Examination of the spinal cord in cases of alumni's by the Marchi method. blesults summarized as follows: (1) the changes in the spinal cord in fatal cases of am•ntia are not systematic, but should be regarded a, acute disseminated (•) the foci exhibit a local association with the blood-vessels; (3) it is probable that a noxious material is carried to the cord by the blood-vessels, and this acts upon the nervous tissue: similar changes are found in old age: (4) even in advanced cases the gray matter may escape in volvement; (•1 if diseased, it is not pri marily a ffected,—tliat is to say. it and the white matter are involved as the re sult of a single cause; (6) the diffuse character of the degeneration in these conditions justifies the conclusion that there is a trophic alteration. and not a functional injury of the nervon: element : (7) the greater part of degenerated fibres are found in the posterior and the anterior cornmissure. Nonne (Deut. Zeits. f. Nervenheilk., Mar. 9, '99).
Case of combined sclerosis of Licht heh»-Pu t na m- Da na type accompanying pernicious anannia. The condition thought to be a primary systemic de generation dependent upon the perni cious anannia. Brown, Langdon, and Wolfstein (Jour. Amer. Med. Assoc., Mar. 2, 1901).
There is a well-established relation of diffuse cord degeneration with per nicious anaemia. In seems highly prob able that the hremolysis and the cord changes are due to the same toxin. While the source of the toxin is un known, the fact that gastrointestinal disturbance is so common in the disease would lead one to suppose that it is of intestinal origin. The diffuse de generations of the spinal cord which occur in conditions without pernicious anannia do not appear to differ essen tially from those of pernicious anemia. It is possible that a common blood circulating poison exists, which may expend its force upon the blood in one individual, upon the nervous apparatus in another, and coincidently upon the blood and spinal cord in others. Frank Billings (Boston Med. and Surg. Jour., Aug. 2S and Sept. 1, 1902).
The bone-marrow usually presents changes. Those most frequently found, according to Muir, are (a) increased num ber of nucleated red corpuscles in the marrow; (b) transformation of the fatty marrow- in the shafts of the long bones into red marrow; (c) absorption of the bone-trabecuhe between the red marrow.
Bone-inert-ow of a case composed mainly of hamatoblasts. Normally, the formation of red corpuscles is probably due to the constricting off, from the nu cleus, of the hrematohlast of protoplasm, colored with hremoglobin. In pernicious anemia this process does not take place.
Itindfleisch (Virehow's Arehiv flir path ologisehe Anatomic, 11. 121. p. 176, '91).
Autopsy showing that the marrow had returned to the foetal condition. A. Pineau (La France MM., Mar. 11, '92).
From the point of view of the function of the bone-marrow, three types of per nicious anreinia may be made: (1) cases without any reaction on the part of the bone-marrow; (2) those in which the reaction is insufficient; (3) those in which there is a degeneration of the bone-marrow, on account of which it fur nishes almost exclusively disintegrating megaloblasts. The condition of the blood is not always an evidence of the changes taking place in the bone-marrow. The percolation of the bone-marrow- seems not to occur in a uniform manner, that it does not seem to affect all the elements in the same way. Neusser (Wiener klin. Woch., Apr. 13, '99).
Five cases of grave anremia in which the bone-marrow apparently had lost its power of forming red corpuscles at a comparatively early period, as the exam ination of the blood showed no nucleated or polyehromatophilic red corpuscles. An absence of nucleated red corpuscles in the blood in cases of grave anaemia indicates that there is no new formation of red corpuscles taking place. The prog nosis for such eases is extremely bad. When the number of red corpuscles is above 1,500,000 per cubic millimetre, the presence or absence of nucleated red corpuscles is of little significance; but, when they are below that number and nucleated red corpuscles are absent, a fatal result may be confidently pre dicted. J. S. Billings (N. Y. Med Jour., May 20, '99).
The albuminoid constituent of the or ganism may be at fault, Fatal ease in which examination of the blood-serum showed that the protcids of the plasma were altered in their respect ive proportions. Adami (Montreal Med. Jour., Aug., '93).
Analysis of the blood-serum removed' from the right heart: it was clear, al most colorless, had a specific gravity of 1020.1. This is below the figure usually given as being that of the specific gravity of serum, namely: 1027 to 1030. It con tanned only 5.2 per cent. of proteids (by weight). These proteids consisted of 2.3 per cent. of globulins precipitated by saturation with magnesium sulphate, and 2.9 per cent. of serum-albumin proper. There was 0.875 per cent. of ash. It will thus be seen that not only were the total proteids reduced about 40 per cent. below the average normal quantity, but also that the normal ratio of the globulins to the serum-albumin was considerably al tered; the ash, also, was about 12 7,.per cent. above the normal. R. F. Button and J. G. Adam' (Brit. Med. Jour., Dec. 12, '96).