EFFECT OF DEFICIENCY IN MAN 



neither prevented nor relieved subacute combined degeneration of the 

 cord in pernicious anaemia, whereas certain types of liver extract did 

 both.i' A lack of response was also obtained ^^ in aplastic and hypo- 

 plastic anaemia, leucopenia, thrombocytopenia and ulcerative colitis, 

 whilst in refractory anaemias folic acid alone was not able to restore 

 the blood picture to normal, proteolysed liver being necessary, and 

 many pernicious anaemia cases responded sub-optimally. Diarrhoea 

 was controlled and clinical improvement was observed in cases of 

 tropical sprue and idiopathic steatorrhoea, but not in cases of coeliac 

 disease ; folic acid did not, however, improve fat absorption. Even 

 in macrocytic anaemia, the blood picture was often incompletely 

 restored.^® Again, in two cases of tropical sprue contracted in India, 

 the response to synthetic folic acid was dramatic, whereas in two 

 other cases no response was obtained. 20 Synthetic folic acid was 

 found to have no effect in four severe cases of hypochromic anaemia 

 contracted in India,^! although it produced rapid improvement in the 

 character of the stools in six cases of chronic diarrhoea, possibly of 

 nutritional origin. ^^ 



Thus, the chief limitation of folic acid is its inability to improve 

 the nervous symptoms in anaemia, and patients whose blood pictures 

 were apparently adequately controlled by folic acid developed signs 

 of posterolateral cord sclerosis, which rapidly became intensified. 

 Increasing the dose of folic acid failed to improve the nervous 

 sjmiptoms, but these disappeared if liver or desiccated stomach 

 extract was administered. 



Ross et al^^ observed that in some cases of pernicious anaemia 

 treatment with folic acid actually made pre-existing signs of nervous 

 disturbance worse, and better results were obtained with liver extract 

 alone than with liver extract plus folic acid. J. F. Wilkinson ^^ 

 confirmed these results and summarised his experience with folic acid 

 in the following words : " I am fully of the opinion that pteroyl- 

 glutamic acid is neither the best nor the cheapest form of treatment 

 for pernicious anaemia and must not be given alone to patients \\-ith 

 neurological symptoms." Folic acid does not induce neurological 

 symptoms in patients without anaemia.^^o 



L. S. P. Davidson and R. H. Girdwood ^s recorded a somewhat 

 different, though possibly related, limitation of folic acid. Two 

 patients with pernicious anaemia and three with sprue developed 

 signs of vitamin B complex deficiency when treated with folic acid, 

 and these did not improve until the folic acid was supplemented by 

 liver extract. As yet there are no means of determining whether the 

 phenomenon is caused by a deficiency of one or more unknown factors 

 or by an imbalance of vitamins. In any event, combined treatment 

 with folic acid and liver extract is advocated in cases of sprue. 



32 497 



