The following observations are published in view of the rarity of the condition, and because of the interesting discussion which followed the report of the only other case on record.
April 14, 1913, J. F., male, aged 41, was admitted to the surgical service of Dr. Henry H. M. Lyle at St. Luke's Hospital, New York City, with the diagnosis of acute suppurative appendicitis. According to the routine procedure of the hospital a leukocyte count was made. While examining a stained smear to determine the differential count I noticed that many of the red blood-cells were not circular but elliptical. So striking was this poikilocytosis that in spite of the absence of erythroblasts, a diagnosis of pernicious anemia seemed to be warranted. An estimation of the hemoglobin, however, showed 110 per cent. (Fleischl-Miescher), and of the red blood-cells, 5,400,000. The patient gave a typical history of