William B. Castle discovered gastric
intrinsic factor, the absence of which causes
pernicious anemia. Intrinsic factor was necessary to facilitate the absorption of an 'extrinsic factor' from the diet. Whipple, Minot and Murphy were awarded the Nobel Prize for Physiology and Medicine, in 1934, for the discovery of the "anti-pernicious anæmia factor" from their experiments with liver in the diet. The 'extrinsic factor' is now known as
vitamin B12 (cobalamin) and provides an effective therapy for pernicious anemia. In 1931 Castle went to
Puerto Rico sponsored by the
Rockefeller Foundation International Health Board in a public health project. He conducted a several-month study for the Rockefeller Anemia Commission, as part of the Rockefeller Foundation's work in trying to combat hookworm in the Caribbean. Anemia was widespread on the island because of the endemic parasite
hookworm and
tropical sprue, the latter a disease which scientists thought possibly related to diet. Castle was assisted by
Cornelius P. Rhoads, known as Dusty, who was affiliated with the
Rockefeller Institute in New York and later became head of
Memorial Hospital for Cancer Care and Research. He also worked with
George C. Payne. They showed that
tropical sprue was caused by intestinal impermeability to this and other
hematopoietic factors in food. They were able to use liver extract therapy to treat tropical sprue successfully. It is still a problem in Puerto Rico, but it can be treated with folic acid and a 3-6 month course of antibiotics. In closely related studies, Castle defined the need for
iron for the bone marrow to make
hemoglobin. Without adequate iron in the diet, children and adults develop
iron deficiency anemia, a common scourge. Castle and his team later characterized the
red blood cell defects that are responsible for
paroxysmal nocturnal hemoglobinuria and
hereditary spherocytosis. They also did important research on
sickle cell disease. It is a genetic disease found at high frequency among people of African ethnicity. == Teaching ==