The Common Picture of Sprue, Pernicious Anemia, and Combined Degeneration

Abstract

I. Summary It is our purpose to show that a common clinical entity is embraced by the accepted diagnoses of tropical sprue, pernicious anemia, and subacute combined degeneration of the spinal cord. Review of published case records of these diseases and a study of our own cases point strongly to there being different intensities of manifestation of a common toxin. This toxin seems to attack the three systems, i.e., the blood, the gastro-intestinal tract and the cord, to varying degrees although nearly always, in cases fully studied, all three systems afford evidence of damage under any one of the three clinical diagnoses. For example, typical sprue may show evidence of cord changes and pernicious features in the blood. Typical Addisonian anemia shows evidence of sprue-like gastro-intestinal changes and of cord degeneration. And finally, subacute combined degeneration of the cord is always associated with a progressive anemia which tends to become pernicious in character, and frequently with achylia and other gastro-enteric lesions. We suggest further that the toxin is more likely a group or type toxin than a unit chemical substance, and that its place of origin is in the digestive canal. Such a conception of these large disease groups means that sprue and pernicious anemia can not be considered as unit diseases with a constant classical and characteristic type. But each is a group of variable clinical syndromes just as we know to be the case in the group of what is called beriberi. This holds true to a lesser degree for combined degeneration.