The altered condition of the blood commonly induces secondary changes, which are not peculiar to any form of anaemia, but are liable to be more pronounced the greater the degree and the longer the duration of the disease. The condition of the blood interferes with nutrition and function, and the most definite changes are degenerative, more particularly fatty degeneration. This manifests itself chiefly in the heart, but it also occurs in the walls of the blood-vessels. In chlorosis and other anaemias a yellow figuring of the intima of the aorta due to fatty degeneration is frequently observed. (See under Diseases of Blood-vessels.) There may also be fatty degeneration of the epithelium of the kidneys (frequent in phthisis pulmonalis) and of the hepatic cells in the liver. There is also in some cases the change in the bone-marrow already referred to, which is in some measure, at least, secondary.

Experiments on dogs show that successive large haemorrhages rapidly produce fatty degeneration of the muscle of the heart. The author met with a case in man in which a single very severe haemorrhage led to a very pronounced fatty degeneration of the heart, having the usual characteristic naked-eye appearances of that condition (which see).

Literature

Andral, Essai d'hematol. path.,. 1843; Wunderlich, Path. Phys. des Blutes, 1845; Malassez, De la numeration des globules rouges du sang, 1873; Hayem, Gaz. Med., 1876; Arch, de Phys., 1887; Jones, Amer. Jour, of Med. Sc, 1880; Harris, St. Barth. Hosp. Bep., vol. xx., 1884; Hoppe-Seyler, Phys. chemie, 1881; Gamgee, Physiol, chemistry, vol. i. Hoemoylobinuria - Lichtheim, Volkmann's Vortrage, No. 134; Lesser (Burns), Virch. Arch., vol. lxxix.; Winkel, Deutsch. med. Wochenschr., 1879, No. 24; Wickham Legg, St. Barth. Hosp. Bep., vol. x., 1874; Forrest and Finlayson, Glas. Med. Jour., 1879;

Fig. 20. - From red marrow which had replaced the yellow marrow of the shaft of the femur in Pernicious Anaemia. a, Nucleated red corpuscles, c, A red corpuscle with granular nucleus. 6, Large nucleated cells, being eosinophil cells, forming the bulk of the altered marrow.

Ponfick, Berl.'klin. Woch., 1883, No. 25. Perniciom Anaemia - Wilks, Guy's Hosp. Bep., 1857; Lect. on path, anat., 1859; Immerman, Ziemssen's Handb.; Zenker, Deutsch. Arch. f. klin. Med., vol. xii.; Eichhorst, Die progressive per-niciose Anamie, 1878; Broadbent, Practitioner, 1875; Cohnheim, Virch. Arch., vol. Ixviii.; Waldstein, Virch. Arch., vol. xci.; Musser (Pernic. Anaem. in America), Philadelphia Med. Times, 1885; Dickinson, Path. Soc. trans., vol. xxix., 1878; Quincke, Deutsch. Arch. f. klin. Med., xxv., xxvii., xxxiii.; Peters, ibid., 1878, xxxii.; Hunter (literature fully), Lancet, 1888, vol. ii.; Mackenzie, ibid., 1878, vol. ii.; Coupland, ibid., 1881, vol. i.; Brakenridge, Lancet, 1892, ii.; Muir and Drummond (normal bone-marrow), Jour, of Anat. and Phys., 1893; Muir (bone-marrow in pern, anaem.), Jour, of Path., ii., 354, 1894. Chlorosis - Becquerel, Gaz. des hopit., 1856; See, Du Sang, etc., 1886; Virchow, Ueber die Chlorose, etc., 1872; Willocks, Lancet, 1881; Rokitansky, Lehrb. d. path. Anat., vol. ii.; von Limbeck, Klin. Path. d. Blutes, 1896.