1293

suffered from complications. The authors state,without giving any explanation of what seems a

remarkably high incidence, that 26 per cent. had

pellagra and 70 per cent. polyneuritis (including22 also having pellagra). Of those addicts not

suffering from one or both of these complicationsonly 15 per cent. were found to have achlorhydria,.an incidence which is only very slightly higher thanmight normally be expected-i.e., 12 per cent.

Amongst the polyneuritic patients 29 per cent.showed absence of free acid and amongst the pellagrins52 per cent. The amount of alcohol consumed andthe length of time it had been taken did not appearto be concerned in these differences, and nine ofthose with normal gastric acidity had drunk from8 to’24 ounces of whisky daily for periods up to 40years. The association of alcohol excess, achlor-

hydria, and proved lack of vitamin B was somewhatstriking, but other workers have shown that in beri-beri achlorhydria is not a frequent finding.No relationship was found between the degree of

anaemia or of liver dysfunction (as far as this couldbe judged and tested) and the frequency of achlor-hydria, and the authors suggest that some factorclosely associated with vitamin B may be concernedin the prevention of achlorhydria ; this they referto as the " achlorhydria preventive factor " and

regard as distinct from either vitamin B or the

pellagra preventive fraction. It is not necessary to

postulate such a factor when recognising the importanceof dietetic factors in the maintenance of normal

gastric secretion, thus lessening the significance of thedirect effects of prolonged irritation from abuse ofalcohol in reducing this secretion. If a man must drinkto excess, it would seem that he will better preservehis gastric acidity if he takes his wine with bran.

THE BLOOD PICTURE IN INFANCY

Mackay’s classical study of the haemoglobin levelin infancy, published in 1931,1 has been followed bysimilar large-scale investigations in all parts of theworld. Two recent surveys, one from Gothenburgand the other from Aberdeen, bring out further

important facts about the cause of the so-callednutritional anaemia of infancy. Dr. Nils Faxén,2using well-controlled technique and statisticalmethods of analysis, studied all the red cell elementsin 374 infants which he considered were in every-way healthy. They all weighed at least 3000 grammesat birth ; they were breast-fed with the additionof vitamins until six or seven months, when mixedfeeding was gradually begun ; and they all lived athome under the care of visiting nurses from thechildren’s care centre. All children who had had

any illness were excluded. His curve for haemoglobinlevels during the first year of life is considerablyhigher than that of other observers, though he notesthe same tendency to a’ lower level of red cells andhaemoglobin and smaller cell size that has been foundby all workers in the second six months. Faxenhimself attributes his satisfactory figures to the carefulselection of his material, and his children must beregarded as healthy infants living under the bestconditions. He found no lowering of haemoglobinduring the winter months, as others have done, andbelieves this is explained by his exclusion of childrenshowing any infection. The truth of this conclusionis only too obvious from different results obtainedby Dr. Fullerton 3 working with less carefully selected

1 Mackay, H. M. M., Goodfellow, L., and Hill, A. B. (1931)Spec. Rep. Ser. med. Res. Coun., Lond. No. 157.

2 Faxén, N. (1937) Acta Pœdiatr., Stockh. 19, Suppl. 1.3 Fullerton, H. W. (1937) Arch. Dis. Childh. 12, 91.

children in Aberdeen. He found subnormal haemo-

globin levels in 87 per cent. of 298 infants from poorhomes between the age of nine and twenty-threemonths, and he concludes that this anaemia is due

mainly to iron deficiency dependent on low birth-weight, artificial feeding, and infective illness.The part played by even mild infections, originallysuggested by Josephs 4 is well brought out. A

group of 26 infants aged six to twenty-two monthswas observed for a year in an institution underexcellent dietetic and hygienic conditions. The

haemoglobin level was lowered with unfailing regularityafter each infection, however mild ; even pyrexiaassociated with teething was effective. This falloccurred even when iron was already being givenand no response to therapy was made until severalweeks after pyrexia had subsided. Why fevercauses a fall in haemoglobin is unknown. Possiblythe sum of unobserved and mild infections are

responsible for the slight fall seen even in Faxén’sadmirable children. Unlike other workers, Fullertondoes not regard maternal iron deficiency as likelyto be a significant aetiological factor. From theoreticalcalculations he decides that this anaemia of infancycannot justifiably be called " nutritional," since

during the first nine months deficiency of iron intakehas little effect on the haemoglobin level. Ontheoretical grounds alone his conclusion that theimportance of a deficient iron intake in infancy canbe at present only a matter of conjecture is possiblycorrect, but the practical fact demonstrated byMackay remains-namely, that infants given iron

gain weight better and resist infections better thanchildren not given iron. Fullerton himself holds thatall children should be given medicinal iron after evenmild infections. Since mild infections seem inevitableunder the present conditions of town life and over-crowding, and the healthy babies fulfilling Faxen’sideal criteria are probably rare in this country, itseems wise to attempt the widespread prophylaxisof the anaemia of infancy, whatever its cause, bythe use of medicinal iron.

FRIENDLY GIVING" Not only do we help to support the needy by grants

of money, food, coal and clothing, by advising them whenin difficulties or ill-health, by providing medical or dentalattention, invalid comforts and medical appliances, wearrange for holidays, and even for Christmas gifts throughour special Fund. We recommend suitable schools for theyoung, help with fees and outfits and advise as to futurecareers. We also try to re-construct those lives whichhave been shattered by bereavement, lack of means andill-health ..."

These words are quoted from the annual reportof the Ladies’ Guild of the Royal Medical BenevolentFund and the detailed reports of the various com-mittees show how well and truly this work is beingcarried out. It is a record of personal service ofwhich the guild may well be proud. The hon.visitors have paid more than 225 visits to beneficiariesduring the year and the case committee has dealtwith 462 persons, while assistance and supervisionhave been given in the education of 86 boys and girls.The clothes committee reports a successful yearwith 681 parcels sent to 370 beneficiaries in spite ofthe extra work entailed by a flood in their premises.Three new branches of the guild have been openedat Weston-super-Mare, East Devon, and GraysThurrock, and others are in view. But the need is verygreat and the work of the guild and society is alwaysincreasing, since their help is not limited to any

4 Josephs, H. (1934) Bull. Johns Hopk. Hosp. 55, 259.