Jeffrey Bland, PhD, discusses the depiction of pernicious anemia in the final episode of Downton Abbey (set around 1925) and uses it to outline the historical medical detective story that led to discovering vitamin B12 (cobalamin) and its role in hematology and neurology. He references late-19th-century observations (Paul Ehrlich, ~1878–1880) of large blood cells (megaloblasts/megakaryocytes) tied to neurological findings, contrasts iron-responsive anemia with the more lethal pernicious anemia that did not respond to iron, explains the later discovery that pernicious anemia results from absence of intrinsic factor, and notes early liver-therapy experiments that provided enough B12 to partially overcome the absorption defect. He frames the condition as a hematologic–nervous system connection.
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So were you a viewer of the final episode of Downton Abbey? All of us were sucked in that were kind of the historians of this epic period of English history. And those of you who are in the functional medicine model probably picked up immediately the extraordinary discussion of Lord Merton and Isabel Crawley and the pernicious anemia component. The episode did you catch that was really interesting, wasn't it? Now, think this was 1925. So it was Paul Ehrlich and his colleague that was at the end of the 19th century, about 1878-1880, that first identified with aniline dyes, the staining of blood and the examination of what were called megakaryocytes. Back in that time, these large blood cells were found in some people that were later found to correlate with things like spinal ataxia and other kinds of peripheral neurological conditions that were then called pernicious anemia in the 20th century, earliest 20th century. But, of course, the vitamin B12 connection was not understood. Vitamin B12 had not been discovered yet. And the early stage recognition was that there seemed to be a couple of forms of this condition. One form was a form that could be modified by taking certain kinds of diets that were studied and could increase the red blood cell number. And these were diets that were rich in iron. And so we got this iron deficiency concept. But then there was another form that didn't respond to iron, and that was called pernicious anemia. It was more serious and it often led to death. And pernicious anemia was a consequence of the absence of intrinsic factor, which, you know, is necessary for the absorption of vitamin B12. This is all what we learned post. Post 1925. But before that, it was thought this was the kind of lethal form of the condition and it wouldn't respond to the normal dietary intervention. But then actually it was found later that if you took liver that was fresh and you squeezed it and you got enough good liver juice that you could get people who had even pernicious anemia to respond by overcoming that threshold of the absence of intrinsic factor, because there was some passive absorption of what was later to be called cobalamin, vitamin B12, if you gave enough of it, so you could overcome the deficiency to an extent, of the absence of pernicious anemic factor, which was intrinsic factor. So this whole interesting story in Downton Abbey, I think sidebar, is a really interesting part of the medical detective story that relates to development of an understanding of vitamin B12, folic acid blood, and, and how that ultimately goes on to relate to the nervous system. So it's a systemic connection, is it not? As we look at the early diagnosis being alteration in the size and volume of red blood cells, and then later going on to recognize that this connected into the nervous system. So the hematological nervous system functional connection. A very interesting little insight for those of you who are sluice, medical sluice of this last issue of Downton Abbey.
