Pernicious anwmia is essentially a haemolytic disease, the Immolysis being due to some as yet unknown poison comparable in its effect on the blood and blood-organs to the action of toluylene-diamine—whether autointoxi cation or infection remains yet to be determined. The poison of pernicious anemia stimulates the phagocytes of the spleen, lymph- and luemolymph glands, and bone-marrow to increased hamolysis (cellular hremolysis). Either the phagocytes are directly stimulated to increased destruction of red cells or the latter are so changed by the poison that they themselves stimulate the phagocytes. The hcemolysis of perni cious anaemia differs only in degree, not in kind, from normal hoemolysis or the pathological increase occurring in sep sis. typhoid, etc. It is not improbable that from the destruction of luemoglo bin poisonous products (histon 1) may be formed which has also a haemolytic action; a vicious circle of hcemolysis may thus be produced. No proof of this exists at present. The of pernicious anemia is not confined to the portal area, as according to Hun ter, but in some cases at least takes place also to a large extent in the pre vertebral lymph- and luemolymph- nodes and bone-marrow. In the majority of cases the spleen is the chief seat of the blood-destruction. No evidences of luemolysis in the liver, stomach, and intestinal capillaries were found in the eight cases. The lmnosiderin of the liver and kidneys is carried to these organ? as sonic soluble derivative of hemoglobin, is removed from the cir culation as Memosiderin by the en dothelium, and then transferred to the liver- or kidney- cells. The deposit of iron in these organs is of the nature of an excretion. In the majority of cases only slight reaction for iron is found at the sites of actual haftmolysi (spleen, lymph- and hmmolymph- glands, and bone-marrow). The greater part of the pigment in the phagocytes of the spleen, lmyph- and Imnolymph- glands does not give an iron reaction while in a diffuse form. When changed to a granular pigment the iron reaction may usually be obtained. The change to hamosiderin is for the greater part ac complished by the endothelium of the liver and kidneys. The varying path ological conditions found in these dif ferent cases of pernicious anamia can lie explained only by a theory of cyclical or intermittent process of luemolysis. This theory is also borne out by the exacerbations so frequently seen clin ically. The autopsy findings, in so far as evidences of lnemolysis are concerned. will depend on the relation between the time of death and the stage of the hremolysis. The changes in the licem olymph - glands found constantly in these eight eases were: dilatation of the blood-sinuses and evidences of in creased hmmolysis, as shown by the in creased number of phagocytes contain ing disintegrating red cells and blood pigment. In some of the cases these changes were accompanied by great in crease in size and apparent increase in the number of luemolymph-glands: in other cases there was no hyperplasia. the only evidence of the changes present being that obtained by the microscopical examination. The changes found can not be regarded as a specific of per nicious anemia, since it is probable that they may be produced by other infections or toxic processes character ized by great hcemolysis. The lymphoid and megaloblastic changes in the bone marrow do not form an essential part of the pathology of pernicious aruemia, and are to be regarded as of a com pensatory nature: an increased activity of red-eell formation to supply the defi eiency caused by the excessive hm molysis. A. S. Warthin (Amer. Jour. .Med. Sciences, Oct., 1902).
In cases in which the urine is dark the latter is found to contain patholog ical urobilin: a substance known to be derived from the disintegration of htem oglobin.
Peculiarity of highly colored mine is that it presents a low specific gravity, averaging 1.014. Presence of patholog ical urobilin described by MaelMunn of high diagnostic significance. W. Hunter (Brit. Med. Jour., July 5, '90).
Case in which the mine, instead of presenting the appearance upon which so much stress is justly laid by Hunter, was habitually pale. R. Douglas Powell (Clinical Journal, Aug., '96).
The gastric and intestinal disorders are probably due to the formation of a toxin, which, in turn, acts as the etio logical factor of the general disease.
Two ptomaines—cadaverin and pu tresein. which are never formed except by the action of micro-organisms—found in the urine of a case. They are not the result of ordinary putrefactive changes, for, in scarlet fever, diphtheria, typhoid fever, and other affections in which putrefactive processes in the intestines are in excess, they are absent from the urine. They have been found in no other condition but cystinuria: three cases, the first of which was studied by Cdranzky and Baumann, the last two by Brieger. The presence of these ptomaines in this ease indicates the action of special micro-organisms in its causation. W. Hunter (Brit. Med. Jour., July 5, 12, '90).
The addition of putrid serum causing normal blood to rapidly form hmmo globin crystals suggests the probability that the disease is dependent upon the formation of some poison or ferment as sociated with micro-organisms. F. W. Mott (London Lancet, Feb. S. '90).
The so-called idiopathic, or "crypto genetic," varieties are probably due to the destruction of the red corpuscles by poisonous substances: toxins or enzymes formed within the body itself or intro duced into it from without. Birch Hirschfeld (La Semaine MC3dicale, Apr. 23, '92).
Typical case in which, although no special derangement of digestion was complained of, there was found at the autopsy a high degree of atrophy of the glandular structure of the stomach and intestines. Eisenlohr (Medical News, Apr. 2, '92).
It is a question whether there can be any more satisfactory explanation of certain cases of surgical infection than this theory of the possible infection of wounds, not from outside, but from bac teria circulating in the tissues, which. under normal conditions, are destroyed and rendered harmless, but which under the abnormal traumatic conditions of the operation are now able to pro liferate and set up local disturbances. The usual explanation of the abun dant growth of bacteria in the vari ous organs after death is that, while there may oftentimes occur an agonal invasion of bacteria, the essential cause of putrefaction is the entry of bacteria, more especially through the intestines after death. This explanation is based on the observation of large numbers of intestinal bacteria in the tissues about ten hours after death. The author be lieves this appearance of post-mortem in vasion of the tissues is only apparent, nut a real fact; it occurs because there is a preliminary period in which the bac tericidal action of the tissues continues and the number of bacteria to be ob tained from the tissues by ordinary methods is singularly small ; following this there is multiplication. The ex istence of a condition of subinfection is considered probable. The writer ha, found minute diplococcoid bodies pecul iarly frequent in the liver-cells in cases of hepatic cirrhosis. The frequency with which the colon bacillus has been found by other observers, associated with more acute hepatic disease, renders it not im possible that this bacillus may have some part to play in connection with the con dition. A careful study of material from eases of htemoehromatosis with the high est power shows that when the pigment has not clumped together into too large masses in the liver-cells for example, or in the abdominal lymphatic glands, there are, in a very large proportion of the ultimate fine masses of pigment, distinct diplococcoid forms or bodies. In short, the condition of hmmochromatosis is of bacterial origin. Anderson, one of the writer's demonstrators, has made a spe cial study of the bacteriology of the stomach in three cases of pernicious anxinia. He has found in all a complete absence of hydrochloric acid, with the presence, however, of considerable quan tities of lactic and some butyric acid, and in all the cases he obtained by plat ing pure cultures of the colon bacillus, and, what is more, on making sections from one of the stomachs he found numerous diplococcoid forms in the sub mucous tissue. This was long before the nature of the pigment in the liver had been realized. In order to confirm the result, Ford made an independent exam ination in a ease at the Royal Victoria Hospital, which absolutely confirmed the findings of Anderson in every respect. J. George Adami (Jour. Amer. Med. Assoc., Dec. 23, '99).