The cause of the so-called pernicious blood picture is still one of the most interesting fields of study in modern medicine. It is now generally recognized that this type of anemia is merely one variety of faulty formation of blood and not a pathognomonic sign. Whatever disease process is able to bring about this particular disturbance in hematopoiesis may produce this blood picture.
The following introductory case first suggested to me that cirrhosis of the liver might be another such disease process. This case was presented at a medical clinic in the John Hopkins Hospital on March 8, 1931.1
A man, aged 50, showed a clinical picture of advanced hepatic cirrhosis together with signs strongly suggestive of pernicious anemia. The liver was markedly enlarged and nodular. The skin was moderately jaundiced (icteric index, 45). There were in addition glossitis, combined sclerosis and a macrocytic type of anemia. The hemoglobin