254 DISEASES OF THE BLOOD 



Liver and -, nn , 



kidney. Spleen. 



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

 Other conditions (with anemia), average . . . 0.079 " 0.362 " 



Healthy organs 0.084 " 0.090 " 



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

 in the spleen ( Warthin l ). 



Extensive studies on the proteid metabolism of pernicious anemia by 

 Rosenquist 2 showed that there is a considerable destruction of tissue 

 proteids, 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 purin nitrogen, indicating destruction of nuclear elements. 

 In anemia due to Bothriocephalus quite similar changes were observed. 



Hunter 3 describes the condition of the urine in pernicious anemia, 

 particularly with reference to the elimination of much ' ' pathological 

 urobilin," 4 which seems to be produced by intracellular destruction of 

 hemoglobin. Iron also appears in the urine in considerable quantities. 



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 toluylendiamin 5 and other hemolytic poisons, such as that 

 of Bothriocephalus y may give rise to a condition resembling 

 pernicious anemia very closely, indicates strongly that hemo- 

 lytic poisons are the cause of pernicious anemia. Histological 

 studies show the same thing, and, as Warthin 6 says : " The 

 hemolysis of pernicious anemia does not differ in kind from that 

 occurring normally or in certain diseased conditions ; the dif- 

 ference is one of degree only." The hemolysis seems to go on 

 chiefly inside of phagocytic cells instead of in the blood, prob- 

 ably because the phagocytes pick up the corpuscles as soon as 

 they have been injured by the hemolytic poisons. The origin 

 and the nature of these hypothetical poisons have been sought 

 in vain. Some authors have referred them to infections of 

 unknown nature, occurring perhaps in the mouth and gastro- 

 intestinal tract (Hunter 7 ), or to hemolytic products of intestinal 

 putrefaction, 8 or to faulty metabolism. Many others, with 



1 Amer. Jour. Med. Sci., 1902 (124), 674. 



2 Zeit. klin. Med., 1903 (49), 193 (literature.) 



3 British Med. Jour., 1890 (ii), 1 and 81. 



4 See also Mott, Lancet, 1890 (i), 287; and Syllaba, Abst. in Folia Hema- 

 tol., 1904 (1), 283. 



5 Syllaba, Hunter (loc. cit.}. 



6 Loc. cit. Lancet, 1903 (1), 283. 



8 See Kiilbs (Arch. exp. Path. u. Pharm., 1906 (55), 73), who found the 

 intestinal contents of patients with chronic intestinal disorders to contain 

 hemolytic substances of undetermined character. 



Herter (Jour. Biol. Chem., 1906 (2), 1) suggests a relation between intes- 

 tinal infection with B. aerogenes capsulatus y which produces hemolytic sub- 

 stances, and pernicious anemia. 



