SOME NERVOUS SYMPTOMS OF PERNICIOUS ANEMIA
Authors: C. EUGENE RIGGS
Journal: JAMA (1913)

tanum is pain in the sttprapubic region.General practitioners have for a long time recognized that pelvic inflammatory lesions in women produce a wide range of referred pains, but there has not been a realization in the past that an even greater number of referred pains come from diseases in the male pelvis.Dr. Wai.tkr Bierrino, Des Moines, Iowa: An instance of rather unusual results following a local infective focus in the prostate recently came to my attention.A traveling sales- man sustained a rather simple injury, a blow on the thigh, after which the following sequence of changes occurred: He developed a typical femoral phlebitis of the left leg, followed by a local abscess formation, which was incised and the exúdate permitted to drain.Three or four weeks of general septicemia, followed and then death.There was a claim for accident insurance because of the local injury.At the necropsy a deep-seated abscess of the prostate, showing diplococci, was revealed.In addition, another interesting fact which was brought out by Dr. McCrae was a marked lihrosis of the myocardium, which also could probably be attributed to tliis latent prostatic infection.There hud been a Neisserhiu infec- tion five years before.Dr. W. O. Bridges, Omaha, Neb.:One effect of disturbance of the prostate which may be overlooked, bus come under my observation • within the last three or four veins, with reference to several cases of abdominal tumor, dependent on obstruction of (he prostate.The.patient voided his urine apparently to his own satisfaction, but the residual urine eventually caused a tumor, which finally besame distinctly palpable. 1did not use the catheter, on the ground that, the patient was aide to pass 8 ounces of urine, in niv pres- ence, without any effect on the tumor of the abdomi n.Two or three days later, a cathéter was passed and the tumor entirely disappeared.Wh.n a catheter is passed Into the prostate, in cases in which sufficient accumulation in the bladder haB occurred to produce a good-sized tumor, if is surprising how much urine can be withdrawn withoul having much ell'ect on the bladder.The reason is that for several weeks, or perhaps several months, the tumor has resulted in such blick pressure of the urine in the kidneys that the urine drained down in the bladder »bout as fast as il was removed, up to a certain point.This is probably I lie reason for our failure in ninny of these eases.I recall one case in which the patient had a tumor for four months, and opera tion was recommended, lie finally went to the hospital, the diagnosis of prostatic obstruction was made and the entire tumor was removed by the use of the catheter.Dr. J. M. Anders, Philadelphia: Dr. McCrae has called attention to certain causes of neurasthenic conditions thai.have beeji, to say the least, neglected by general practitioners in the past, lie has well said (hut a most careful history is an important matter in the study 01 these cases.I have learned from experience one fact to which I wish to cull attention, namely, that, in the absence of Bymptomä referable to these organs and in the absence of the history of a gono-