JAMA. 1913;61(7):481-484. doi:10.1001/jama.1913.04350070035012.
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About seventeen years ago my attention was especially attracted to the distinctiveness of the nervous symptoms occurring in pernicious anemia, and at that time I reported a case before the American Neurological Association in which the pathologic findings were those of a subacute combined degeneration of the spinal cord. At this time I called attention to the fact that the sclerosis was apparently vascular, not systemic in origin. Stengel has stated that this type of anemic patients give the highest blood-count. Bramwell in 1910 reported a case in which the nervous symptoms were characteristically those of disseminated sclerosis and in which the cord symptoms developed three years before the anemia became marked, and he emphasizes the fact that the nervous phenomena may occur a long time before the anemia or cachexia which precedes or accompanies the degenerative changes in the spinal cord. This also has been my observation. Not only


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