Mr. President and Gentleman.—You have no doubt all seen the Spahlinger Treatment for Tuberculosis mentioned in the papers recently, and as I had the opportunity of studying it on two occasions during my recent trip, I thought it might interest you if I made a few remarks about its preparation, the results of its application, and upon some of the cases.

Upon the recommendation of a Harvey Street physician, who gave it as his opinion that although the treatment was not substantiated, he considered there was “something in it,” I visited Mr. Spahlinger in Geneva, and as I had heard a good many derogatory remarks about the way his treatment had been introduced to the public, I asked him the reason why it was not in favour with the majority of the profession. He informed me that the “Press,” contrary to his expressed wish, had prematurely published the information. Mr. Spahlinger, although not a qualified medical man, has been through the greater part of his curriculum, and has been working at his treatment for about 12 years, during which time he has treated a large number of patients with very satisfactory results. He stated that he was willing to see any doctor who came to Geneva in reference to the treatment, as he did not wish it to be thought that the remedy was a secret one.

In explaining his method he said he was four years and nine months establishing his laboratory, the time being divided up as follows:—

First.—Collection of sputa (about 20 patients were used) and virulisation of the organisms by passage through a series of animals.

Second.—Training the organisms to give up their toxins “in vitro” at various temperatures.

Third.—Immunisation of the horse, which is a slow process. The basis of his treatment is that the tubercular organism has a number of toxins, and the horses are gradually immunised against these.

Fourth.—Preparation of the antitoxin. His great difficulty is to manufacture in large enough quantities, but he reckons that he gets about 1000 doses from each venesection, though I am not able to state the exact amount of blood that he withdraws.

For incubation he uses broth cultures in Roux’s tubes, the vaccines being made from the white scum containing the organisms which forms on the top, and the serum from the fluid below.

He considers there are 28 varieties of toxins, and that he had only made a preparation from 25 of these. So far he has been working with a partial serum, but his results are decidedly interesting.

The serum for phthisis is always a mixed one containing streptococcal, staphylococcal, and pneumococcal elements, with that of any other infection thought advisable in a particular case, otherwise the results he stated would be disappointing.

The serum is used in the acute stages only of both phthisis and surgical tuberculosis, the above mixed serum being used in the former, and a mixed bovine and human serum in the latter.

The vaccines are used in the chronic phthisis or the chronic stage after subsidence of temperature, surgical tuberculosis, and in predisposed cases. They are composed of various tuberculin bodies less the ectotoxins removed by free washings.

The average time for immunisation in the phthisical cases is six months, and in surgical tuberculosis about 4–5 months, although these will vary considerably according to the severity of the cases.

Dosage.—The serum is given by the injection usually in doses of 2 c.c. about twice in 7–10 days, but more frequently if required; and in doses of four or five times the amount by the mouth – he has given 20—30 c.c. in one dose. In one case he found it useful as an external application to fisculæ. The vaccines are given hypodermically in 2 c.c. doses once a week (1–1,000,000 of original dilution).

Cost of Production.—As I understood that the upkeep of the laboratory (on account of the number of animals, etc.) was expensive, and that it had taken nearly five years to establish it, I questioned him re the ultimate cost of his preparations, as I felt they would only be procurable by Governments, institutions, or the well-to-do. He replied that he hoped to be able to put them on the market at a reasonable price so that everyone should benefit.

Animals.—In the preparation of his serum and vaccines he has used black and white guinea-pigs, rabbits, monkeys, dark goats, and black and white cows and black horses. He gave it his experience that, although the serum could be prepared from other coloured horses, the pure black gave him the best results. The cows he is now using as controls to test the durability of his preparations. The animals are not kept confined to stalls, but are allowed out freely.

Cases.—Whatever interest there may be in the preparation of the serum and vaccines in this treatment, one cannot but be struck by the clinical results. A great many of Mr. Spahlinger’s patients were cases given up by doctors and sanatoria as incurable, and he rather courted such cases, thereby inviting the possibility of failure, as he was anxious to establish the curative effect of his treatment before publishing it. The “Press” unfortunately preceded him, and he was in consequence inundated with requests for treatment before he was ready.

On my two short visits to Geneva, which according to our present conception of what is required cannot be looked upon as an ideal place for the treatment of tubercular infections, I saw several cases—some recovered and others still under treatment.

No. 1.—A boy, 14 years, who has been under treatment for two years and recovered with a large cicatrisation at the left apex, was brought to him originally by his greatest opponent as an incurable case.

No. 2.—A young man – under treatment for the previous 12–18 months – who after ten days’ treatment, although improved, was too ill to be propped up for any physical examination, was recovering and able to go to the laboratory for treatment.

No. 3.—An English lady, who had gained nearly two stones in weight in about three months, was also improving, and on my second visit three months later I found her still further improved, although, owing to Mr. Spahlinger’s frequent absences she had not had continuous treatment.

No. 4.—A lady medical student from a London Hospital was fully convinced of the improvement she was making under the treatment, and her chart and physical examination bore out her statement.

No. 5.—A British naval officer from an initial pleurisy with effusion, and ill with tuberculosis for years, who had travelled everywhere, was positive he had not had so much relief from any other form of treatment he had been under.

No. 6.—A woman living in Geneva – his first case – had remained well since 1912, after vaccine treatment for tuberculosis glands of the neck with fistulæ and lupus over the upper end of the sternum. The half dozen scars in this case were well healed and in good condition, and the lupus had disappeared, the scar being insignificant.

No. 7.—A man, who had been cured of phthisis three years before was still living in Geneva following out his occupation of a tailor, and had had no relapse. He had no active signs in his lungs.

In London I examined four men who had been treated there before the war by different doctors, and were still there, and had remained well since treatment.

No. 1.—9st. 10lbs. in 1914, had gained 2st. 3lbs., and was very well and acting as “chef” in one of the large hotels.

No. 2.—Was a furniture remover at one of the largest London warehouses, and quite well.

No. 3.— 9st. 7lbs. in 1914, was 13st. 3lbs., and working as a porter in one of the large hotels. This man had had marked symptoms of phthisis, but not one of the serious cases.

No. 4.—Who had both hip and chest infections from 1911–1914 was a bad case. He had been in several hospitals, and was going downhill when the treatment was exhibited. He recovered after two or three months’ treatment, and had a subsequent orthopædic operation upon his leg. Although not a robust man, he is well, and is now able to walk with slight assistance from a stick.

Another interesting case – a lady – who had suffered an injury of the patella with secondary infection by Koch’s bacillus and ultimate excision of the kneejoint with 21/2 inch shortening of the leg, developed renal tuberculosis, and getting no improvement from various forms of treatment, was on the verge of extirpation of one kidney when Spahlinger’s treatment was recommended by a London consultant with most satisfactory results. She was under treatment for two years – having two series of injections – twelve each year at weekly intervals. She was nine months in bed, and on getting up it was discovered she now had only 1/2 inch of shortening in that leg. She was now quite recovered from the renal tuberculosis, and has gone a voyage in lieu of a third course of vaccine treatment.

Another female patient in Paris who was delirious, with pulse 140, temperature 105.8 when the treatment was begun, had four doses of serum daily for about 15 days in May, 1921. Since then she has had no treatment, and is apparently quite well, although Mr. Spahlinger doubted whether this case had obtained immunity with serum treatment only.

During my second visit I read a letter from the relative of a child, who had been unconscious when the treatment was begun, and in which the treatment had been intensive as no improvement was manifest after two doses. In ten days the child was up and trying to walk. I have no knowledge that this was a case of meningitis.

Types of Cases.—It will be seen by the foregoing hat the cases covered skin, gland, bone, lung and kidney infection, and judging from the cases I saw or heard about I consider there is a great deal of clinical evidence in favour of the treatment, as many of the cases had been given up as hopeless by their doctors, or by the sanatoria, and yet recovered and returned to work, some having remained well for seven years.

Mr. Spahlinger is trying to get some statistics as to the results of his treatment, and all his replies up to the time of my last visit were favourable. The results are certainly striking, and everything should be done to prove or disprove the efficacy of the treatment. Sir James Allen has interested himself in the matter, and is endeavouring to obtain some supplies for New Zealand.

I was much struck with the gratitude of all the patients, and with their readiness to come and be examined, or do anything to further the dissemination of any information that would be of benefit to Mr. Spahlinger and his treatment.