PERNICIOUS ANEMIA 253 



Chemical Changes. Erben's 1 analyses of the blood in pernicious 

 aueinia gave the following results : The proteids are decreased, both in 

 the serum and in the blood as a whole ; particularly .in the latter, because 

 of the great decrease in the number of corpuscles. The quantity of pro- 

 teids in the individual corpuscles is increased, corresponding to their 

 increased size. Fibrin is decreased in total amount, but relatively 

 normal as compared with the total proteids ; albumin is normal ; serum 

 globulin much decreased. The proportion of water is much increased, 

 both in the serum and in the corpuscles. Fat is present in normal 

 amounts ; cholesterin is decreased, although in relatively normal 

 quantities in the corpuscles. Lecithin is decreased in the total blood, 

 but increased proportionately in the corpuscles. The total ash is 

 increased, owing chiefly to an excessively large proportion of NaCl 

 and a slight increase in calcium and magnesium ; potassium and phos- 

 phoric acid are decreased because of the small number of corpuscles ; 

 but the serum itself contains more P 2 O 5 and potassium than normal. 

 Although the total iron is, of course, much decreased, there is iron in the 

 serum (indicating hemolysis) and the proportion of iron in the cor- 

 puscles is increased ; but as the amount of iron in the corpuscles is even 

 greater than corresponds to the hemoglobin increase, it would seem that 

 either the hemoglobin in pernicious anemia is very rich in iron, or that 

 'the corpuscles contain iron bound in some form other than hemoglobin. 



The analyses of Rumpf 2 agree quite closely with those of Erben, and, 

 taken jointly with other analyses in the literature, show the large pro- 

 portion of water in the blood, the small amount of solids, the large 

 amount of NaCl, and the decrease in potassium and iron. Eumpf also 

 examined the brain, liver, heart, and spleen in one case. Water was found 

 increased in the heart, decreased in the other organs, the solids not being 

 decreased in any of the organs. There was little fat in any of the organs or 

 in the blood, but NaCl was generally increased. The liver contained four 

 or five times as much iron as normal; the spleen three or four times. 

 Eumpf is inclined to lay great stress on the general poverty of the body 

 in potassium, and suggests its therapeutic application. Syllaba 3 found 

 bilirubin and also free hemoglobin in the blood of seven patients. 

 Schumm 4 could find no proteoses or other evidences of proteid decom- 

 position in the blood in a case of pernicious anemia. 



v. Jaksch and also v. Limbeck 5 have found some decrease in total 

 alkalinity, which probably depends on the loss of proteids and their 

 fixed alkali. 6 The red corpuscles are very susceptible to hemolysis by 

 lowering of osmotic pressure (" high isotonicity, " equal to 0. 54 per cent. 

 NaCl v. Limbeck). The specific gravity of the whole blood is, of 

 course, decreased, being sometimes even lower than that of normal serum. 



In six cases of pernicious anemia Stuhlen 7 found abundant iron in 

 the liver and spleen microscopically, and less constantly in the kidneys 

 and bone-marrow. Hunter 8 gives the following results of analysis of the 

 liver, kidney, and spleen for iron : 



1 Zeit. klin. Med., 1900 (40), 266. 



2 Berl. klin. Woch., 1901 (38), 477. 



8 Abst. in Folia Hematol., 1904 (1), 283 and 589. 

 * Hofmeister's Beitr., 1903 (4), 453. 



5 " Klin. Pathol. des Blutes," Jena, 1896, p. 311. 



6 See Brandenburg, Zeit. klin. Med., 1902 (45), 157. 



7 Deut. Arch. klin. Med., 1895 (54), 248 (literature). 



8 Lancet, 1903 (i), 283. 



