On Feeding Certain Liver Constituents in Pernicious Anemia.∗

Abstract

Since Minot's 1 demonstration that a high liver diet is extraordinarily useful in the treatment of pernicious anemia we have been attempting to find whether certain liver constituents can be used as effectively as whole liver.

Spermine was prepared from beef pancreas by the method of Dudley 2 by steam distillation and precipitation as the phosphate. The phosphate was dissolved in weak acetic acid and fed in this solution, 100 to 150 mgm. daily being added to a diet containing no liver, kidney nor sweetbread. The distribution of spermine suggested its trial, for 100 gm. of tissue semen contains 260 mgm., pancreas 25, liver and kidney each 15, muscle and thymus 5.

The clinical results were believed to be negative and are appended. (Fig. I.) Case J. J. was probably in a period of spontaneous improvement.

The alcohol ether soluble fractions of fresh beef liver were used next. Five kilos of liver were obtained fresh from the slaughter house, minced, twice extracted with 4 liters of cold 95 per cent alcohol, then 2 to 3 liters of cold ether, and finally 4 liters of boiling alcohol. The three fractions were filtered separately through filter paper and evaporated almost to dryness in vacuo. The yield was 360 to 420 gm. (about 30 per cent water) and 10 to 15 gm. were emulsified with grape juice and fed twice daily.

Five consecutive cases have shown improvement on this regime, as shown on the appended chart. (Fig. 11.)

Finally, one patient has been placed on 50 to 100 mgm. thioneine daily. At the end of 12 days he was definitely worse; thioneine was replaced by the liver extract and he has improved.

The alcohol ether soluble fraction has been divided by washing several times with 95 per cent alcohol, then ether, then 95 per cent alcohol again.