Deficiency Anemia in Chinese,Responding to Cod Liver Oil.

In attempting to survey the anemia situation in North China several factors presented themselves to us as significant. (1) Even outside the so-called famine areas food deficiencies are common, particularly qualitative deficiencies. This point is elucidated by the work of Hsien Wu 1 and his collaborators, who showed that the North China diet is low in fat and on the verge of fat soluble vitamin deficiency. (2) Attacks of prolonged diarrhea, due to dysentery or to yet unknown causes, in a population living on such a diet are apt especially to bring out 2 groups of symptoms: of anemia and of hydrops. (3) We were impressed with the fact that severe secondary anemias of unknown origin, when hospitalized, showed a seemingly spontaneous recovery in the course of about 2 months. Such anemias of lesser severity were also seen during pregnancy, on proper diet already showing marked improvement before term. These anemias are hematologically characterized by a color index in the neighborhood of unity, of the absence of anisocytosis or poikilocytosis, of the absence of nucleated red cells and of immature granulocytes and of practically normal white cell formula. There are no hemolytic features. These anemias show free hydrochloric acid in the gastric juice after histamine injection. There are no neurological symptoms. These cases are easily differentiated from cases of the chlorosis type of which we recently observed some instances.

While these factors were becoming clear in our minds, 2 fresh instances of anemia of this type came under observation. The patients were young soldiers, for a long time living under severe deprivation and lately for 2 months suffering from diarrhea of unknown origin. The first patient (Chart 1) was placed on the Hospital's ordinary Chinese diet. This diet is a well balanced diet, meat free and predominantly vegetarian, but decidedly better in quality than the ordinary diet of the poorer classes. After an observation period cod liver oil was given in doses of 15 cc. daily.