Fig. 4.—This photograph is of a Samoan about 65 years old. The scrotum will weigh about 30 pounds. Both legs are also involved in the disease.

Treatment.-Prophylaxis is the watchword.

Boil or bake all foodstuffs and drink in the tropics. Change of residence to prevent further infection is recommended. Internal remedies, such as methyline blue, etc., have not proven of any benefit. Tonics and antifebrile remedies are used. The parts are elevated, bandaged or strapped to reduce the swelling. Puncturing the limbs or swellings and the use of evaporating antiseptic lotions have been recommended. Blood-vessels have been ligated in the leg with beneficial results. Excision of the scrotum, labia and mammæ are practiced with good results in suitable cases.

THE CURE OF CONSUMPTION BY FEEDING THE PATIENT WITH SUBCUTANEOUS INJECTIONS OF OIL, AND ITS DIGESTION BY THE WHITE GLOBULES OF THE BLOOD.

By THOMAS BASSETT KEYES, M. D., of Chicago,

Chairman of the First Organization Committee of the American Congress of Tuberculosis, and one of the Vice-Presidents of the International Congress of Tuberculosis, St. Louis, 1904.

By the method of treatment which I am about to describe in this paper I believe that consumption can be absolutely cured. First, however, before entering into the merits of this treatment, let us briefly consider the disease.

Tuberculosis is a disease of mal nutrition, and while the presence of the germ confirms the diagnosis, before the germ can grow it must find a suitable soil, there must exist a pretubercular condition. It is estimated that we all breathe in a great many of these germs but that they cannot grow in a healthy, well nourished individual. People who have consumption do not eat fats, oils and cream in sufficient quantities. The first requisite in an attempt to cure tuberculosis has been for many years to give the patient oils of various kinds, and the most successful sanitariums of late years have adopted a process of food forcing, using the fats of meats, butter and cream as the principal foods to be relied upon to effect a cure, each article of diet being selected for its fat-producing and strength-giving properties. To this a vigorous out-of-door life has been advocated, because why? It promotes appetite and the outdoor life is conducive to place the body in condition for the absorption of more fats. I was one of the

first to advocate tent life for the treatment of tuberculosis in two articles entitled: "Camp and Outdoor Life as an Aid to the Permanent Cure of Tuberculosis, Feb. 21, 1900," and "Some Results of Camp and Outdoor Life in Northern Wisconsin, Congress of Tuberculosis, May 15-16, 1900," and some four years ago I located an out-of-door camp for the treatment of these invalids in Northern Wisconsin. To maintain nutrition has long been considered the prime requisite of cure and an increase of weight is an indication that nutrition is overcoming the disease, and as weight increases there comes strength, and the passing away of the other distressing symptoms, such as the products of the disease, expectoration of mucus, fever and finally cough. Professor Osler has stated that the arrest and cure of the disease is entirely a matter of nutrition and that the whole object of treatment is to fortify the patient's constitution against the inroads of the disease so that the individual cells of the body have the stamina to fight against and destroy the tubercle bacillus. Regarding tuberculosis Dr. J. H. Elliot, in Canadian Journal of Medicine and Surgery, March, 1903, says that nutrition is dependent upon the proper assimilation of food, while improvement must be proportionate to the increase in the amount assimilated. All therapeutic measures, says Marfan, should be devoted to the end of nutrition and the earlier such measures are instituted the greater the prospect of Without going further into the fact that the whole cure of tuberculosis, up to the present time, is dependent upon our ability to nourish the patient, except to say that the methods of Dettweiler, VonLeyden, and Hoffman of Germany depend upon results from nutrition, and to this end they have advocated forced diet regardless of appetite. If the patient was to recover he must eat. Out-of-door life was important inasmuch as it supplies to some extent the appetite.

cure.

Anorexia is one of the worst symptoms against the cure of tuberculosis. It is impossible to get the average patient to eat enough fats, and a person who has consumption is the one who leaves the fat from his meat, eats very little butter, and little of cream and milk. When a patient is far advanced in the disease he is unable on account of this loss of appetite and nausea, to eat sufficient food to

maintain nutrition, and therefore gradually declines as the disease advances.

In the above few words I have tried to convey the importance of nutrition, in the cure of this disease, believing that the cure rests entirely upon our ability to so nourish the system and stimulate the cells of the body that they will throw off the disease.

The Digestive Power of the White Blood Cells.—Experiments have been conducted principally by the Italian physicians, and a few others, viz.: Gabrelschewski, arch. f. exp. path. 1891, bd. 28; Czerny, arch. f. exp. path., 1893, bd. 31; Leviertato, arch. Italiano di Clinica Medica, n 3, 1893; Tarchettia e Parodi, La Clinica Medica Italiana, n. 10, 1899; Kraminer, Berl. Klin. Woch., n. 6, 1890; Oliva, Gazzetta Degli Ospedali, 17 guigno, 1900; Tarchetti C. Sull, esistenza di un fermento diastace nei corpuscoli bianche, Gazzetta Degli Ospedali, n. 90, 1900; Sull natura e sul significato della sostenza iodofila dei globuli bianchi, La Clinica Medica Italiana, n. 8, 1900; Di una pretesa degenerazion amilodea sperimentale, La Clinica Medica Italiana, n. 7, 1900; Richerche nulla degenerazione amiloidea spermintale, La Clinica Medica Italiana, n. 11, 1902; Porcile V. sul valore semeiologico della reactione iodofilia nei purulenti, Gazzetta Degli Ospedali, Milano, n. 102, 1900, which go to show that there is a glycogenic ferment in the cells which has the power to digest starches. These experiments have been carried on principally to discover a cause for the disease of diabetes. It has been

shown more or less perfectly by some of these same observers that fats also may be digested by the blood, and that the white blood cells have the power of digesting oils. Though these experiments, according to Tarchetti, La Clinica Medica Italiana, 1900, are not definite, it is clear that the white cells of the blood possess a ferment or property which has the power of digesting fats and starches, and without going into the process, chemical, phagocytic, osmotic, etc., which has been gone into by Dr. Spezia in the numbers 5 and 6 of the Gazzetta Medica Lombarda, 1904, for as Tarchetti, Gazzetta Degli Ospedali, n. 28, 1904,' says: Is it possible to follow the rapid course of the oil injected into the internal organism and the phenomena.

positively chemical, of osmosis, of phagocytosis, and of digestion intercelluar?

2nd.

Upon the digestion of oils by the blood I base this claim for a cure of tuberculosis. So far I have tried to show: 1st. That the cure of consumption must necessarily depend upon a proper supply of nutriment, the disease being primarily a disease of mal-nutrition. That consumptives suffer so much from loss of appetite, nausea, and perhaps non-absorption, that, as a rule, they are unable to take sufficient amounts of fats to overcome the disease. 3rd. That the blood cells possess a ferment capable of digesting fats.

I shall now give my results in the cure of tuberculosis by the subcutaneous injection of oil. The oil which I have selected in the treatment of my cases has been olive oil of a very high grade, thoroughly sterilized, using olive oil in preference to other oils on account of it being nonirritating and very readily accepted by the system. The point selected for the injection has been over the shoulder blades, injecting one day over one shoulder, and the next day over the other, excepting when a large amount of oil is used when it is necessary to inject over both. There is very little pain connected with the injection and the following day it is hardly possible to find where the injection was made. By being careful in my technique of cleanliness and sterilization, so far no infection has taken. place and consequently no soreness, though I believe the non-irritating properties of the oil have a great deal to do with this. The amount of oil used varies. I commence by injecting 12 cc. of oil each day and the third day increase the amount to 24 cc. of oil. If no unpleasant symptoms arise I keep gradually increasing the dose to full tolerance of the patient which varies with the individual and the stage of the disease. Those who are poorly nourished will sometimes assimilate large quantities of oil up to about 200 cc. daily. In this manner I have treated nine consecutive cases successfully, and within 24 hours after each treatment there is a remarkable benefit and amelioration of all symptoms, such as diminished morning cough, night sweats, increased strength, and finally gain in weight. Some of the very worst cases of tuberculosis, under this plan of treatment, have gained each day and I believe have