GASTRIC CANCER. — This condition almost always shows itself after the age of forty years, whereas pernicious anae mia is generally observed early in life. In cancer the skin is pale; in pernicious anemia the peculiar lemon color is strik ing in the majority of cases. While gastric symptoms and absence of hydro chloric acid are prominent features of cancer, the digestive disorder is slightly marked in anaemia and examination of the gastric contents is negative. Finally increasing emaciation attends a cancer ous disorder, whereas in cases of perni cious anemia the patient not only retains his adipose tissues, but sometimes be comes corpulent. In rare cases, however, there was extreme emaciation.
Attention drawn to the impossibility of marking off pernicious anaemia from all other anmmias. There is no marked boundary-line; one anfemia passes in sensibly into another. T. G. Stewart (Clinical Journal, Sept. 14, '98).
The difference between the pernicious anaemia and other grave anmmias lies in the clinical course, that of the former be ing characterized by the fact that, even after the removal of the apparent cause, the luemapoiesis persists in a faulty di rection, manifested by insufficient new formation and perhaps increased destruc tion of corpuscles. There is in this dis ease then a morbid cell-activity that tends to persist with great pertinacity in the wrong direction. E. Grawitz (Ber liner klin. Woch., Aug. S, '98).
Etiology.—Although the disease occa sionally occurs in children, it is most common in adults between the ages of twenty and forty years.
Males are attacked more frequently than females, with a slight difference in favor of the former. The disease is more prevalent among the better than in the lower classes, and is most common in Europe, especially in Switzerland: e.g., in regions in which the people are badly fed, and who live in poorly-ventilated and badly-lighted houses. Fright and grief are prominent etiological factors.
The following group of etiological fac tors has been established in pernicious anmmias: 1. Gastrointestinal disease of long standing, poor food, imp aired di gestion; chronic constipation, especially in women frequently pregnant; irregular defecation in women and girls. especially those of hysterical temperament. In such cases it is due to intoxication from the gastro-intestinal tract. 2. Pregnancy. Here, too, probably. there is an autoin toxication from the intestinal tract, on account of pressure exerted by the gravid uterus on the bowel. 3. Chronic luemor especially of small size. 4. Con stitutional syphilis, particularly when associated with sclerosis of the marrow of the long bones. 5. Bad hygienic con ditions of various kinds, especially in the female sex; hard work, with insuffi cient food, had air, and emotional ex citement. In higher social strata the
disease may be found in women who are subjected to intense mental strain as the result of a desire to equal men in phys ical efforts. Frequent pregnancy and prolonged lactation are also factors. 6. Chronic poisoning, as, e.g., by carbon monoxide. 7. Bothrioccphalus and an chylostomum—those eases belong here that are not cured after the expulsion of the worms. E. Grawitz (Berliner klin. Woch., Aug. 8, '98).
Scarcity of hoematoblasts and loss of contractility of blood-clots are the most important signs. In severe anemia it is usual to find that some nucleated red blood-corpuscles are present; but, apart from leueocythmmia and from blood in fections, such corpuscles are not merely scarce, but are also of small size. Hayem (La Presse Med., Oct. 7, '99).
In 110 personal cases of pernicious anaemia, there were 57 males and 53 fe males, and only four cases followed par turition. Late middle life predisposed to it, as shown by the fact that in 82 of the eases the patients were over 40 years of age. Pernicious anmmia is much more frequent than the text-books would lead one to suppose. Some cases had pre viously been diagnosed as tuberculosis. There was very little, if any, relation between the menopause and pernicious arnemia. It had nothing to do with syphilis. Iliemorrhage was quite com mon, especially of the nose and gums. The striking constancy of the symptoms in almost all cases, even in some of the so-called mild ones, was noted, viz.: muscular weakness, dyspncea, gastro intestinal disturbance (paroxysmal diar rhma). The appetite was poor in all but three cases, and in these it was ravenous. In two-thirds of the cases there had been a temperature of 99° to 100° F., and even higher. The urine in 53 cases was normal, while others had had a trace of albumin with granular casts. Nervous symj,toms had not been constant. Some eases had bad myelitis. As to the blood, the white corpuscles were subnormal; the number of red corpuscles was 2,500,000. The diameter of the white corpuscles was greater than normal. The proportion of lymphocytes was relatively high. There vas no relationship between the symp toms and the blood condition. The aver age duration of this disease was from one to two years. The longest-lived case was five years. All treatment was hopeless, unless the use of laxatives would be of service, working along the line of Hun ter's idea, that of gastrointestinal tox remia. Arsenic did little, if any, good in these cases. R. C. Cabot (Med. Record, May 12, 1900).