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January 27, 1984

An `Extrinsic Factor' and Pernicious Anemia

Author Affiliations

From the Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn; and the Hematology and Nutrition Laboratory, Veterans Administration Medical Center, Bronx, NY.

JAMA. 1984;251(4):522-523. doi:10.1001/jama.1984.03340280072035

This classic of lucid exposition brought together the elegant series of prior studies published by Castle and his collaborators beginning in 1929 and demolished the recently expressed opposing view by Greenspon1 that gastric juice worked alone as a hematopoietic factor. A half century later, this 1936 article remains a model of clear presentation of a series of straightforward observations to draw almost inescapable conclusions.

Elucidation of Pernicious Anemia  In 1822, Coombe had first described what was almost certainly pernicious anemia in a 47-year-old male patient with a "deadly pale color" who suffered from "a species of dyspepsia... probably owing to some disorder of the digestive and assimilative organs."2In 1860, Austin Flint, Sr, "that remarkable American physician and teacher,"3 aware of the atrophy of the secretory glands of the stomach recently reported by Handfield Jones after microscopic examination of 14 human stomachs, remarked with respect to pernicious