Gout, Steatorrhoea, and Megaloblastic Anaemia.

Examination in Hospital.-He was febrile and pale with a smooth tongue. No splenic enlargement was detected. There were no significant neurological signs. The haemoglobin level was 33 per cent., red blood count 1,360,000/c.mm., colour index 1-27, average red cell diameter 7 8,t, and white blood count 5,800/c.mm. There was marked anisocytosis, poikilocytosis, scanty platelets, and 1 per cent. reticulocytes. The sternal marrow was richly cellular with normal myelopoiesis, and there was marked erythroid hyperplasia with numerous early and intermediate normoblasts, but no megaloblasts or macronormoblasts. The gastric contents contained free acid. A barium meal reached the caecum in one hour, but showed no clumping or mucosal abnormality. During his stay in hospital he gave a recent history of gout in his big toes, with attacks lasting up to one week. A radiograph of his feet, however, showed no evidence of gout. He was treated with blood transfusion, liver injections, and vitamin B12, and gradually improved. By June, 1953, his haemoglobin level was 83 per cent.