iii:M<)('/ih'<)\iAT0Sis 483 



lu'lle i'oniul ;)S.7 ^in. of iron in llic livci- in one case (the normal 

 amount is 0.3 gm.), and Bemouille " found 18.3 gm. or 2,95 per cent, 

 of the dry weifrht in the liver, 2.65 per cent, in the pancreas, and the 

 same in tlie spleen. Anschiitz found 14.69 per cent, in the lymph 

 glands, 7.62 per cent, in the liver, and 5 per cent, in the pancreas of 

 a case, ^hi'ir and Dunn "'' obtained the following percenttige figures : 

 Liver, 6.43 ; pancreas, 2.49 ; spleen, 0.825 ; retroperitoneal glands, 

 11.64; kidneys, 0.406: adrenals, 0.121; heart, 0.714; skin, 0.188; 

 small intestine, 0.14. The hemofuscin is found in the smooth muscle- 

 fibers of the gastro-intestinal tract, blood-vessels, and genito-urinary 

 tract. Under the heading of local hemochromatosis, von Reckling- 

 hausen grouped such conditions as brown atrophy of the heart, and 

 pig-mentation of the intestinal wall, which probably are quite dis- 

 tinct from the generalized hemochromatosis, since the local form oc- 

 curs as a physiological process in old age. 



In a considerable proportion (50 of 63 collected by Sprunt) of the 

 cases of generalized hemochromatosis there occurs diabetes, called by 

 Hanot, "bronzed diabetes," because of the coloration of the skin. 

 It has been suggested that the pigmentation is due to decomposition 

 of the blood-corpuscles in the diabetic blood, but the pigmentation 

 and sclerotic changes precede the diabetes, which is secondary to the 

 atrophic and sclerotic changes in the pancreas. There can be little 

 question that both the pigment formation and the tissue changes de- 

 pend upon some intoxication, the origin and nature of the toxic agent 

 being entirely unknown. In many cases it has seemed probable that 

 alcohol might have been the inciting cause. There is no evidence of 

 any abnormal blood destruction which might account for the pigmen- 

 tation, and Parker suggests that the difficulty lies in the inability of 

 the tissues to get rid of the iron set free in normal catabolism.'^^'' 

 Roessle believes that the primarv^ change is in the capillaries, whereby 

 hemorrhagic extravasations take place, and phagocytosis of red cor- 

 puscles by gland cells results in pigmentation. 



Opie's conclusions concerning this subject are as follows: (1) 

 There is a distinct morbid entity, hemochromatosis, characterized by 

 widespread deposition of an iron-containing pigment in certain cells, 

 and an associated formation of iron-free pigments in a variety of 

 localities in which pigment is found in moderate amount under physi- 

 ological conditions. (2) With the pigment accumulation there occur 

 degeneration and death of the containing cells and consequent inter- 

 stitial inflammation, notably of the liver and pancreas, which become 

 the seat of inflammatory changes accompanied by hypertrophy of the 

 organ. (3) When chronic interstitial pancreatitis has reached a cer- 

 tain grade of intensity, diabetes ensues, and is the terminal event in 



T5Corr.-Bl. Scliweiz. Aertze, 1911 (40). 010. 

 Tsa.Jour. Path, and Ract., 1914 (19), 226. 

 -EbSee Quart. Jour. Med., 1914 (7), 129. 



