The New England Pediatric Society
Boston Medical and Surgical Journal
apparently recovered from the disease for over two years. In a study of 24 cases of pernicious anemia, Stockton 17 observed that 18 were affected with gastric disturbances; while 6 were free of such disturbances, 10 were constipated, 8 had diarrhea, and in 6 there was an irregularity of the bowels. In 11 instances the liver was enlarged; in 13 it was not; 9 cases showed a dilatation of the stomach. In 13 instances there was an absence of gastric digestion, in 8 the gastric digestion was
... gestion was diminished, and in 3 it was fairly good. Five cases showed evidence of gastric catarrh. In 6 instances there was an absence of acid in the gastric contents, while the average of the total acidity varied around 10. In 3 cases free hydrochloric acid was present in traces; in all others it was absent. Austin 18 found an absence of free hydrochloric acid, and of the ferments in his cases, while the gastric motility was diminished in most instances. He also noted an increase of urobilin in the urine and of stercobilin in the feces; occult blood was also observed in the feces. Of the 79 cases observed by Cabot,19 only one presented hydrochloric acid in the stomach contents in any considerable quantity. Our own observations extend over a series of 58 cases of pernicious anemia, in all of which gastro-intestinal symptoms were noted. Of the 58 cases there were 49 males and 9 females, the ages ranging between thirty and sixty-two years. In all of these cases complete blood examinations had been made, and only those have been included in this report in which the physical characteristics as well as the examination of blood left no doubt as to diagnosis. The symptoms manifested were loss of appetite, nausea, vomiting, indigestion (fullness, pressure, distention), diarrhea and constipation. The gastric contents were examined in 43 of the 58 cases. In 30 of these there was absence of gastric digestion (achylia gástrica). In 9 the gastric digestion was diminished and in 4 it was normal. In the 30 cases with absence of gastric secretion the total acidity ranged between 8 and 14. In the nine with diminished gastric secretion, the total acidity ranged between 22 and 46, free hydrochloric acid between 0.02% to 0.06%. In the 4 with normal digestion the total acidity ranged between 32 and 65, free hydrochloric acid between 0.11% to 0.16%. The gastric secretion was examined in five patients presenting an absence of free hydrochloric acid during the period of improvement in the state of the blood as well as of the general health; in none did the secretion return during the stage of apparent recovery. From a study of the 58 cases of pernicious anemia, it is evident that a| large proportion of these cases are attended with gastro-intestinal disturbances as well as with an absence of gastric secretion; there is present an achylia gástrica in about 70% of cases and even in the stage of apparent recovery the gastric secretion does not return. In a smaller proportion of cases, 20%, there is a marked diminition of the secretion, and in a few instances, about 10%, it remains normal. It is quite probable that the poison which produces the hemolysis is the same which is also responsible for the alteration in the gastric secretion.