474 



SCIENCE. 



[X. S. Vol. XXI. Xo. 534. 



was healthy when these corpuscles were dis- 

 covered, the statement about his death nat- 

 urally aroused some suspicion. Professor 

 Flint wrote a note in Science, May 20, 1904, 

 discussing the matter of form changes in the 

 erythrocytes, and pointing out that in progres- 

 sive pernicious anemia, and other blood dis- 

 eases, the variations in form and size are well- 

 known facts. He adds : ' In view of these 

 facts, it seems impossible to accept the proposi- 

 tion that the subject of the observation was a 

 liealthy mulatto.' 



It has been my intention to supply the 

 information about the death of the subject of 

 this observation, but for various reasons it 

 has not been possible to do this with certainty 

 until the present time. I am now able to 

 state that the cause of death was cardiac fail- 

 ure subsequent to an attack of acute inflamma- 

 tory rheumatism. As is often the case, the 

 attack was preceded by tonsilitis, which began 

 about three months after my observation had 

 been made. Consequently, there was no con- 

 nection between the condition of the corpuscles 

 and the cause of death. 



I wish to add some further points to sub- 

 stantiate my claim that the subject of the 

 observation was healthy at the time the cor- 

 puscles were described. In the first place, 

 his general physical condition indicated it. 

 He was able to make his living by manual 

 labor, and was studying hard to maintain his 

 standing in his classes. He complained of no 

 illness. As to his blood, it is to be noted that 

 I said that the number of red and white cor- 

 puscles was normal, and that the quantity of 

 haemoglobin was normal. There were no 

 normoblasts nor megaloblasts. On the other 

 hand, when the corpuscles were observed in 

 the fresh state, the uniformity of the elliptical 

 shape was the remarkable feature. The 

 poikilocytosis, to which Professor Flint refers, 

 was much more prominent in the dried speci- 

 mens. Now it is a well-known fact that there 

 are no cells more susceptible to influences 

 than the blood corpuscles, and, therefore, the 

 poikilocytosis shown in my dried specimens 

 can not be given much weight. 



Speaking further about the form variation 

 of red corpuscles, I would say that it is a ques- 



tion about which opinions differ considerably. 

 However, it is not my intention to discuss 

 that point further than to make a few state- 

 ments bearing upon this particular case. Pro- 

 fessor Flint quotes from Ewing's ' Pathology 

 of the Blood,' p. 256, as follows : ' Some 

 times in non-infectious purpura hemorrhagica 

 the red corpuscles are undersized and many are 

 oval.' 



I may say in this connection that Professor 

 Ewing saw a specimen of this blood of which 

 I write, and he was of the opinion that the 

 anomaly was one of congenital or develop- 

 mental origin. He based his view in the first 

 place upon the fact that the number of cor- 

 puscles and quantity of haemoglobin were nor- 

 mal, and in the second place upon the general 

 condition of the individual himself. The sub- 

 ject certainly did not have purpura. And 

 further, I may add that while in Germany re- 

 cently I had an opportunity to show the same 

 si)ecimen to several men, among them being 

 Ehrlich. The opinions of these men differed 

 somewhat, but in only one instance did doubt 

 arise as to the health of the subject. With 

 this one exception (and the man was not a 

 pathologist, by the way), the specimen did not 

 suggest pernicious anemia nor purpura. Dr. 

 Arneth, in Wiirzburg, a man who has made 

 several thousand blood slides from a great 

 variety of clinical cases, had not seen such a 

 specimen. One pathologist of considerable 

 reputation thought that the shape was an 

 artifact, fle was doubtless influenced by the 

 work of Weidenreich, who claims that the 

 mammalian erythrocyte is not normally bicon- 

 cave, but bell-shaped. Weidenreicli iittribntes 

 the biconcavity to the corpuscle's extreme 

 ' Empfindlichkeit,' by virtue of which, with 

 slight increase in the density of the plasma or 

 other fluid, the biconcavity arises by loss of 

 water from the corpuscles.* If his work be 

 confirmed by later investigations it would have 

 an important bearing, not only upon this varia- 

 tion which I report, but upon all clinical ob- 

 servations of form changes in the red cells. 

 T do not think that the variation I have 

 described was an artifact, however, and my 



* \Yeidcnreich, Arch. f. Mik. Anat. ii. Eiificick., 

 \'.m, p. 4.59. 



