Tuberculosis

In 1967, I lived some months at Coral Harbour on Southampton Island in northern Hudson Bay and often traveled with Tommy Nakoolak, then, at sixty-two, patriarch of the island's sizable Nakoolak clan. Of Knud Rasmussen, the great Danish ethnologist, it was said that he was the only man known who collected old women. They, of course, were the repositories of the ancient tales he loved and recorded. Similarly, whenever possible, I lived and traveled with older Inuit who told and taught me many things the lore, the legends, the skills of their people. 

Tommy Nakoolak was small and wiry, kind and considerate, and he owned a Peterhead boat, the Tereglu (the word for a baby bearded seal), which he handled as if it were a racing yawl. One day along Coats Island, south of Southampton Island, he spotted a herd of walruses on a rocky promontory. "You want pictures?" he asked, and when I said yes, he swung the boat around and headed full speed for the rocks. He sheered past them so closely, I tensed instinctively for the coming crash, but Tommy only smiled. Like many old-time Inuit, he had an astounding geographical memory and knew every rock and ridge along hundreds of miles of coast. 

One day while his sons were hunting caribou on Coats Island, Tommy said: "Come, I'll show you something." He took the Tereglu to a secluded bay near Cape Pembroke. Ashore were ancient stone houses, man-high cairns, box-like graves built of large flat stones, and everywhere masses of bleached bones of caribou, walrus, bowhead whale, and seal. "This is where the Sadlermiut lived," said Tommy. A mysterious, long-isolated Stone Age people, the Sadlermiut were briefly known to the outside world and then all were killed by a whaler-brought disease in the winter of 1902. They may even have been Tunit, the powerful Dorset-culture people. Extinct everywhere else for 800 years, they had found a final refuge on these isolated islands. (The people who now live on Southampton Island are descendants of mainland Inuit brought by whalers and traders to the island to replace the extinct Sadlermiut.) 

The Sadlermiut were "discovered" in the summer of 1824 by the explorer Captain G.F. Lyon of the Royal Navy. He anchored his ship, HMS Griper, off Cape Pembroke. From the camp which Tommy Nakoolak was showing me, a man approached the Griper, riding on a most peculiar craft. It consisted of "three inflated seal- skins, connected most ingeniously by blown intestines, so that his vessel was extremely buoyant." The man's legs dangled in the water while he propelled this strange float toward the ship with a narrow- bladed paddle made of whale bone. The poor man had never seen other humans before and he was afraid: "his teeth chattered and himself and seal-skins trembled in unison. 

Lyon went ashore. The people were shy but friendly, of "mild manners, quiet speech, and as grateful for kindness, as they were anxious to return it." The men wore pants of polar-bear fur; their mittens were the skins of murres, feathers inside. The women were slightly tattooed, and "their hair was twisted into a short club, which hung over each temple." The men's topknots were even more impressive: "Each man had an immense mass of hair as large as the head of a child, rolled into the form of a ball, and projecting from the rise of the forehead." 

Once the Sadlermiut had been numerous. At Native Point on Southampton Island, the archaeologist Henry B. Collins of the Smithsonian Institution found, in 1954, "the largest aggregation of old Eskimo house ruins in the Canadian Arctic." But whalers began to stop at the islands and contact with another world was fatal to the long-isolated people. When the whaling captain George Comer visited Southampton Island in 1896, only seventy Sadlermiut were left. Comer admired the strength and courage of these "fearless people" who had only stone-tipped harpoons and spears: "For an Eskimo in his frail kayak to attempt to capture a [50-ton/ 45-tonne] whale with the primitive implements which they manufactured meant great courage. 

In the fall of 1902, the whaler Active stopped at Southampton Island. One sailor was sick; he may have had typhus or typhoid. Sadlermiut visited the ship and took the disease back to their village. That winter the last Sadlermiut died in lonely agony upon their island. Collins studied their house ruins and graves in 1954 and 1955 and "found evidence that the Sadlermiut descended from the Dorsets - that they were in fact the last survivors of the Dorset culture."

In recommending nutriment adequate to the increased demands of the system, it is not understood that stimulation also is indiscriminately advocated. ‘The object is not stimulation, but power, and that diet must be the best which is capable of imparting the greatest degree of vital power to the various textures, as well as to the blood itself. For this purpose, vegetable food, however nutrient, is very inadequate ; animal diet, on the contrary, stimulates the digestive functions, enriches the blood, invigorates the whole system, and, under judicious regard to existing circumstances, is unquestionably the most restorative of lost power. 

Animal and invigorating diet has been, it is true, generally deprecated in pulmonary cases ; and increase of fever, with aggravation of organic disorder, are usually apprehended as the result. ‘That this idea cannot be always well-founded, the above cases decidedly demonstrate. 

That in certain circumstances of pulmonary disorder injurious Consequences are to be apprehended from the liberal and indiscriminate use of animal diet, Iam ready to concede ; and also, that caution is necessary to adapt the kind and quantity to existing circumstances,—otherwise fever, disorder, and debility, will result, instead of vigour and health. But, on the other hand, I am convinced that, under groundless, or, at all events, mistaken fears of this kind, a system of exclusive abstinence is pursued to the certain aggravation of existing disorder, when a discriminating adoption of a system directly opposite to it is that which is indicated. 

On this point, an interesting feature in the last-detailed case merits attention :—the exacerbation of the cough and febrile symptoms shortly after the adoption of animal diet. ‘This is a result which I admit is of very frequent occurrence in circumstances of great general debility, and in proportion to the degree of debility. It has been usual to regard such an occurrence as highly unfavourable, and as an immediate urgent ground for withholding animal diet in future, and for having recourse to less stimulating vegetable preparations. I am disposed to view the matter in a different light. Knowing, on incontrovertible principles, that the constitution, in these circumstances, absolutely requires the nutritious and invigorating influence of animal diet, the symptoms in question cannot be owing to these properties, but necessarily are due to some other coexistent circumstance. This, | believe, usually consists of such disorder of the alimentary viscera, whether dependent on general debility and habitual organic atony, or upon existing depravity of secretions, as is incompatible with the adequate conversion of animal diet to its proper use. It lodges unreduced in the duodenum, irritating to morbid action that organ ; and as the various secretions have been deficient or depraved, the excitement of the circulating activity locally takes place without corresponding activity of the glandular function of the liver, and the other secreting actions connected with digestion, whence necessarily morbid local action and febrile excitement. To relinquish measures so essential to restore the constitutional powers on this account, is a mistaken course. Correct the existing disorder; stimulate the secreting functions of the liver and the other secretions ; promote habitually the alvine evacuations ; and perseverance in animal diet is no longer injurious, but beneficial, and what the very debility, indicated by the febrile exacerbations in question, urgently calls for. It is an interesting practical fact that, in such circumstances, the excitement of fever by the use of animal diet is generally in a degree moon to existing debility; and as vigour is regained by the use of that means, the febrile exacerbations in question are less liable to occur, and, when occurring, produce much less influence either on the constitution or on the local disorder. In chronic catarrh and mucous secretion of the bronchiz dependent on slighter pulmonic congestions, increased freedom of expectoration supervenes after every meal, and seems, in such cases, a favourable symptom rather than otherwise, indicating the beneficial effects of food in restoring and invigorating the system. When, as in the above-detailed case, the same disordered condition is associated with great general debility, increase of expectoration is naturally to be expected from the remission of chronic congestion under an invigorating diet ; and in such circumstances, being analogous to the critical expectoration in acute inflammations, is rather favourably symptomatic of returning vigour, than an indication for farther reduction of power. 

 These remarks by no means imply the propriety of adopting animal diet in all cases indiscriminately. Where, from existing disorder of the lungs or digestive organs, or from extraneous circumstances of impure air, the digestive power is materially impaired and counteracted, what good can be effected by administering food ? The injurious consequences supervening are naturally in a degree proportioned to existing debility and incapacity Sr digestive action. A just estimate of the digestive capacity is not less essential than a just estimate of the existing demands of the debilitated frame. 

The question naturally occurs, what was the real nature of the pulmonary disorder in the foregoing case? No evidence appearing of the existence of tubercles, the inference is, that the purulent expectoration proceeded from brochial secretion or ulceration. But regarding the attendant symptoms and the rapidly progressive decline of the powers, the result of porerarenes in abstinence and antiphlogistic treatment may e anticipated. As no criterion for judging of the existence of tubercles usually is afforded* farther than the symptoms manifested in this case, the practical deduction is, that an invigorating system of dietetics is now generally deserving of trial in sumilar cases. It may be objected that, however useful animal diet may be in chronic catarrh, purulent secretion, or even ulceration, this system of diet is not applicable to the case of tubercular ulceration.

Observations among the animal kingdom show that the carnivora rarely have tuberculosis, while the vegetable feeders are particularly prone to this form of disease. Carnivora, while fed upon an animal diet, cannot be successfully innoculated with tubercular matter ; confined and fed upon an opposite class of food products and the experiments rapidly become successful.

Tuberculosis in the human subject is most frequently found in starch and sugar-fed subjects and in those who are compelled to live in close quarters.

The only line of treatment that has yielded any satisfactory results has been the sending of such cases to the wild mountain regions where the diet of necessity is largely of the animal class, such as game and fish. With this out- of-door life, an almost exclusive use of an animal diet, and a moderate amount of alcohol and cod-liver oil to supply what CHO element the system absolutely demands, has resulted in the positive cure of a fair percentage of genuine tubercular subjects.

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.

On my first visit to Hay River, in 1906, the mission was in charge of Rev. Mr. Marsh, an excellent man in many ways, and remarkable as one of the first missionaries in the North to realize the deadliness to the Indian of the white man's house. Few things are more common in missionary conferences than to have those who have just returned from work in distant fields show with pride the photo graphs of the native communities at the time of the coming of the missionaries, and again a few years later. Typically the first picture shows a group of tents or wigwams, while twenty years later the missionary is able to point with pride to how, year by year, the number of cabins increased until now the last tipi has gone and a village of huts has replaced them. They do these things and we listen and applaud, in spite of the fact that we ourselves have come to realize that the way to deal with tuberculosis, which is deadly among us but far more deadly among the primitive peoples, is to drive the affected out of the house and into tents in the open air ; and while charitable organizations in New York are gathering money to send the invalids of the city into the open air, there are also in New York missionary organizations gathering money to be used in herding the open air people into houses. While the missionary shows on the one hand a series of pictures indicating the growth of his village of civilized looking dwellings, it would be interesting to ask him if he happens to have also a series of photographs illustrating the growth of the graveyard during the same period. No dwelling could be more sanitary and more likely to forestall tuberculosis than the tipi of the Indians of the Mackenzie Valley. It is not only always filled with fresh air, but it never becomes filthy, because it is moved from place to place before it has time to become so ; but when a house is built it cannot be moved . The housekeeping methods which are satisfactory in a lodge that is destined to stand in one place only two or three weeks at a time, are entirely unsuited for the log cabin , which soon becomes filthy and remains so. Eventually the germs of tuberculosis get into the house and obtain lodging in it. The members of the same family catch the disease, one from the other, and when the family has been nearly or quite exterminated by the scourge, another family moves in, for the building of a house is hard work and it is a convenient thing to find one ready for your occupancy ; and so it is not only the family that built the house that suffers but there is also through the house a procession of other families moving from the wigwam to the graveyard. 

Mr. Marsh saw these conditions and attempted to remedy them , but the Indians had become used to the warmth of the house and refused to go back to their old tenting habits. One family in particular had a daughter grown to womanhood who showed in the spring the symptoms of tuberculosis. In the fall when they wanted to move back from their summer camp into their filthy cabin, Mr. Marsh gave the father a lecture on the unsanitariness of the house and on the necessity of their living in a tent that winter if they wanted to save their daughter's life. But the arguments did not appeal to the Indian. He could not see the germs that the missionary talked about, and did not believe that the cabin had anything to do with it . He announced that he knew better than to freeze in a tent if he could be comfortable in a house and therefore he would stay in the house. But it happened that Mr. Marsh had been a heavyweight prize fighter before he became a missionary, and so he walked into the Indian's house one day and threw him and his family bodily outdoors and their gear after them, nailed up their doors and windows, and told them that he did not want to see them around the village until the next spring. There was some loud talk among the Indians and several threats of shooting and other vio lence, but eventually the family moved out into the woods and stayed away all winter as directed. In the spring they came back with their daughter apparently cured, and when I saw her she looked as well as any woman there. Mr. Vale and Mr. Johnson have since taken up Mr. Marsh's work along lines he had set for them and apparently with good results. In some other places, however, tuber culosis has made a nearly clean sweep of the population. This is noticeably true at Fort Wrigley, where we were told that only nineteen hunters are left in all the territory belonging to that post.