Courtesy: Medical Miracles, from Readers Digest 1981.
November.
From the frontiers of science and the far horizons of
personal courage, these stories of medical triumphs and miracles will reaffirm
your faith in the awesome powers of the human spirit. Dramatic victories and
human triumphs.
Selected and edited by the editors of Readers Digest
It was a pure horror of a disease. It started innocently enough. Victims noted that everyday chores tired them
more than usual. Soon they were finding
difficulty rising from a chair. Their
skin took on a waxy, yellowish cast; tongues became flaming red and sore. Some sufferers became addle-headed; a few
went on to paralysis.
Pernicious anemia was a leisurely killer. It might take two to five years to claim its
victims. But, eventually, all died. When they finally expired, blood counts were
often down from a normal five millions red cells per cubic millimeter of blood
to a watery 500,000—not enough to carry the needed amount of oxygen around the
body. Slowly, tissues and organs were
asphyxiated.
Physicians fought futile battles against this doom. A mysterious poison was killing some thought
the red cells off. Others made a better
guess; that the bone marrow, which manufactures red cells, had, for unknown
reasons, forgotten how to produce the trillion new cells needed each day. Still others believed that the spleen played
some role in the disease and that its surgical removal would help. Such patients did well for a while, and then
began slipping again. Whatever the
treatment, the end result was always the same: death.
The conquest of this disease was, I believe, one of the
first instances in medical history in which a universally fatal illness was
converted into a minor inconvenience.
Today, tens of thousands of people live normally with pernicious anemia,
scarcely aware that they have it. Here
is the story of how this came about.
Both my grandfather and father had been country doctors in
New Hampshire, and I was tempted to follow in their footsteps. But, while studying at Johns Hopkins, I
became interested in pathology; the study of disease itself. Blood in general, and the anemias in
particular, fascinated me almost from the start. I studied the anemia, which accompanies
hookworm disease, and observed tropical anemia in Panama in 1907 while the
Panama Canal was under construction.
Opportunity to get at the problem in a concentrated way came in 1914,
when I was invited to San Francisco to head the new Hooper Foundation, the
research arm of the University of California’s Medical School.
The anemia, of course, is a wide spectrum of diseases, and
even in those days most of them were curable.
But pernicious anemia was different.
The normal lifespan of a red blood cell is 120 days. As each dies, it must be replaced—ten million
are needed each second. In pernicious
anemia the new cells were not produced in adequate number. It seemed obvious to me that the only source
of building material for red cells was food, and I blocked out a study along
these lines.
The first step was to produce artificial anemia in
dogs. Form neck artery I intermittently
withdrew blood until the level of hemoglobin—the vital red coloring matter in
blood cells—was 40 to 50 percent below normal.
[The procedure, incidentally, did not seem to bother the animals at
all.] Then various diets were tried to
see which, if any, hastened production of new red cells.
At this point a compact, blond young woman appeared in my
lab and demanded a job. German-born
Frieda Robscheit—later she would Americanize her name to Robbins—was absolutely
determined. ‘I am going to work with
you, whether you like it or not,” she said.
I hired her, and she turned out to be one of the finest collaborators any
researcher can ever had.
Our first problem was to devise a basal diet for our dogs,
one that would provide essential nourishment but would be the poorest possible
for building blood. Then we would
supplement this diet with various foods to see which would hasten production of
red cells.
Months, years, passed.
Thousands of red-cells counts were made as the work crawled methodically
along. Scores of foods were tried as
blood builders—milk, eggs, lettuce, Naturally, we also tried a variety of
meats. A slaughterhouse near the lab
furnished whatever we required in this line; spleen, pancreas, bone marrow,
brains, sweetbreads. And in time an
extraordinary performer emerged. It was
liver in as little as two weeks liver restored low-red-cell dog blood to normal. We found it difficult to believe that any
food could act with such speed and efficiency.
But our work was by no means completed. If liver was to be the hero in conquering
anemia, the fact had to be nailed solidly down—which meant trials on many more
dogs, with time of recovery exactly measured.
In 1921, I moved to Rochester, New York, to become dean of a
medical school then being started. As
soon as the new laboratory was ready, Frieda Robbins came east by train,
accompanied by our kennel. Finally, in
1925, we felt confident enough to report: “Liver feeding remains the most
potent factor for the sustained production of hemoglobin and red cells.” Now, somebody else had to extend our findings
to treatment of pernicious anemia in human.
Dr. George R. Minot of Hayward was one of the very finest in
Boston medicine. Tall, rail-thin,
fastidious, reserved, he was totally dedicated to his patients. When he heard of our work on dogs he
determined to try liver on his pernicious anemia cases.
Not at all well himself—he suffered from diabetes—he
enlisted the help of a younger colleague, dr. William P.murphy, then at Peter
Brigham Hospital. The two almost
literally stuffed their patients with all the liver they could get down
protesting gullets. Sometimes Murphy
mixed ground raw liver with orange juice and poured this in. Patients in a coma got ground liver via
stomach tube.
The response was almost beyond belief. Within a few days, patients looked better,
felt well, and their red-cell counts were climbing. May be these people weren’t doomed after all!
On May 4, 1926, Minot, in his flat New England voice, read a
paper before his peers at the annual meeting of the Association of American
Physicians. He reported that he and Bill
Murphy had stuffed 45 patients with liver.
Some had had blood counts lower than on million, now all but one had
near normal counts. That one was an
elderly lady who so despised liver that she said she preferred death to eating
it. Most of the other patients were up
and about—no longer breathless, no longer weary. Most were back at normal occupations. Minot’s report was acclaimed by a standing
ovation.
Ata hospital in Boston next morning, doctors were preparing
to give an elderly man a transfusion—the only thing that had kept him barely
alive for several years. “Why not just
let me die?” the weary sufferer asked. A
young doctor burst in. “Did you see the
morning paper?” he asked. A news report
had summarized Minot’s paper. Liver diet
was started immediately, and within a week the patient had new life in his
limbs.
Such events were soon being enacted all over the world. A year later, Minot and Murphy reported on
105 patients. There had been three
deaths: one in an auto accident, one from cerebral thrombosis, one from unknown
causes—but none from pernicious anemia.
In 1934, Minot, Murphy and I received identical cablegrams
from Stockholm. We had been accorded
medicine’s highest honor, the Nobel Prize.
A way had been found to rescue the doomed—but the story was
still by no means complete. Even at
outset it was clear that it wasn’t liver that was working such wonders, but
some elusive X substance in liver. The
problem was to get rid of useless components and concentrate on the
substance. Dr. Edwin J. Cohn, the gifted
Howard chemist, took this job upon himself.
Soon he had an extract, one tablespoon of which was the equivalent of
half a pound of liver. Next came an
injectable liver extract 400,000 times as potent as the mother stuff; a short
every two to four weeks was sufficient to keep blood normal.
The search for the X substance came to an end at last in
1948, with the cornering of Vitamin B12.
An invisibly small amount of it—a millionth of a gram a day—was
sufficient to control a disease once totally deadly.
Pernicious anemia, which had probably plagued man from the
beginning, at last could be rendered harmless.
