(Medical World, December 15th, 1933).
[Both anaemia and pernicious anaemia are currently treated with large daily quantities of liver and liver extracts. In an important article, contributed to Medical World, Dr. Bayly criticizes the liver treatment and suggests an alternative. His long and important article had to be shortened and numerous quotations and references had to be left out. Those interested in the subject should obtain the original from which these extracts are taken. Editor, H.T.].
PERNICIOUS anaemia has always been a rare disease. Nevertheless, since the introduction of special form of treatment by liver extract, which affords an immense profit to the manufacturers by securing a market for a species of slaughterhouse offal that, in no great repute as a table delicacy, had hitherto never commanded a high price, one has been led to suppose that pernicious anaemia was one of the most widespread scourges of mankind, and the alleged inestimable benefit of this product of laboratory research has been stressed on every possible occasion.
From the commercial aspect the explanation lies in the hope of the manufacturers that by an intensive and judicious advertising campaign the medical profession will be impressed with the desirability of applying the remedy (and similar products) to a wider range of conditions than that contemplated in the original research.
We must now deal with some of the facts of clinical experience, and, in order to gain a balanced view of the subject, pass in review what medical authorities have to say regarding its value, its undesirable effects, and the later developments to which it has led; finally, we must consider a form of treatment which, possessing none of the disadvantages of liver therapy, may be said to be truly curative, in that it actually destroys the toxic property of the blood which is at the root of the trouble.
To quote Douglas McAlpine, M.D., F.R.S.P.:-.
“With the advent of liver-treatment and its remarkable effects on the blood-picture, it was thought by some and hoped by many that a panacea for all the evils of pernicious anaemia had arrived. As far as the spinal cord symptoms are concerned this has not proved to be the case, except in the opinion of a few.”.
T. Ordway and L. W. Gorham draw attention to the fact that “it cannot be termed a cure since it has no affect on the underlying pathological process”.
In fact, as the Lancet confesses: “. . . it certainly seems as though liver therapy was largely symptomatic and not directed towards the actual cause of the disease”.
“It is remarkable that despite innumerable experiments” on animals “it has not yet been possible to find the truly active substance in the anaemia diet. The manner of action or point of attack of the liver diet has not yet been explained”.
We can scarcely feel surprised, therefore, at the opinion of J. Neuburger, quoted in the Journal of Organotherapy of November December 1929, that:-. “The liver diet certainly does not strike the cause of the disease; recurrences show this. Just as little can liver diet assert a specificity for pernicious anaemia. The favourable effects on symptomatic manifestations do not extend to achylia. The collected review of the literature show a good many failures. . . .
Personal experiments and observations in cases of pernicious anaemia have shown that liver diet by no means represents the remedy for pernicious anaemia . . . . the quantitative blood-picture is certainly not influenced in the sense asserted. Unprejudiced observations will show that the nature of pernicious anaemia does not render at all possible an influence of liver diet on the disease picture and on the course of the disease”.
In addition to those already mentioned, R. Seyderhelm reports three cases in which severe symptoms of intoxication of the nervous system, such as hallucinations, disturbances of speech and coma, were undoubtedly the direct result of the treatment, since ” before the introduction of liver diet such symptoms were never observed”.
T. Ordway and L. W. Gorham report instances of patients developing gout from a high liver diet ” while there is always the possibility of renal disease ensuing upon its prolonged use.”.
It is this prolonged and continual use which has proved an inherent drawback to liver therapy. “Occasional or inherent administration has no purpose at all. According to experience, it may be stated that at least 25 grams of liver must be given daily”.
The ingestion of this amount of liver daily proved so nauseating and repulsive to patients, and caused so much gastric disturbance, that effort were made to administer it in the from of extracts or injections; but, as H. Elias has pointed out,” however excellent the preparation are, cases are still reported in which whole liver has proved of value, whereas the liver preparations remained without effect”.
One of the chief importers of these preparations into this country states: ” Liver extracts . . . rarely represent the full vitamin or mineral content of the original material”.
Nor can they be regarded as altogether harmless, for we read: ” the injectible liver preparation made by Koch in 1927 has, in addition to an intense effect on blood pressure, many other unpleasant secondary symptoms”.
This need hardly be a matter for surprise, since past history provides numerous instances of the more or less dangerous consequences, allergic and otherwise, of injecting foreign proteid of any kind, whether derived from the blood or tissues of animals, directly into the human system; it would rather be matter for comment if liver therapy thus applied proved an exception to this.
We read in the Practitioner for March 1930:-.
“If beefsteak is allowed to digest for an hour in the stomach of a normal man and the mixture is then syphoned off and given to a patient with pernicious anaemia, improvement occurs in the same way as with liver therapy “.
The credit of initiating this type of experiment on human patients appears to belong to the well-known biologist, W. B. Castle and his associates, and the Journal of Organotherapy for March-April 1932 refers to their methods as “brilliant examples of how research should be conducted”.
Whether or not patients at the Mayo clinic or elsewhere appreciate having their semi-digested meals “syphoned off” for purposes unconnected with their own benefit is undisclosed; nor do we find any discussion as to the appetising nature of this gruelly mess compared to a diet of raw liver. No doubt we should be told (in the familiar phrase) that ” it was well tolerated”.
“Very recently,” according to D. F. Cappell and J. A. W. McCluskie, “Morris and his co-workers (1932) claimed very striking results in pernicious anaemia by parenteral administration of highly concentrated gastric juice derived from man, swine, dogs or cattle”.
The fact that such methods of treatment can be devised and accepted in methods of medical circles at the present day is to the writer an indication of the depths of degenerate beastliness to which medical practice has been led through the influence of the cult of vivisection, which masquerades under the assumed title of “pure science”, when it is in fact the most unscientific, demoralizing and misleading humbug which has ever been foisted on a credulous humanity.
Those still obsessed by the notion that progress in medical knowledge is to be achieved solely through animal experimentation, will probably fail to see anything revolting in such remedies as human vomit and similar concoctions, which have proved popular in medicine since the dark age; as in the case of the mentally deranged there appears to be no means of making them realize that their ideas and practices are odious to persons of normal culture and refinement.
Moreover, however tolerant one desires to be, it is difficult to avoid the impression of a peculiar perversity in those who cling so desperately to such methods as we are discussing when all the time other remedies, possessing no features repugnant to the aesthetic sense, and of proved efficacy, are readily available.
In fairness it must be added that to a very considerable extent, of course, the choice of a remedy is governed by the advertising efforts of the commercial firms who not infrequently find a very profitable market in this way for products which otherwise would have been consigned to the waste-bucket.
For some years it has been known that Marmite, an autolyzed yeast preparation, is ” a curative agent as potent as liver extract for the treatment of tropical macrocytic anaemia.” The author from whom this is quoted, Lucy Wills, M.A.(Cantab.), M.B., B.S.(Lond.), continues:-.
“The response of this disease to treatment with Marmite is in all ways comparable with that produced by suitable doses of liver extract in the same condition or true pernicious anaemia.” “The frequent association of extreme oedema with the severe anaemia, and the fact that both respond so readily to treatment with Marmite are undoubtedly important”.
“At present it is only possible to state that in Marmite, and probably in other yeast extracts, there appears to be a curative agent for this dread disease which equals liver extract in potency, and has the advantage in India of being comparatively cheap and of vegetable origin”.
Following on these successes, Alexander Goodall, M.D., M.R.C.P., applied the method to all his “maintenance” cases of pernicious anaemia. He writes:-.
“Without exception these have done well. Several of these were originally of great severity; in two cases recovery took place in a primary condition, and in another it occurred in a relapse after taking liver treatment”.
“There is, I think, little to choose between the effects of whole liver, liver extract, stomach, stomach extracts, and Marmite given by the mouth. One point of difference in the case of Marmite emerges in the primary and relapse cases, and that is the persistence of a high colour-index. . . . This feature many be regarded as unfavorable to Marmite, but the end-result is just as good as that effected by liver.”
The only difficulty encountered in giving Marmite was the occasional occurrence of nausea if large doses were required. “Most patients found it palatable and welcome it as a change from liver.” For maintaining health a teaspoonful twice or three times a day was found to be sufficient and it is worth noting that the saltiness, which is perhaps the main objection to Marmite, has been overcome recently in a similar product of yeast, possessing the same properties in other respects, called “Yeastrel”.
While liver therapy and its allied forms of treatment have almost entirely held the field, and have been eulogized and in both lay and medical Press, hardly any attention has been paid to a form of treatment which is entirely unconnected with animal experimentation and the commercialism with which the latter has become inextricably associated.
I refer to the application of ultra-violet light. The use of certain wave-lengths in lessening nausea and vomiting and improving the blood-picture had been remarked by Leo O. Donnelly, M.D., in 1924, but later investigations, confined for the most part, it appears, to America, have established the treatment on a sound scientific basis which is in striking contrast to the nebulous and contradictory theorizing of the liver therapists. Not only are the clinical symptoms of the disease abated and the blood-picture restored to normal, but the toxaemic condition of the blood which lies at the root of the disorder is eradicated.
It will be interesting to see if the merits of this more scientific and aesthetic form of treatment will be fully and carefully explored in this country.
There can only be two possible reasons for failing to do so: one is that the method lacks the one thing which commands instant recognition from present-day medical science, namely, a basis in animal experiment; the second is that the commercial undertakings responsible for producing the necessary apparatus appear to be less vociferous than those concerned with selling animal excreta and other products at fancy prices, and so are less effective in impressing the medical profession by means of advertisements and offers of free samples.