Simple Achlorhydric Anæmia in Children

By F. M. B. ALLEN, M.D., M.R.C.P. (LOND.), and G. P. MCCULLAGH, M.B., B.SC., from the Belfast Hospital for Sick Children. FOR SOIIIC timlic past attetition h,as beenl directe(l in the perio(licals of this eouiitrv and America. to al conidition variousy (lescribd)e(l as simiple achlorhvdrii anim (1), cryptogenic achylic chiloranremil (2), pseudlo-pernlicious anmemia (3), lwpochromatic ainlmia (4), i(liopatlih( Secondtild v anieia (i), aiil chronic clilorosis (G). It is tru,c, however, that Faber (7) in 191-1 lrew attention to tle contlitiolln and tfiat vaious continental ohserxvers have enmplhasiscdl its (listinctiveiess from timie to time. It seems to us thlat the teirm 's'imiple aclilorlvdric atienlia' is thle Imlost Suitabcl, as this includes and emplhiasises the comminon clinical features of the collndition. 'T'hie disease is said to be mOrt, coininoti in fcmiialces withi an ag-e iicidencc o(f 35 to 4(0 vears. .\ilaiaIs tile prIm lomiiiittnt featuirt, l)nt it is associatecd with -astroinitestiiail sv mlitoms, partirt Ruinl ot flatulicnee. I he aniem a is characteristic iln that the red blood eel Is are onlxnviodcratcIvrcduccd, if at all, wIlereas thle luelmloglobiii reacihes very lo\x\ redinh-s, Lxwent)y-fixc per ccnit. inot beilng, unu11LsuIaUl. I)x\SPl(va is prolililil t, ailld tielat it ci,t I It In gI tie ceel s max ii unCibCerMIx i fLL1n1 mnillions, is uLnable to attenl Io 1(1I-ltltic whereas tIc pitltienit haviiigV i)( uei inIs anzemia xw ithi a rede(l'0lItt1.i(tOfideIIr thlret mnillionis May lie capable of errylli g onl with Illi \\ork. Accordil", to Davies () itl 'lie gastro-intestilnal synipif)tOIis consist of dliscoimifort and fullhless after food, a poor appetite, and fiatuilelice. These aire, like the aIlnumila, of long stii(liig , i1d may (doiiin1at. th. piCtUlrc lfo an1niltbelt of years. 'the atnorexi amay h Illore Illarlcd in thle Illmornling, and(l illiprox toardtls evening. D)iscomfort is worse after hieat, andl less after carbohlydir-te foods; ill conisequence, the tliet l)heotoies one of bi-ad, potatoes, iiillk puddings, aid tea, thi patienlt )eiig le(t by I lr svnm1po)is to beliexe that othler loods are inijutr)ios. M\I aii of the patieiits, wxxel asked, i-tnat llcdA o)I the6iloss of (desire foralii 'hi]tlge ol (liet; they hadl niot touLcheCd iiieat fotx-vc rs, atul thte cere satishied it thl(e ingestcd small and( freq(Luenit carbolhvdiratec fe(s. lit comiiplexion is salloxx, rebsebilingl pernicious aMU1i1l, but listillilgislicd frl'oiti sconidary mtnUeial b1 an iceric tillge. Accorditig to soi(c observe-rs, there is an atl-0lv1 o)t tof lieILuCoLuS uiiellbrl-ae of tIh