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84
Reviewing the cases it was found that the symptoms and prognosis in subacute
combined degeneration of the spinal cord could be divided clinically into two
distinct groups. In the one, where the lesion was early and the symptoms consisted
of mild paraesthesiæ in the hands and feet and were more in the nature of a peripheral
neuritis rather than a cord lesion, the prognosis was excellent on adequate liver
dosage. Where, however, there was involvement of the posterior or lateral columns,
no improvement could be expected in spite of massive doses of liver and iron, but
it was found that if the adequate amount of liver or extract were administered, the
disease would remain stationary.
Owing to the inability of the manufacturers and the Medical Research Council
to come to some definite arrangement on the scheme originally formulated, the
work has consisted in the examination of extracts indirectly from two manufacturing
houses through the Research Council.
The work has only been made possible by the untiring assistance of Dr. Alston
of the Archway group laboratory; for, during the year, a very large amount of
pathological investigation has been necessary, which included well over two hundred
and fifty full blood counts alone.