It is easy to distinguish several indirect effects of the introduction of the liver therapy in pernicious anemia by Minot and Murphy. The differential diagnosis between pernicious anemia and other obscure and severe anemias has been sharpened. The rôle of the gastro-intestinal tract in the pathogenesis of anemias has been stressed and the nutritional factor more strongly emphasized than during the preceding ten years of high tide of interest in vitamins.
The following study of a single case is presented because of the anemia, for some time looked on as pernicious; because of the spruelike disturbance of intestinal absorption and motility; because of the tetany resulting from this disturbance, and finally because of marked duodenal changes and their relation to the other symptoms.
REPORT OF A CASE
—Mr. A. J., aged 41, born in Wisconsin of Swedish extraction, is an unmarried farmer. He has never been away from the