DR. KOCH'S METHOD OF TREATING CONSUMPTION. 617 



the employment of labor is constant, and the planter can estimate 

 closely what the yield will be for a given time. The old plants 

 are easily replaced by the suckers that have been previously cut 

 off and kept for this purpose. These advantages are shared by 

 all the cultivators of sisal ; but, in addition, the planter in Florida 

 will have at his door a market that now absorbs eighty-four per 

 cent of all the fiber produced. He will not only bring into use 

 land now almost worthless, but will probably make for himself a 

 fortune and introduce a new industry into the United States. 



4 



DR. KOCH'S METHOD OF TREATING CONSUMPTION.* 



By G. A. HERON, M. D., F. E. C. P. 



(~*\ ENTLEMEN : This demonstration is given at the request of 

 VX my friend Dr. Koch, who desires that in London and else- 

 where his method of treating tuberculosis should, so far as is at 

 present practicable, be open to the inspection of the medical pro- 

 fession. Certain parts of this work are already established upon 

 a basis of clinical observation. Other parts of it remain still to 

 be worked out. I think practically all that is yet known to be of 

 consequence in the work is stated in Dr. Koch's paper, which was 

 published in Berlin on the 14th of last month a paper which has 

 excited more wide-spread interest than any other contribution to 

 medical literature. As a matter of course, you are all familiar 

 with the details of the paper, and I propose to do no more to-night 

 than to touch briefly upon those parts of it which it seems to me 

 are essential to the understanding of the method of the adminis- 

 tration of the remedy to our patients, and to a clear apprehen- 

 sion of the obvious results which follow its use in human beings. 

 The mode of action of the remedy within the body is not yet 

 fully known. This much, however, is certain : tubercle bacilli 

 are not destroyed by it in the tissues. It is upon the living tuber- 

 cular tissues encircling the tubercle bacilli that the remedy pro- 

 duces its effect, and Koch says of this action that there is, " as is 

 shown by the visible swelling and redness, considerable disturb- 

 ance of the circulation and, evidently in connection therewith, 

 deeply seated changes in nutrition, which cause the tissue to die 

 off more or less quickly and deeply, according to the extent of the 

 action of the remedy. ... To recapitulate/' he goes on to say, " the 

 remedy does not kill the tubercle bacilli, but the tubercular tis- 

 sue ; and this gives us clearly and definitely the limit that bounds 

 the action of the remedy. It can only influence living tuberculous 



* Address delivered at the City of London Hospital for Diseases of the Chest, December 

 1, 1890. 



VOL. XXXVIII. 12 



