The William Sydney Thayer and Susan Read Thayer lectures in clinical medicine : Lecture 1, The hereditary factor in some diseases of the haemopoietic system. Lecture 2, Some diseases in the Jewish race / by Sir Humphry Rolleston Bart., K.C.B., M.D., Regius Professor of Physic in the University of Cambridge.

  • Rolleston, Humphry Davy, Sir, 1862-1944
Date:
[1928?]
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Licence: In copyright

Credit: The William Sydney Thayer and Susan Read Thayer lectures in clinical medicine : Lecture 1, The hereditary factor in some diseases of the haemopoietic system. Lecture 2, Some diseases in the Jewish race / by Sir Humphry Rolleston Bart., K.C.B., M.D., Regius Professor of Physic in the University of Cambridge. Source: Wellcome Collection.

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    hydria may be quoted: among 153 persons on whom fractional gastric analyses were done, 40 were found to have pernicious anaemia, but among the remaining 113 there were only 16 with definite anaemia, 3 having less than 3,500,000 red cells. The increased resistance of the red cells in pernicious anaemia to hypotonic salt solutions contrasts with their fragility in chronic haemolytic jaundice. The achlor¬ hydria, almost constant in pernicious anaemia (according to Hurst in 98.3 per cent), is thought to favour the incidence of anaemia by allowing the bacterial flora of the gastro-intestinal tract to grow in unrestrained profusion. Martius, in 1897, regarded achlorhydria as a true benign constitutional condition, and more recently it has been found in otherwise normal relatives of patients with pernicious anaemia; Hurst considers pernicious anaemia, sore tongue and sub¬ acute combined degeneration of the spinal cord as constitutional conditions, inasmuch as they depend on constitutional achlorhydria. Among healthy persons achlorhydria occurs in 4 per cent and among these pernicious anaemia will supervene in 16 per cent, and subacute combined degeneration of the cord in others. The question must then arise as to the degree of the immediate exciting cause—infection—that determines the anaemia, Hunterian glossitis or the spinal cord lesion. Hurst and Bell argue that together with a haemolysin a neurotoxin is produced in the alimentary canal by bacterial activity, and that according to the relative amounts of these two toxins anaemia or nervous manifestations are predominant. This explanation of the cord changes, which Woltmann found in 80.6 per cent of 150 cases of pernicious anaemia, is attractive, but has not escaped opposition; Piney argues from the absence of cicatricial (gliotic) tissue and re¬ action around the degenerations that they are not toxic but due to abiotrophy—a premature wearing out due to inherent defect in formation. Knud Faber, while firmly convinced that pernicious anemia is due to an intestinal toxin, vigorously criticizes the view that achlor¬ hydria is due to any constitutional or inborn defect, and brings forward much evidence to shew that achlorhydria is the result of gastritis; he admits that achlorhydria is the most frequent, but not the only, antecedent of pernicious anaemia, and in support of his contention refers to his report of 5 definite cases without achlorhydria. As