"ACHLORHYDRIA PRECEDING PERNICIOUS ANEMIA"

To the Editor: —I have read (The Journal, November 21, p. 1638) the report of a case of achlorhydria preceding pernicious anemia in which the achlorhydria had existed for fourteen years previous to the development of the anemia. I can report one case of pernicious anemia in which the achlorhydria was present twenty-five years before the appearance of symptoms of pernicious anemia. In this case the pernicious anemia developed and progressed, with clinical signs and symptoms of an organic lesion of the spinal cord, namely, so-called subacute combined sclerosis of the spinal cord, which is present in a large percentage of cases of pernicious anemia. This patient developed pernicious anemia with all its usual signs and symptoms, and the achlorhydria was present twenty-five years before the appearance of the anemia, as shown by analysis of the gastric contents. In another case, a woman had achlorhydria twenty years previous to the