392 THE CANADIAN MEDICAL ASSOCIATION JOURNAL

far more under control, and less a disability,
than an uncertain or incompetent sphincter in
the normal position.
Of the, technical difficulties of the Lockhart
Mummery perineal resection I speak with as-
surance, since I have had opportunity on two
occasions to practise it since his publication.
Of these two cases I may state that both are
alive. I nearly cut the urethra in one, and
avoided it in the second.
With such a relatively hopeful prospect, we
ask practitioners to try and bring some of
that large group of inoperable cancers of the
rectum within the very favourable or medium
group? This can only be done by constant care;
by considering as suspicious of cancer all symp-
toms referable to the bowel which are a persis-
tent deviation from the individual's habit; and
by proving the patient to be free from cancer
before considering him free.

A METHOD OF PREPARATION OF A LIVER EXTRACT POWDER

FOR THE TREATMENT OF PERNICIOUS AN2EMIA
BY J. B. COLLIP
Department of Biochemistry, University of Albu'ta
Edmonton South
COHN and others working in collaboration The Cohn extract has recently been made
with Minot and Murphyl have developed a available by the Eli Lilly Company who are
method of preparing a liver extract which has marketing a liver extract (No. 343) prepared
been proved effective as a substitute for liver by them under the direction of the Committee
feeding in the treatment of pernicious anamia. on Pernicious Anemia of the Harvard Medical
The principles laid down by Cchn in his School. The published method of preparing
original communication on the method of this extract is as follows 2
preparation of an active extract of liver were Livers from edible animals are ground
as follows:- directly into water and the mixture adjusted
Raw liver was minced and suspended in an to the isoelectric point ( approximately pH 5
appropriate amount of water and the pH ad- to 6). The mixtuire is then heated to coagulate
justed to 9. Insoluble material was removed proteins, (approximately to 800 C.) stirred for
and found to be inert. The watery solution thirty minutes and filtered. The filtrate is
of soluble extractives was adjusted to pH 5 reduced in vacuo to a small volume and enough
and the precipitate which resulted was re- 95 per cent alcohol added to produce a con-
moved. This was found also to be inert. The centration of 70 per cent. The precipitate
filtrate was heated to 700 C. and the heat- which is formed is discarded and the filtrate
coagulable proteins thereby removed. The reduced to a small volume added to absolute
filtrate was extracted with ether and no loss of alcohol and the precipitate separated, dried
potency was noted. The watery solution at in vacuo and powdered.
this stage was proved to be effective in the The extract is a yellow powder having a not
form either of a syrup or powder prepared by unpleasant taste, almost entirely soluble in
simple concentration in vacuo. An active powder water. It is precipitated from the aqueous
was prepared by adding absolute alcohol to the solution by alcohol and acetone. It is insoluble
concentrated watery solution above mentioned in ether.
until the concentration of alcohol in the mixture The extract of liver as prepared by the
was approximately 95 per cent. The precipit- method outlined below is essentially crude as
ated material was dried and powdered. This compared to the Cohn final product. There is
powder fed in daily doses of from 9 to 14 gms. also nothing original in its preparation, as the
caused a prompt and rapid improvement in the principles developed by the Harvard investiga-
blood picture, and the clinical condition of three tors have been kept in view throughout. It has
patients suffering from pernicious anwmia. this advantage that its preparation is fairly
 CoLLIp: LIVER EXTRACT PPOWDER FOR TREATMENT OF PERNICIOUS ANmEAIA 393

simple and at the same time not costly. Also
the amount which has to be administered in
treatment is not much greater than has been
advocated for the more highly refined product.
The preparation of the extract is as follows:
Frozen liver is allowed to soften and is finely
minced while still in the semi-frozen state. It
is then dropped in boiling water (ap-
proximately four volumes) and violently
agitated. The temperature is not allowed to
become higher than 800 C. It is kept at this
temperature for a few minutes only and is then
rapidly transferred to a large canvas bag dnd
the juice immediately expressed. The press
juice is transferred to a large number of
enamel meat trays and these trays are placed
in a wind tunnel. If there is any delay in the
process at this stage possible bacterial action
may be circumvented by the addition of a
phenol preservative or by adequate acidification
of the press juice. By means of a hot air blast
through the tunnel the press jtuce is reduced to
a small volume without itself becoming heated.
Concentration by the air blast is carried on
until the liquid is of a syrupy consistency. It
is then transferred to a large enamel container
and two volumes of acetone are added. The
acetone precipitate is collected on large filters
and allowed to drain. It is then air-dried at a
temperature not exceeding 600 C. The air-
drying can be conveniently carried out by
placing the precipitate again in shallow trays
in a wind ttmnel or over steam radiators.
When the drying process is completed the solid
residue is powdered in a drug mill and is ready
for use. It is most readily and satisfactorily
administered in gelatine filled capsules.
Some points of interest in this method are:-
1. The use of only one reagent, namely acetone.
2. A very large percentage of the acetone used
can be easily recovered.
3. The non-necessity of the use of a vacuum
at any stage.
4. The effective precipitation with acetone at
67 per cent concentration.
5. The non-necessity of adjusting pH.
6. From 15 to 17 grammes of the extract
powder are equivalent to 1 pound of fresh liver.
A much higher fresh liver equivalent per
gramme of extract can be attained by making
the press juice, either fresh or concentrated, acid
to one-quarter of 1 per cent with acetic acid,
bringing to the boil, filtering and then proceed-
ing as has been outlined above. This modifica-
tion has a serious drawback. When the heat-
acetic coagulable material has been removed the
precipitation with acetone later yields a pre-
cipitate which is extremely sticky and difficult
to handle. Leaving the heat-acetic coagulable
proteins in the extract makes for a simpler and
more adaptable process.
Extract, the equivalent of 1500 pounds of
fresh liver, has been used in the treatment of
pernicious ancemia cases by a number of clin-
icians. Dr. Adamson3 of Winnipeg has recently
reported two cases in which the extract has
been used with excellent results.
It is too early as yet, however, to make any
specific claims for the effectiveness of this ex-
tract. Nevertheless the results obtained by clin-
icians who have been good enough to test out
the extract in pernicious anawmia cases in doses
of from 10 to 15 grammes daily have been so
uniformly good that a much wider trial would
seem to be warranted.
REFERENCES
1. COHN, E. J., MINOT, G. R., FULTON, J. B., ULRICKSp
H. F., SARGENT, F. C., WEARE, J. H. AND MURPHY,
W. P., Proc. Am. Soc. Biol. Chem., 1927, vii, 69.
2. Report of Council on Pharmacy and Chemistry, J.
Am. M. Ass., 1928, xc, 385.
3. ADAMSON, J. D., Canad. M. Ass. J., 1928, xviii, 151.

Reduction of Cervical Dislocation.-Victor as a fulcrum. The ligaments which have held

F. Marshall and Clarence C. Reed, Appleton, the vertebra firmly in its faulty position do not
Wis., recommenid the method of Walton. The offer opposition to this movement, so that force
essentials of Walton 's plan of reduction are: is not required first to elevate in this way and
(1) dispensing entirely with extension, and (2) then to rotate to the proper position. The patient
using only retrolateral flexion and rotation. The should be thoroughly anesthetized (nitrous
proper method is simply to raise the depressed oxide), and should be in the sitting position
process and rotate. This can be accomplished
only by extending the head obliquely backward This gives freedom of movement and prevents
toward the right or left as the case may be and confusion of the proper movements of reduction.
using the transverse process on the same side -J. Am. M. Ass., July 16, 1927.