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A physiological process in which phagocytes play a leading rdle is the removal and disintegration of the red blood-corpuscles which Clomipramine Buy have lived their life and are no longer fit for work. The cells containing the red blood- corpuscles, which Clomipramine 50 Mg are found in the bone marrow and in the spleen, however much opinion may differ as to their mode of origin, can not, I think, be regarded in any other light than as phagocytic elements with this definite function. * " Fortschiitte der Medicin," Bd. i. They exist normally in the red marrow and in the spleen^ and we may recognize (1) cells which appear to be, from their Buy Clomipramine Online size and shape, elements of the pulp; (2) cells which belong to or are derived from the endothelium of the capillaries; and (3) the cells of the stroma. Clomipramine Anafranil The grad- ual production of the pigment in this way has been so often described, and is so well known, that I need not now dwell upon it. In certain morbid conditions we see this process widely extended, and we find cells containing Clomipramine 20mg red blood- corpuscles in the liver, in the lymph glands, even in the blood itself; and particularly is this the case in those states associated with rapid blood deterioration and destruction, as in acute fevers, when Clomipramine Hydrochloride Tablets these bodies may be enormously increased. In certain forms of anaemia so abundant are they in the bone marrow and in the spleen Clomipramine 10 Mg that they Clomipramine 50mg have been regarded as directly concerned in the widespread luemo-phthisis. The observations of Quincke* and his pupils have shown that the liver is the chief seat of blood destruction in pernicious anannia, but the totally different appearance presented by this organ, even in long-stand ing cases, to that met with in malaria, shows a radical difference in the nature, possibly in the seat of the hannolytic action. In the former case the Clomipramine Ocd pigment is chiefly in the Buy Clomipramine liver cells ; in the latter, in the stroma and about the blood-vessels. We can not from this regard pernicious ana;mia as a hepatic disorder. The liver, probably, makes the best disposal it can of an abnormally large amount of coloring matter, which is, I should suppose, not brought to it in the same form as in malaria, but rather in a form similar to the raw material of the bile pigment, which would account for the active par- ticipation of the liver cells. The deep beefy-red color of the muscles in pernicious anaemia also tells of an abnormal- ly large quantity of coloring matter at the disposal of the tissues. In chronic emphysema, in mitral obstruction, and in all affections in which the circulation within the lungs is per- manently embarrassed, the condition of brown induration which ensues affords a very beautiful illustration of the same process. The blood-corpuscles by diapedesis reach the stro- ma of the air cells, where they are seized upon, just as are coal particles, by the Clomipramine 25mg connective-tissue cells, and are gradu- ally converted into a pigment which retains for a long time its brownish tint, but which may ultimately become black. Neumann, in a recent papcr,f doubts whether the brown induration of the lungs is really the result of the ingestion of the red blood-corpuscles by the stroma cells. He holds that in many instances, at least, structures within the cor- puscles, which resemble so closely the red blood-discs, are in reality only pigment forms having the size and color of the red blood cells. We certainly see structures within the cells which can not possibly be mistaken for anything but red blood-corpuscles, and, I think, the expert eye can usually discriminate between such and the round aggrega- tions Clomipramine Tablets of pigment, however deceptive may be Clomipramine Hydrochloride their form and color. * "Deutsches Archiv f. klin. Med.,'' Bdr. xxv, Clomipramine For Ocd xxvii, xxxii, xxxiii. f Virchow's "Archiv," Bd. ex. 390 OSLER : ON PHA 000 YTE8. [N. Y. Med. Jock., riui^ocytoHiH liAM liocn Htudiod in tho prncoHs aHHOc'mtcd witli absorption of rxtriivasatpcl Mood. I>aii^liaiis was tho first to show tlinl l)loo(l clTiiscd into tlic tissue did not simply disintt'i^ralc and (iisnppcar, Imt that the lonnoctivc- lissui' t'h'MM'iits wt«rt' a<"tiv«'ly at work, and that no small proportion of the colored corjxisclcs was ultimately takon into tho ititorior of their protoplasm. This has heeti amply (MMitirmed, and i think there can he no (piestion as to the faet, hut observers are hy no means Anafranil Clomipramine unanimous, however, whether the phaj^oeytes are essential in the process. I'roha- i'lv in iari;e extravasations oidv the peripheral parts are dealt with in this way. 'i'lie lixed connective-tissue cells with mii^rated leucocytes all share, 1 helieve, in the process. It must not he forixotten, as Neumann has pointed out, that |)i!jfment Ljramiles in the interior of the cells may resemble blood-corpuscles very closely. However this may be, there can be wo doubt that the cells are concerned in the trans- formation of the Invmoi^lobin, whether they take it up with the corpuscles or after it is ditlused from them.

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