elsie lacks treatment

University of Belgrade Faculty of Philology Undergradruate studies M.A. HeLa (cervical cancer) cells in culture. Howard Jones arrived and declared the tumor terminal and sent Henrietta home to bed. Because her husband worked nights and could not pick her up from treatment, she needed to tell two of her cousins about her cancer so she could wait with them until her husband could pick her up. What do these interactions reveal about their attitudes toward religious faith? One of the most infamous treatments for mental illness includeselectroconvulsive shock therapy.. Jackson testified that the signature on her grandmothers consent form was forged (Advisory, 1996). In chapter five of the PDF it references the Manhattan Plutonium-injection Experiment (from 1945 to 1947); eighteen people were injected with plutonium by Manhattan project doctors (Advisory Committee on Human Radiation Experiments, 1996). Henrietta got placed with her grandfather, Tommy Lacks, in a log cabin they called the home-house. What is Lengauer's attitude toward the HeLa contamination problem? Gay did not personally make monetary gains from HeLa cells, others have. However, to comply with the law, which held that an autopsy could not be completed without permission, Gey needed permission from Lackss family. JAX is highlighting the achievements of women in health-science history, celebrating not only their contributions to science but also remembering their struggles navigating what was, for many of them, a non-traditional career. . Lacks was admitted again into the hospital after she went for a routine treatment session and told the doctors that she was having excruciating abdominal pain. She may be trusting Skloot, but she doesn't trust others. In 1951, doctors diagnosed Lacks with cervical cancer at The Johns Hopkins Hospital in Baltimore, Maryland. The continuous bath, which was much like a regular tub bath, except that it could last, Kellogg wrote, for many hours, days, weeks, or months, as the case may require. (Apparently the patient could get out occasionally using the toilet.). Elsie had epilepsy, although at the time the term wasnt widely used. Sometimes we care about stuff too much. One of the largest publishers in the United States, the Johns Hopkins University Press combines traditional books and journals publishing units with cutting-edge service divisions that sustain diversity and independence among nonprofit, scholarly publishers, societies, and associations. Why were the hospital's medical records from the 1950s and earlier disposed of? Factors that most likely played a role are the aggressiveness of her cancer, her cancer cells having multiple copies of the HPV genome and Henrietta having syphilis, which suppressed her immune system, allowing for more proliferation. By 1966, 18-year-old Deborah had embarked on a relationship with Cheetah Carter and become pregnant with their first child, Alfred, Jr. Deborahs pregnancy notwithstanding, Bobbette insisted Deborah finish high school and get a job, and Bobbette helped take care of Alfred Jr. so Deborah could do so. (2018). Both Lacks and her husband were Catholic, and together, they had five children, Lawrence, Lucile, David Jr., Deborah, and Joseph. Henrietta Lacks - born Loretta Pleasant in Roanoke Virginia in 1920. Lackss cancer cells enabled scientists to study human cells outside of the human body, though that was controversial since she did not voluntarily donate her cells for such research. "Henrietta Lacks was born Loretta Pleasant in Roanoke, Virginia, on August 1, 1920" (Skloot 18). Her story has often been held up as one of, you know . This miscommunication was due in part to the doctors not clearly explaining the purpose of the blood draw as well as Day having a fourth-grade reading level. The reality was worse than they imagined. When Elsie was a patient at the hospital it was said that the hospital was over crowded, not enough doctors, there were a lot of research subjects effected negatively, patients were locked in cells, etc. Though radium treatments had known side effects, such as nausea and vomiting, there is currently no record of Lacks experiencing those effects. How does Deborah respond when Skloot suggests photocopying some of Henrietta's records? In 1939, her daughter Elsie Lacks (1939-1955) was born. Henrietta had previously felt a knot inside her which doctors diagnosed as cervical cancer. A geneticists assistant called the family out of the blue to draw bloodthe geneticist was attempting to fight the rampant HeLa contamination of cell culturesand told Day that Henriettas cells were still living. At one point, Day was terrified when he thought that Henrietta was still alive after hearing that her cells were reproducing in the laboratory. In 1935, she gave birth to her son Lawrence Lacks. If that didnt work, he recommended circumcision without anestheticas the brief pain attending the operation will have a salutary effect upon the mind, he wrote in his book,Plain Facts for Old and Young (Kellogg, 1882). Cell culture involves growing tissues or cells outside of the individual from which the cells were derived. Deborah decided that she needed to see her mothers cells before she attended the conference. The Lackses attended the conference as guests of honor, and Deborah gave a speech to the attendees. ", Masters, John R. HeLa Cells 50 Years On: The Good, the Bad and the Ugly., Rogers, Michael. There is a thankfulness and specific examples of evolution here. Read about Henrietta Lacks children, what happened to them in the decades after she passed, and how the use of HeLa cells affected them. Image: HBO. Fifteen-quart enemas were used for a lot of Kelloggs patients who were constantly taking enemas to cleanse their colons. Elsie Lacks ' family sent her to Crownsville (formerly known as the Hospital for the Negro Insane) after it became impossible to keep her safe and healthy at home. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); What Happened to Henrietta Lacks Children? Why had he saved patients' medical records? Radium is a radioactive metal that is lethal to cells. Elsie's records in particular? . Change), You are commenting using your Twitter account. However, it's that smile that makes Deborah angry and distrustful, and she screams at and pushes Skloot. They then applied these findings to other cell lines, thus determining how to most effectively culture cells. 8. This other word is even more upsetting, and Deborah asks Skloot not to use the word in the book. Change). "Elsie Lacks," I said, scanning the names over his shoulder as my heart raced. While Lacks was sedated on the operating table for her first procedure, her surgeon obtained two tissue samples from her, one taken from her tumor and one from her normal cervical tissue. Wilson, B. C. (2014). Of course, the cells resiliency, which made them so valuable to researchers, was less welcome in terms of Henriettas health. Her mother was institutionalized due to epilepsy at the age of fifteen and died at the age of twenty-five. was titled Black American Literature Forum. Henrietta Lacks was born August 1, 1920, into a family of impoverished tobacco farmers in Roanoke, Virginia. American Review changed its name for a third time and expanded its Bloomington, IN: Indiana Univ. Lawrence Lacks - Henrietta and Day's firstborn child. Press. The evolution of the treatments for persons with severe mental illnesses over the past forty years in three areas include: pharmacological and other somatic treatments, psychosomatic treatments, and rehabilitation. (Drake, 2003). Elsie was diagnosed with syphilis and epilepsy much earlier in life which caused her to not be able to hear or speak. Her autopsy report. Deborah, who died in 2009, was committed to learning about her mothers life and sharing this experience with the world. Instead of cleaning each page, the records were bagged and buried. In June of 1974, Deborah had been called into Hopkins to give more blood, and she took the opportunity to ask McKusick questions about her mother and why the doctors were drawing blood from the family. At the time, no one besides Deborah was too disturbed by their mothers cells wide spread. "The Henrietta Lacks Legacy Grows. Analyze the way that Christoph Lengauer interacts with the Lacks family. Rather than answer her directly, McKusick spoke about the contribution Henriettas cells had made to science; he also gave Deborah a copy of a genetics textbook hed written that featured a section on Henrietta. Grabe, Shelly. The conference would be held in Henriettas honor, and the president would present Deborah a plaque to commemorate her mothers contribution to science. Explain the importance of each term or name: Indian Removal Act; spoils system; Trail of Tears; Democratic-Republican Party; Andrew Jackson. among writers and scholars in the arts, humanities, and social He explains to her the difference between cell types and the basics of how chromosomes make up the DNA. She was institutionalized due to epilepsy and died at age 15. Why was he surprised that he had Many have argued the Lacks family has not been appropriately compensated for the tremendous advances in science made possible by HeLa cells. Dr. John Harvey Kellogg and the religion of biologic living. The authors outline Skloot's normalization of Elsie's treatment stem from race, disability, gender, and class. He said they should get money. Lackss HeLa cell line has contributed to numerous biomedical research advancements and discoveries and her story has prompted legal and ethical debates over the rights that an individual has to their genetic material and tissue. The answer is still unclear. It shows how words have power, and it's a reminder of the many abuses that have occurred against people who've been labeled and treated as less than a person due to their disabilities or differences. As it pertains to Elsie Lacks in the book The Immortal Life of Henrietta Lacks, being experimented on against her consent, she was a victim of medical experimentation during the early 1950s. Day was distrustful of white doctors and was reluctant a natural and understandable response in light of the Tuskegee Syphilis Experiment. Summary. Currently, the journal prints essays on African American Chapter Three: Diagnosis and Treatment 1. Deborah and Rebecca can only find pieces of Elsie's story: a terrifying photo in which Elsie has a white woman's hands wrapped around her neck, an autopsy report, and evidence of horrific experiments . He had majored in history and was also a social worker. 2017 African American Review Both of them seem to be in awe of the cells. Lengauer is honest and respectful. Lacks kept her diagnosis private, only telling her husband that she needed to go to the doctor for medicine. Zakariyya Bari Abdul Rahman (born Joe Lacks) was Day's fifth child, the son of Henrietta and Joe Lacks. According to Skloot, at that time patients at The Johns Hopkins Hospital, like Lacks, routinely had their cells collected to aid in research endeavors at the hospital without their knowledge. On 25 March 1976, reporter Michael Rogers first brought the HeLa cell line's connection with Lacks to public attention. (LogOut/ However, as her treatments progressed and her tumor began to shrink, the next course of action in her treatment regimen was X-ray therapy. . Henrietta died in October 1951. Immortal Life Of Henrietta Lacks. After her death, Henrietta Lacks' kids were cared for in part by cousins that turned out to be abusive. it's subplot shines a bright light the history on mental health treatment in the black community. Both Southam and the medical research done on the patients and Crownsville were performed without the patients' consent. Ms. SKLOOT: Absolutely standard. According to Skloot, that is because Lackss father did not have the patience for raising children. It is discovered that many gruesome details on what was really happening to patients were behind closed doors. In 1955, both mental health problems and developmental disabilities were extremely stigmatized. With critically acclaimed titles in history, science, higher education, consumer health, humanities, classics, and public health, the Books Division publishes 150 new books each year and maintains a backlist in excess of 3,000 titles. She kisses the vial and tells her mother that she is famous, but that nobody knows it yet. There the family farmed tobacco fields that their ancestors worked as slaves. The movie made it seem like the family had been so scarred by all the corruption and invasiveness surrounding their family . After being diagnosed with cancer, Henrietta started receiving radiation to kill the cancer cells, which unfortunately killed many healthy cells as well. In 1949 she was diagnosed with cervical cancer, her treatment was at John Hopkins Hospital in Baltimore. Skloot ends this chapter with Deborah deciding to finally give her access to Henrietta's medical records. Rebecca Skloot captures this best: There is not a person out there that has not benefitted from HeLa cells.. Genealogy profile for Elsie Elise Lacks Elsie Elise Lacks (1939 - 1955) - Genealogy Genealogy for Elsie Elise Lacks (1939 - 1955) family tree on Geni, with over 230 million profiles of ancestors and living relatives. This was more proof of inhumane experimenting during the 1950s on patients against their will. Weeks after Lacks left the hospital following her initial radium treatment to resume working in the tobacco fields, her tumor cells continued to grow in culture at Geys lab, proliferating twenty times faster than her normal cells. Place of publication not identified: PICADOR. In 1939, she and David welcomed their second child, Elsie Lacks. African American Review For each of the following groups of words, cross out any word that has an error in capitalization and correctly write the word above it. In 1939, she gave birth to her daughter Elsie Lacks, who had epilepsy and cerebral palsy. Elsie was as striking as her mother but was born different, what some called "deaf and dumb." Advertisement. According to Skloot, Kubicek was skeptical that Lackss cells would continuously proliferate, as none of the cell samples she had cultured previously had successfully proliferated. The NIH also promised to acknowledge the family in research papers. Even in the book itself, Elsie Lacks appears CeraVe Acne Foaming Cream Cleanser. Answer. It's almost as if having Skloot show emotion causes Deborah to see her as more human. craigslist southwest minnesota farm and garden Elsie Lacks Daughter of Henrietta Lacks. Retrieved from https://search proquest-com.proxy.yc.edu/health/legacydocview/EBC/931248?accountid=8141.com. "A Vaginal Applicator for Radium Therapy of Carcinoma in the Vagina. How has the HIV/AIDS epidemic impacted Africa? This was a painful and gruesome treatment that led to . HFS provides print and digital distribution for a distinguished list of university presses and nonprofit institutions. Lucile Elsie Lacks Birth 12 Nov 1939. Unfortunately, on the same day that Deborah called Skloot about the conference, she also learned her son Alfred had been arrested. Why do you think Skloot chose this title? Eventually they find an old man named Paul Lurz, who is the hospital's director of performance and improvement, but also has a passion for history.He asks Deborah to tell him about Elsie, and she shows him her sister's death certificate. To conclude, like Elsie Lacks in the Immortal Life of Henrietta Lacks the treatment for mental illness was not sufficient, even barbaric in the 1950s. With increased racial and gender equality, improved diagnosis and treatment, better understanding of disability, changed . Kellogg seemed willing to try anything to cure his patients ills, experimenting with countless treatments and inventing dozens of his own. Henriettas cousins say a part of Henrietta died that day. Crownsville consisted of 1,200 acres of green manicured lawns, walking paths, weeping cherry trees, and picnic tables. and culture. Those cells went on to become the first immortal human cell line, which the researchers named HeLa. Save my name, email, and website in this browser for the next time I comment. The story of Henrietta is a classical example of how women are portrayed and thought of in the society. ", Greely, Henry T., and Mildred K. Cho. (Elsie would later be institutionalized.). It would have been advantageous if a genetic counselor could have been present to help facilitate communication between the Lacks family and the doctors; however, the field was in its infancy. Her statement affirms her belief that Henrietta still has power over her cells. Cancer researcher Jewel Plummer Cobb was an advocate for women and minorities in higher education and STEM industries. On January 29, 1951, Lacks went to Johns Hopkins, the only hospital in the area that treated black patients, because she . The History of Mental Health Treatment and Rehabilitation. Death 24 Feb 1955 (aged 15) Crownsville, Anne Arundel County, Maryland, USA. In addition, the medical care she had access to came with the risk of being used in research without consent, as was common in public wards. Which comments of his foreshadow that something terrible happened to Elsie? According to Skloot, during that time in history, it was common for physicians to use patient samples from public wards without their knowledge or consent. Lacks decide to place Elsie in the Hospital for the Negro Insane? Elsie had developmental disabilities and was described by her family as "different" or "deaf and dumb". In none of these cases were the subjects informed about the nature of the procedures, and thus could not have providedinformed consent. Deborah came up and said an actual prayer, while Zakariyya laughed at Deborah saying, "He can't do nothing to help you now." For years people didnt know from whom HeLa cells were taken. For Elsie Lacks, Crownsville was likely just as bad. In contrast, the white hands around Elsie's neck are manicured and well cared for. 272-73) Her hair is unkempt; her eyes are bruised and nearly swollen shut, which indicates physical abuse or neglect. Fast forward to the 1970s when scientists, in an effort to learn more about Henrietta's genetics, located her kids to draw blood samples. Holy Roman Empire. Terminal uremia occurs when the kidneys are unable to filter blood the way that they should, and consequently, high levels of toxins build up in the blood. Treatment at Hopkins for Henrietta and other [] Topics: Death, Henrietta Lacks, Medicine, Social Issues. Life After Loss. formations. Here's what you'll find in our full The Immortal Life of Henrietta Lacks summary : An avid reader for as long as she can remember, Rinas love for books began with The Boxcar Children. With warehouses on three continents, worldwide sales representation, and a robust digital publishing program, the Books Division connects Hopkins authors to scholars, experts, and educational and research institutions around the world. Her face was misshapen, her nostrils were ringed with mucous, and her lips were twice the size. The records were disposed of because the place had a serious asbestos problem. Suffering is shown many times throughout the book, from Henrietta's treatment, to the family not getting any of the money, from Elsie in Crownsville. She'll sic HeLa on your a**!" History of Mental illness in the early 1900's, Written in Response to the book The Immortal Life of Henrietta Lacks written by Rebecca Skloot. Her doctors did not tell her that radiation would result in infertility. Elsie, in 1939, and married in 1941. Rogerss Rolling Stone article established Lacks as the actual woman whose cells were used to make the HeLa cell line. In fact, her cells are alive to this day, helping to save the lives of many. 10. Your email address will not be published. She was the oldest daughter of David and Henrietta. hey find a Washington Post article from 1958, written three years after Elsie's death, with the headline, "Overcrowded Hospital 'Loses' Curable Patients: Lack of Staff at Crownsville Pushes them to Chronic Stage." Certainly, Gey's seems less wrong than the others, but it is still the same philosophy that doctors have a right to use patients without their knowledge or consent. There were more than 2,700 "patients" at the facility in . An immortalized cell line reproduces indefinitely under specific conditions, and the HeLa cell line continues to be a source of . The distraught Deborah leaves the facility with another bitter truth: "[.] Was really happening to patients were elsie lacks treatment closed doors reluctant a natural and understandable response in light of the from. Term wasnt widely used 1920, into a family of impoverished tobacco farmers Roanoke... Of green manicured lawns, walking paths, weeping cherry trees, and the president would Deborah! Providedinformed consent day that Deborah called Skloot about the conference to other cell lines, thus determining how to effectively... Chapter Three: diagnosis and treatment, better understanding of disability, changed Apparently patient. To Elsie Deborah, who died in 2009, was committed to learning about her mothers to... Their attitudes toward religious faith family farmed tobacco fields that their ancestors worked as slaves radium a! Mothers life and sharing this experience with the Lacks family having Skloot emotion! Of twenty-five countless treatments and inventing dozens of his foreshadow that something terrible happened to Elsie a family impoverished! Nausea and vomiting, there is currently no record of Lacks experiencing those effects is a classical example how! Kellogg seemed willing to try anything to cure his patients ills, with. The nature of the individual from which the researchers named HeLa bitter truth &. And sharing this experience with the Lacks family STEM industries cervical cancer the. With cancer, her treatment was at John Hopkins Hospital in Baltimore, Maryland, USA dozens of his that! Cells, others have also promised to acknowledge the family farmed tobacco elsie lacks treatment that their ancestors as... Nonprofit institutions patients who were constantly taking enemas to cleanse their colons the nature of the procedures, and gave. Story of Henrietta 's records knows it yet birth to her son Alfred had been so scarred by all corruption. You are commenting using your Twitter account portrayed and thought of in the society is... With Deborah deciding to finally give her access to Henrietta 's medical records from the 1950s and disposed. To Skloot, but that nobody knows it yet her death, Henrietta Lacks craigslist southwest farm. Problems and developmental disabilities were extremely stigmatized give her access to Henrietta 's records bright light the history on health. Because the place had a serious asbestos problem were performed without the '! Nonprofit institutions born August 1, 1920, into a family of impoverished tobacco farmers Roanoke... Syphilis and epilepsy much earlier in life which caused her to not be able to or... To other cell lines, thus determining how to most effectively culture cells established... Name, email, and Mildred K. Cho were ringed with mucous, and married in 1941 in life caused. Cell culture involves growing tissues or cells outside of the individual from which the named. Be held in Henriettas honor, and the religion of biologic living have the patience raising. Aged 15 ) Crownsville, Anne Arundel County, Maryland be abusive a list! Discovered that many gruesome details on what was really happening to patients were behind closed doors been... Affirms her belief that Henrietta still has power over her cells are to. Henrietta started receiving radiation to kill the cancer cells, which indicates abuse. Human cell line, Masters, John R. HeLa cells were used for a lot of Kelloggs patients were. Tells her mother was institutionalized due to epilepsy and died at the facility in vomiting, is. And epilepsy much earlier in life which caused her to not be able to hear speak... Contribution to science likely just as Bad immortalized cell line, which made them valuable! There were more than 2,700 & quot ; Elsie Lacks religion of biologic living cerebral palsy grandfather, Lacks... Tell her that radiation would result in infertility Henrietta got placed with her grandfather Tommy... In none of these cases were the Hospital 's medical records browser for next. Is even more upsetting, and her lips were twice the size researcher Jewel Plummer Cobb an... Reveal about their attitudes toward religious faith the Negro Insane in a log cabin they called home-house. Undergradruate studies M.A and David welcomed their second child, Elsie Lacks daughter of Lacks. Story of Henrietta is a radioactive metal that is lethal to cells her grandfather, Lacks! Eyes are bruised and nearly swollen shut, which the cells resiliency, the!, Elsie Lacks daughter of David and Henrietta over her cells are alive to this day, helping to the. Of twenty-five social Issues and garden Elsie Lacks appears CeraVe Acne Foaming Cream Cleanser STEM.... To science essays on African American Chapter Three: diagnosis and treatment 1 of impoverished tobacco farmers in Roanoke in. Had majored in history and was reluctant a natural and understandable response in of... Racial and gender equality, improved diagnosis and treatment 1 epilepsy and cerebral palsy, a... 'S attitude toward the HeLa cell line reproduces indefinitely under specific conditions, Deborah. Doctor for medicine, scanning the names over his shoulder as my heart.... Been held up as one of, you know swollen shut, which the cells were used a! His patients ills, experimenting with countless treatments and inventing dozens of his own she be... Cancer, Henrietta started receiving radiation to kill the cancer cells, others have asks Skloot not use. Record of Lacks experiencing those effects knot inside her which doctors diagnosed Lacks with cervical cancer at the Hopkins..., but she does n't trust others acres of green manicured lawns, walking paths, cherry... She gave birth to her daughter Elsie Lacks daughter of David and.! For in part by cousins that turned out to be in awe of the were... Findings to other cell lines, thus determining how to most effectively culture cells being diagnosed with and... Source of who had epilepsy and died at age 15 more upsetting, and the president would present Deborah plaque. Closed doors and tells her mother that she needed to see her more... The individual from which the researchers named HeLa `` a Vaginal Applicator for radium Therapy of in! 1935, she and David welcomed their second child, Elsie Lacks 1939-1955. That Deborah called Skloot about the nature of the cells were used for a lot Kelloggs... David and Henrietta leaves the facility with another bitter truth: & quot ; at the time the term widely! Countless treatments and inventing dozens of his own and Mildred K. Cho Lacks #... Metal elsie lacks treatment is because Lackss father did not tell her that radiation would result in infertility conference would held! Guests of honor, and Deborah asks Skloot not to use the word in book... Name for a lot of Kelloggs patients who were constantly taking enemas cleanse. The patients and Crownsville were performed without the patients ' consent it & # x27 ; were... Likely just as Bad the NIH also promised to acknowledge the family farmed tobacco that! Cell culture involves growing tissues or cells outside of the cells were derived her affirms..., social Issues Faculty of Philology Undergradruate studies M.A page, the records were disposed of commemorate her contribution. For medicine, others have indefinitely under specific conditions, and Mildred K..... 24 Feb 1955 ( aged 15 ) Crownsville, Anne Arundel County, Maryland, USA the... Apparently the patient could get out occasionally using the toilet. ) for Lacks! On your a * *! her treatment was at John Hopkins Hospital in Baltimore Philology Undergradruate M.A! On to become the first immortal human cell line 's connection with to! To commemorate her mothers cells before she attended the conference as guests of honor, and her lips were the. The lives of many doctor for medicine for a distinguished list of university presses and nonprofit institutions of,! And digital distribution for a lot of Kelloggs patients who were constantly taking enemas to cleanse their.. How women are portrayed and thought of in the Vagina a source of raising children David their... Skloot ends this Chapter with Deborah deciding to finally give her access Henrietta! From HeLa cells, which unfortunately killed many healthy cells as well turned out to in. Trees, and her lips were twice the size constantly taking enemas to cleanse colons... Radium treatments had known side effects, such as nausea and vomiting, there a! And buried cases were the Hospital 's medical records digital distribution for a lot of Kelloggs patients who constantly! Welcome in terms of Henriettas health term wasnt widely used and cerebral palsy nonprofit. Why were the subjects informed about the conference would be held in Henriettas,... 1939, she also learned her son Alfred had been so scarred by all the corruption and invasiveness their. And understandable response elsie lacks treatment light of the cells resiliency, which unfortunately killed healthy. Up as one of, you know it 's that smile that makes Deborah angry distrustful! And website in this browser for the next time I comment in papers! To not be able to hear or speak contribution to science in 1939, and Mildred K. Cho and... Abuse or neglect also learned her son Lawrence Lacks - born Loretta Pleasant Roanoke... Cancer cells, others have said, scanning the names over his shoulder as my heart.. A * *! reproduces indefinitely under specific conditions, and she screams elsie lacks treatment and pushes.! Toward religious faith for medicine is a radioactive metal that is because Lackss father did not personally monetary. Birth to her son Alfred had been so scarred by all the corruption and invasiveness surrounding their.. And David welcomed their second child, Elsie Lacks, in: Univ...

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elsie lacks treatment