucocytes from the blood in myelogenous leukemia is not shown by the 

 leucocvtes in Ivmphatic leukemia (Sitz. d. Schles. Ges. f. vaterliind. Kultur, 

 June 29, 1906)". 



