The opinion that the toxemia responsible for the production of the symptoms of pernicious anemia (hematopoietic, gastro-intestinal and nervous) is of intestinal origin is chiefly based on the prominence of the gastro-intestinal symptoms of the disease. The atrophic degeneration of the tongue, the hunterian glossitis, the achylia gastrica which frequently precedes the anemia by many years, the atrophy of the gastric and intestinal mucosa found occasionally post mortem as the anatomic substratum of the achylia, direct the attention to the gastro-intestinal tract. To this may be added the association of severest anemia with intestinal parasites and occasionally with incomplete obstruction. Though the anemia found in intestinal malignancy can usually be distinguished from the pernicious anemia of unknown etiology, it is noteworthy that a relatively small carcinoma of the ileum or first part of the cecum is frequently associated with a profound anemia.
It may be assumed that the involvement of
KARL K. KOESSLER, SIEGFRIED MAURER, ROSEMARY LOUGHLIN. THE RELATION OF ANEMIA, PRIMARY AND SECONDARY, TO VITAMIN A DEFICIENCY. JAMA. 1926;87(7):476–482. doi:10.1001/jama.1926.02680070022006