A NOTE ON SODIUM MORRHUATE IN TUBERCULOSIS

TUBERCULOSIS is the greatest medical problem of the day, being one of the most frequent causes of sickness and death in tropical as well as temperate climates If anything like a cure for this disease could be discovered, the losses of the great war would be replaced within a very few decades. During the last year I have been working at a new line of treatment of tuberculosis on similar lines to thlat which has proved of great value in my hiands in the case of the other human disease produced by an acidfast bacillus, namely, leprosy. By a similar process to tlhat by which sodium gynocardate is made from clhaulmoogra oil a preparation has been made of the sodium salts of tlhe unsaturated fatty acids of cod-liver oil after extraction by ether. Thjis I bave termed "sodium xnorrhuate."' A 3 per cent. watery solution is sterilized in an autoclave and J per cent. carbolic acid added. 'T'his may be injected subeutaneously with very little pain, and also intravenously. I had previously shown in 1916 that intravenous injections of sodium gynocardate in leprosy produced febrile and local reactions with breaking down of the bacilli and had suggested its trial in tuberculosis as that disease is also produced by an acid-fast bacillus. As, however, in rare cases of leprosy prolonged febrile reactions with temporary exacerbation of the disease may follow sodium gynocardate given intravenously,2 I hesitated to use it in tuberculosis by that method. Given by the mouth in plhthisis some gain in weight only resulted, and it causes painful local induration lhypodermically. Several attempts I made to investigate the use of the drug in tubercle infected animals failed for want of a virulent bovine culture. It was in these circumstances that I was led to prepare sodium morrhuate fronm cod-liver oil. Its subcutaneous injection proved to be nearly painless, and a year's experience has shown it to be of great value in leprosy. This is a most importaut point, as it proves tllat there is nothing absolutely specific in the products of chaulmoogra oil in that disease, and supports my view that the sodium salts of the unsaturated fatty acids of these two oils act in some way on tie coating of the acid-fast bacilli, that of tuberculosis having been shown to contain palmitic and other unsaturated fatty acids. During the past year sodium morrhuate lhas also been used with very promising results in tuberculosis by several careful observers to whom I have supplied it, and morpholoaical chianges have been noted in the tubercle bacilli iti the sputum. A wide field of investigation has thus been opened out, as it appears to be possible that the organism.s of otherchronic diseases, including that of syphilis, miglht possibly also be broken up in the system by similar mlethods. Sodium-l morrhuatehas now been under trial for a year, and from my own limited experience and the more extensive experience of Dr. E. Muir, M.D., F.R.C.S.E., of the Kuhia Mission Hospital in the unhealthy Burdwan district of Bengal; of Captain R. Knowles, I.M.S., director of the Pasteur Institute, Shillong; of Dr. Caleb Davies, M.B., Ch.B., in Eastern Bengal, and of Lieut.-Colonel A. W. R. Cochrane, M.B., F.R.C.S., I.M.S., of the Bhowali Sanitariurn, Kumaon Hills, to all of -whom I am greatly indebted for trying the new treatment. I am satisfied: that it isharmless. The three first named observers are convinced of its great value, althouglh the last, with a shorter experience, is not satisfied that it has producedl any permanent effects either for good or evil. Thei r reports will be published in full, together with my own more limited experience, in an early number of the Indian Journal of Medical Research, with details of the methodl of preparation, which is essentially the same as that of making sodiumgynocardate already recorded.8 Limits of space will only allow of a brief summary of the results so far obtained being recorded here to enable others to give the method a trial.