THE TREATMENT OF HEMOCHROMATOSIS BY MASSIVE VENESECTION *

HEMOCHROMATOSIS is a rare disease characterized clinically by the triad of cirrhosis, diabetes and bronzing of the skin. The pathologic picture is one of massive accumulation of iron pigment throughout the tissues, with particular concentration in the epithelial glands and especially the liver and pancreas.1 The lymph nodes, heart, adrenals and testes are also frequently involved. The clinical course and gross and microscopic pathologic char-acteristics are well known. The etiology and pathologic physiology are far less factually established, although recent investigations have yielded fairly convincing evidence as to its pathogenesis. Contrary to earlier conclusions,2 there is now sound evi-dence that in hemochromatosis the serum iron is elevated, with a diminution and relative saturation of the total iron binding capacity of the plasma.8'4 There is also strong evidence that iron absorption is greater than normal,5 a fact which has been attributed to failure or improper operation of the duodenal mucosal blocking mechanism.6"8 It is also well established that human beings have no active mechanism for the excretion of iron,9 and that other than through bleeding only extremely small amounts (about 0.5 mg. per day) are lost by exfoliation of various cells and loss of tissue. Thus, over the years a slowly increasing load of iron saturates the iron depots and eventually most of the body tissues. Such an accumulation may occur in several different situations, a possible classification of which is: I. Hemochromatosis associated with anemia. A. Increased iron absorption associated with anemia. 1. Potentiated by transfusion. 2. Potentiated by massive oral or intravenous administration of iron. B. Exogenous—pure