Vitamin B 12 and Tropical Sprue

Manson in 1883 advocated the use of a folk remedy, liver soup, for the treatment of tropical sprue. Subsequently, with the development of morphological haematology, it was recognized that there were some similarities between tropical sprue and pernicious anaemia (Reed & Wyckoff, 1926). After Minot & Murphy (1926) demonstrated the effectiveness of liver therapy in pernicious anaemia, detailed studies of the haemopoietic response to liver therapy, in patients with megaloblastic anaemia due to tropical sprue, were also undertaken. Bloomfield& Wyckoff (1929) treated a patient with tropical sprue from the Philippines with 400600 g of liver extract daily for 37 days and noted a 14% reticulocyte response on the eighth day, an increase in haemoglobin from 50% to g5%, an increase in body weight of 30 lb and a decrease in diarrhoea but persistance of steatorrhoea. Ashford (1930) also obtained haematological responses to both orally and parenterally administered liver extract. Castle et ul (1935) observed that liver given orally was ineffective in some cases of sprue but that liver extracts administered parenterally produced a response (Fig I). However, in all these cases it is not clear whether the observed responses were due to the vitamin BIZ or folate content of the liver preparations. With the isolation of vitamin B, and the recognition that it was deficiency of this vitamin which was responsible for the blood changes of pernicious anaemia, it was natural to try its therapeutic efficacy in tropical sprue. Puerto Rican patients with tropical sprue and megaloblastic anaemia were shown to respond to single injections of 10-25 pg of the vitamin, by a reticulocytosis, a rise in haemoglobin, an improved sense of well-being, a disappearance of glossitis and a decrease in diarrhoea (Spies & Suarez, 1948; Spies et al, 1949; Suarez et ul,