ZOMOTHERAPY IN TUBERCULOSIS.

By Lawrason Brown, M.D.,

RESIDENT PHYSICIAN, ADIRONDACK COTTAGE SANITARIUM, SARANAC LAKE, N. Y.

Some months ago two French scientists, Richet and Hericourt, 1 announced most favorable results in the treatment of tuberculosis with raw meat or its juice. They began two years ago to publish their observations, and during the last year both have written glowing accounts of the efficiency of this treatment. They have long been experimenting upon dogs, endeavoring to find some curative agent for tuberculosis; but all to no avail until they began to feed their dogs exclusively upon raw meat. Their dogs, 129 in number, may be divided into three groups. The first, composed of 30, received no treatment; the second, numbering 58, was treated by different methods, while the third, 41 in number, was fed on raw meat. At first the amount was unlimited, but later they found that 10 to 12 grammes per kilogramme of body weight of the animal was sufficient The first and second groups lived, on an average, 52 days, while the dogs fed on raw meat lived, on an average, 227 days; in other words, the period of life was very nearly five times longer in the dogs fed with raw meat. From their experiments they conclude that cooked meat in any quantity is inefficacious, that meat deprived of its serum is moderately efficacious, and that muscle serum is as efficacious as raw meat. Raw meat they found also to act prophylactically.

The explanation of the action of the raw meat, although discussed at the Paris Conference in 1900, is still unsettled. Richet at that time attributed the beneficial effects to some body in the meat-juice that prevented the development of tuberculous granulations. According to Maragliano, meat acts as a stimulant, and therefore promotes the formation of an antitoxin in the body. More recently Richet has advanced a “ metatxophic antitoxic action." The tuberculized animal, he says, dies by a slow and progressive intoxication of the nervous system. The active elements of the muscle serum preserves the nerve cell from a tuberculous intoxication.

Richet and Roux’ have obtained favorable results in experimental meningeal tuberculosis in dogs. Twenty dogs were inoculated with tubercle bacilli in the spinal canal between the atlas vertebra and the occiput. Eleven of these were fed on raw meat and three survived, two of which were injected with tuberculin and did not succumb, as did one of the dogs which survived after being fed on cooked meat. Nine dogs were fed on cooked meat, and all died.

Chantemesse,’ who first looked upon raw meat as a stomachic, has later taken an opposite view on account of his own observations. He injected two dogs with tubercle bacilli. One he fed upon raw meat; the other with cooked meat. The first remained sound and well; the second died.

Salmon 4 divided a number of dogs into three groups. The first, which received raw meat and was then injected, died as quickly as the controls. A Eecond group, injected and then fed on raw meat, gained in weight and lived a fairly long time. In the third group treatment with raw meat was not begun until the disease had advanced considerably, and there was much loss of strength. On these raw meat exerted no influence. This author also calls attention to the fact that a dog which has apparently recovered from tuberculous peritonitis may still show at autopsy numerous fresh nodules in the peritoneum and internal organs and an extending tuberculosis.

Frankel and Sobemheim 1 have published their results obtained by zomotherapy in tuberculous dogs and rats. Nine dogs and four rat were injected with carefully estimated quantities of an emulsion oi tubercle bacilli. Four dogs and two rats, fed on a mixed diet, were used as controls, and the remainder fed on raw meat. The dogs all died in six weeks. These authors suggest that Bichet and Hericourt’a results may be due to the fact that a non-virulent tubercle bacillus was used in the injections.

The literature on zomotherapy in human tuberculosis is more extensive, but no more conclusive. Duhoureau 8 mentions the case of his son, who, from smaller doses than those given by Hericourt, derived much benefit. Hericourt advises 600 to 700 grammes of raw meat, or the juice of 1000 to 1300 grammes of raw meat, per diem. In a recent article Hericourt 7 has collected statistics in zomotherapy in human tuberculosis. Besides eleven cases treated by himself, he reports twelve cases treated by others. These cases may be tabulated as follows:

It is but natural that anyone acquainted with pulmonary tuberculosis should, if the cases have not been selected, regard these uniformly good results somewhat skeptically.

Hericourt quotes, in addition, several favorable reports. Dr. Petit-Clerc" mentions three cases in the second stage of pulmonary tubercu¬ losis who recovered under treatment by raw meat and fresh air. Dr. Sarge 9 has seen a case of pulmonary tuberculosis in the third stage recover under zomotherapy. Garnault 10 reports two cases in the second and third stages of pulmonary tuberculosis who apparently recovered under raw meat and iutratracheal injections of orthoform. Josias and Roux" have followed zomotherapy as treatment in six cases of pulmonary tuberculosis in children, three of whom were in the second stage and did very well, and three in the third stage, who did not do so well. Three cases of meningeal tuberculosis were treated without favorable results.

At present the prevalent opinion is that Richet’s method is only a better means of offering nourishment and of enabling a larger quantity of food to be given. The resistance of gouty persons toward tuberculosis is, Weber 12 thinks, probably due partly to the meaty food. He recognizes, however, that due proportions of vegetables and fruits are of great importance. In some cases a fair amount of butchers’ meat will stimulate the appetite enormously for all kinds of food, and render digestion more vigorous. Meat albumin, in contradistinction to milk albumin, writes Ross, 13 quickly and readily manifests its better qualities in the early observable improvement in the sufferer, and the benefit so obtained is not so easily undone as in the case of casein albumin. The cause, he thinks, is due to the fact that the adult has more muscle, and so needs more muscle-juice, or the muscle-juice contains more iron. Possibly, he says, the meat-juice contains some antitoxic substance. Browning the meat, he thinks, has little effect upon the real properties of serum.

Myosin albumin returns a maximum of nutrient for a minimum of effort, peptonizes readily, and is promptly absorbed, throwing little or no stress and irritating overaction on the stomach. But Bernheim 1 * warns us that the benefit of alimentation is not measured by the quantity of food ingested, but by the quantity digested. The raw-meat treatment of Richet and Hericourt is, in effect, really suralimentation, but suralimentation in'such a form that the majority of patients can stand it. “ When, under the pretext of recovering the albuminoids, one submits the tuberculous patient to an exclusive meat diet, when one declares the carbohydrates—vegetables, sugar, cereals, etc.—to be secondary, the patient is deprived of an element primordially essential to repair, is given only an insufficient diet of phosphates, has his hyperacidity increased, and in place of increasing the artificial arthritism, which would be of value, a state of affairs is favored which would increase the susceptibility to the bacillus.”

On account of the great expense, but few patients can carry out the raw-meat treatment as suggested by Hericourt, who advises that the juice of six pounds of rare beef, free from fat, bone, and cartilage, be taken daily. However, smaller quantities can be used advantageously. Two patients who took the full amount for several months made good recoveries. In one of these the disease was advancing quite rapidly. Many patients have been given beef-juice extracted from meat slightly browned, and it seemed to exert a very beneficial but no specific action.

In reviewing the experimental work done on this subject one is struck, as Frankel remarks, by its meagreness. Chantemesse, Salmon, and Frankel are apparently the only observers to repeat Riehet’s work. Frankel obtained opposite results, Salmon’s results were inconclusive, while Chantemesse, from experiments upon two dogs, upholds Richet. For this reason at the suggestion of Dr. Trudeau, and largely under his guidance, the following experiments were carried out:

From the foregoing experiments on the treatment of experimental tuberculosis by raw meat, the following conclusions may be drawn.

1. That raw meat has no perceptible effect on the duration of experimental tuberculosis in dogs if the bacilli are virulent and a sufficient number injected intravenously.

2. That raw meat has no effect on the prolongation of the duration of experimental tuberculosis in dogs, even if the bacilli are attenuated, provided a reasonable quantity be injected intravenously.

3. That under the same conditions dogs fed on a mixed diet with no raw meat may live a much longer time.

Regarding the use of meat in pulmonary tuberculosis, it may be said:

1. That meat is highly essential in the dietetic treatment.

2. That much meat with a judicious admixture of carbohydrates, fats, etc., is essential to the treatment.

3. That rare meat is better than meat well cooked.

4. That meat-juice is of great value in suralimentatioo, as myosin albumin is easily digested by most patients—even the dyspeptic, and it affords a“ maximum of nutrient for a minimum of effort.” (In a few patients meat-juice causes diarrhoea and meteorism.)

5. That meat-juice can be taken when patients can take no other form of meat, i. e., when there exists a marked repugnance to all solids.

6. That the juice from raw meat seems slightly, if at all, more beneficial than the juice from meat slightly browned.

7. That the disadvantages of preparing and preserving raw meat-juice more than offset its advantages. (Patients who object to juice from raw meat will willingly take that from meat browned.)

8. That meat-juice is of value, as it can be administered in the form of jellies, ices, etc.