864 Progressive Pernicious Anemia. 



with certain gastro-intestinal disturbances, at the same time 

 accepting the action of absorbed toxic snbstances from the 

 intestines as its cause. This hypothesis recently received a 

 substantiation by the investigations of Tallquist, which proved 

 that certain lipoid substances which develop in the intestines 

 during qualitative or quantitative changes of the splitting of 

 the fat and are then absorbed, possess a distinctly hemolytic 

 action. Berger & Tsuchipa found in fact a lipoid substance 

 in the gastric and intestinal mucous memlirane of such patients, 

 which could be extracted by ether, and showing about a ten times 

 stronger hemolytic action than the lipoid substances of normal 

 mucous membranes. 



The development of the disease as a result of a lipoid action 

 was established experimentally also in secondary pernicious 

 anemia by Tallquist, which disease sometimes develops in man 

 in the presence of the Dibothriocephalus latus in the intestines. 

 A similar origin of the disease is further suspected by Tallquist 

 in those cases in which the disease develops in connection with 

 malignant growths in the gastro-intestinal canal. 



Certain infeetious diseases (syphilis, malaria, tuberculosis) also play an etio- 

 logical part in man. 



From the veterinary standpoint severe anemias are fre- 

 quently included in this atfection, which are caused by gastro- 

 intestinal parasites (dochmiasis, strongylosis), blood parasites 

 (trypanosomiasis, piroplasmosis), even those which are pro- 

 duced by chronic suppurations or other exhausting diseases. 



To what extent this broadening of the conception of pernicious 

 anemia is justified can only be determined when in such cases the 

 characteristic changes of the blood in the presence of pernicious anemia 

 are established by thorough hematologic examinations. It is probable 

 that all of these affections belong to the simple secondary chronic 

 anemia, which in severe cases may be associated with poikilocytosis, 

 although in some cases the pernicious nature of the affection cannot 

 be disputed without further consideration. 



Many human physicians count only those cases as pernicious anemia 

 which at least apparently develop independently (Grawitz). 



Pathogenesis. Ehrlich explains the development of the 

 disease in man in such a manner that the unknown causative 

 agent produces on the one hand a destruction of the red blood 

 corpuscles, and on the other a degeneration of the bone marrow, 

 thereby producing the formation of megaloblasts or megalocytes 

 in the' bone marrow. In opposition to this Tallquist lays the 

 principal stress on the exhaustion of the regenerative power of 

 the bone marrow, while he conceived the formation of megalo- 

 blasts only as a result of the increased functions of the bone 

 marrow. 



Anatomical Changes. The autopsy shows outside of the 

 changes of the blood yet to be mentioned, in general the same 



