Pernicious anemia in Asiatic Indians.

By C. R. DAS GUPTA, M.B. D.TJ\i. AND J. B. CHATTERJEA, M.D. P ERNICIOUS ANEMIA (PA) is essentially a disease of the temperate climate, affecting chiefly the w’hite races. Friedlander’ reviewed the racial incidence of the disease and showed that it is rare in Negroes and comparatively rare in the dark-skinned w’hite races such as Italians and Greeks. It is rather uncommon in Jew-s and is very rare in Orientals. Only a few cases have been described by Taylor and Chitkara2 in Asiatic Indians and by Schwartz and Rappolt3 in Chinese. On the other hand, nutritional macrocytic anemia (NMA), which is almost indistinguishable hematologically from PA is frequently seen in Asiatic Indians. NMA is said to be produced by the deficiency of an “extrinsic” dietary factor, as yet unidentified. In contrast with PA, the “intrinsic factor” appears to be secreted in normal fashion by the gastric mucosa. The crucial point of difference betw-een the two conditions thus lies in the presence or absence of the “intrinsic factor” which can only be detected by a complicated biologic test..4 There are, however, other important points which help in the differentiation of the two conditions and these are: (1) age incidence, (2) state of gastric acidity, (3) associated neurologic manifestations, (4) response to therapy. 1. Age incidence: PA is usually seen after the age of 40; but NMA may be found at any age, the majority of the cases being seen during the first three decades of life. 2. State of gast.ric acidity: Absolute achiorhydria is the rule in PA during all phases. In NMA gastric acidity is variable: some cases may show’ absolute achlorhydria, some hypochlorhydria and others isochlorhydria; a fewmay even show hyperchlorhydria.5 6