NASAL INSTILLATION AND INHALATION OF CRYSTALLINE VITAMIN B12 IN PERNICIOUS ANEMIA

SINCE the introduction of liver therapy by Minot and Murphy in 1926, the treatment of pernicious anemia has undergone many alterations simplifying procedures for both patient and physician. Oral administration of whole liver has been discarded because of the expense and the unpalatability of this material in sufficient quantity to be effective. Ingestion of liver extract, dessicated defatted hog stomach, liver-stomach concentrate, proteolyzed liver preparations, normal gastric juice, and vitamin B₁₂ substances, as well as sublingual administration of vitamin B₁₂ have not proved satisfactory for complete therapy of pernicious anemia. While folic acid corrects the hematologic disturbance, it does not favorably influence the neurological complications. The administration of massive doses of vitamin B₁₂ by mouth produces adequate response in patients with Addisonian anemia,* but this mode of treatment is costly. Recent reports on the effectiveness of reaction products of vitamin B¹² and intrinsic factor in oral therapy are encouraging although