THE VALUE OF COD LIV'ER OIL AND TOMATO JUICE IN
THE PROPHYLAXIS OF INTESTINAL TUBERCULOSIS.
By M1ACK McCONKEY, M.D.,
New York State Hospital for Incipient Pulmonary Tuberculosis,
RAY BROOK, N. Y.
The administration of cod liver oil and either tomato juice or
orange juice alleviates the symptoms of intestinal tuberculosis,' and
experimentally tomato juice prevents ulcerative intestinal tuberculosis
These cli'nical and experimental observations sug-
gested the use of cod liver oil and tomato juice to prevent the occur-
rence of intestinal tuberculosis complicating, pulmonary tuberculosis.
At Ray Brook the remedy has been used for this purpose during the
past eleven years, and the results are herepresentedl.
'Until the roentgenologyical studies of Brown and Sampson in
1919,3 autopsy studies revealed that intestinal tuberculosisfrequently
logically the intestinal tracts of 141 patients, of whom I111 were in the
moderately advanced and 30 in the far advanced stages of pulmonary
tuberculosis at the time of their admission to Trudeau Sanatorium.
They found evidence of intestinal ulceration in 40 instances, or28%o.
In 1928 at Ray Brook, 32, or 16%/ of 196 patients, of whom 167 were
in the moderately advanced and 29 in the far advanced stages of the
disease presented evidence of intestinal ulceration on admission as
(letermined by the roentgenological procedure of Brown andSampson.
During the past eleven years, the nuimber of patients comingr to
Ray Brook with intestinal uilceration has gradually declined from
16% in 1928 to 3~/c in 1938 (Table 1). It is of interest that the inci-
dence for the year 1938 is approximately the same for Trudeau* and
Attendant with this decline, there has been a notable rise in the
sale of cod liver oil, tomato and citrus fruit juices as shown by the
figures kindly furnished us by the United States Department of Agri-
culture (Table 2). The sale of tomato juice alone has increased 77-
*Personal communication from Dr. HomerL. Sampson.
ing the sputum, that in the first years of this stu(dy, when we were all so afraid of
intestinal tuberculosis, we used to tell our patients just that, "If you swallow the
sputum, you are going to get intestinal tuberculosis.' As a consequence we used
to go around and find the sputum cup full of saliva and probably a half tea-
spoonful of mucopurulent sputum in the cup.
After the studies went along a few years, w~e began to pay less attention to
that and now we don't tell the patient anything about swallowing his sputum. A
Pood many of those patients you saw in both groups swallowed a good deal of
sputum. That perhaps in some ways is justifiable criticism, but I would like to
make that comment. We no longer advise our patients not to swallow their
In regard to the very far advanced stage of the disease in the Grace Dart
patients, I think from the clinical studies in our patients it is perfectly justifiable
to say that we will expect less tuberculosis of the intestine here than wve would in
the Grace Dart Home. However, those autopsies y-ou must remember are all on
patients who succumbed to their disease and they were no longer moderately
advanced cases, thev were far advanced cases of tuberculosis.
dence of intestinal tuberculosis in those far advanced groups is striking, consider-
ing that they swallow their sputum, and many of them couldn't take the cod liver
oil and tomato juice the last month or two of life.
I would like to comment also that in the 20 patients who took cod liver oil
andI tomato juice, only two had clinical intestinal tuberculosis. The other four
had from one to six pin head size ulcers in the intestinal tract, and they are not
in any sense to be called clinical intestinal tuberculosis; anatomically they were,
and were reported as such.
In answering Dr. Jones, I michtsaythat among our patients as they came
into the sanatorium less than 2 per cent of our moderately advanced cases have
even today any form of collapse therapy. Those fig.,ures on ~incidence are when
the patients come to uis.
form of collapse therapy wouldmateriallyaltcr our figures.
true that collapsing a lunLg and stopping a positive sputum will prevent intestinal
tuberculosis and also tubercular laryngitis.
Dr. Heise has asked that I say a word about Dr. Smith's and mv work on
intestinal tuberculosis experimentally.
Dr. Smith and
vitamin studies and found that if you deprive the guinea pig of vitamin C, par-
tiallv deprive him of it over a number of months and feed him tubercle bacilli, or
tubercular sputum, he will develop ulcerative intestinal tuberculosis that resembles
in everv way that seen in man in approximately, 20 per cent of some 70o pigrs,
whereas in the control animals who had adequate vitamin C, there w,ere only
3 or 4 who developed intestinal tuberculosis. Thismig,htlead one to believe that
vitamin C is the only important factor in preventing intestinal tuberculosis, but
I do think we have to remember that the guinea pig can in a measure, at least,
synthesize vitamin D from dry hay, which is includedi in his diet.
I think the inci-
I hardly think that an inicidence of 3 per cent of any
It is undoubtedly
a'll of our