Pernicious Anemia

Abstract

Following the discovery of Minot and Murphy that raw liver is highly effective in the treatment of pernicious anemia, liver fractionation was undertaken by Cohn, Minot and their associates. The Cohn liver fraction G, in which approximately two-thirds to three-quarters of the potency of the original liver is recovered in 3 to 4% of its weight, has been generally employed in the oral treatment of pernicious anemia. Use of this preparation, involving the consumption of 10 to 14 gm. of material daily, entails some inconvenience to the patient. In attempting to isolate and identify the active principle Cohn, West and others have made very highly concentrated preparations but the procedures employed have not found practical application on account of their complexity and the losses of active principle entailed.

We here describe a method whereby the bulk of material administered orally to pernicious anemia cases to produce a given therapeutic effect may be substantially reduced, not by employing fractional methods as heretofore, but by so treating the raw liver or liver fractions (Cohn Fraction G) as to increase their therapeutic efficacy several fold.

These experiments were started immediately after Castle's demonstration that a thermolabile agent derived from the normal human stomach could interact with beef muscle to produce an active product which when administered to pernicious anemia cases induced remission with reticulocyte rise and increase in red cell count, while control pernicious anemia cases receiving normal human gastric juices alone and other control cases receiving beef muscle alone exhibited no such effects. Since fresh untreated muscle exerted no effect whatever, while a given weight of fresh muscle previously treated with normal stomach juice exerted a very substantial effect approximately equal to that exerted by an equal weight of fresh raw liver, it appeared important to determine whether a similar pre-treatment with normal stomach juices or stomach tissues would cause a corresponding rise in the therapeutic efficacy of the already active raw liver or liver fractions.