618 THE POPULAR SCIENCE MONTHLY. 



tissue ; it has no effect on dead tissue, as, for instance, necrotic 

 cheesy masses, necrotic bones, etc., nor has it any effect on tissue 

 made necrotic by the remedy itself." 



In dead tubercular tissue living tubercle bacilli are often 

 found. If the organisms so situated do not escape in some way 

 from the body, they may find a nest for themselves there, and so 

 set up fresh centers of tubercular disease. This fact clearly indi- 

 cates that the treatment of tuberculosis by this new remedy must 

 be continued for some time. From what is now known, it seems 

 likely that about six weeks will be required to rid patients in 

 the early stage of consumption of the symptoms of their disease. 

 Whether this does or does not mean the complete cure of the dis- 

 ease is at present a question which will be answered conclusively 

 by patients treated in hospital wards. It is in the highest degree 

 probable, as every bacteriologist will understand, that relapses 

 will occur. They must be treated on the principles already laid 

 down by Koch, and their importance as a factor in the ending of 

 the case must be worked out in public hospital practice. This I 

 can say concerning the success which attends the use of this rem- 

 edy in tuberculosis. I have never seen in a considerable series of 

 cases treated by any remedy such uniformly good results, nor 

 results so favorable to the patients. I do not, in what I have just 

 said, include cases of advanced lung tubercle. Of that class of 

 patients I have seen too few treated in the new way to entitle me 

 to speak of them from my own knowledge. What we have heard 

 and read of such cases in connection with this treatment leads us 

 to expect at most temporary amelioration of their condition. At- 

 tention can not be too forcibly drawn to what Koch says, in his 

 paper of November 14th, concerning the grave responsibility 

 which will in future rest upon medical men, who leave any means 

 untried to diagnose tubercular disease in its earliest stages. To 

 that end the examination of the sputum ought, he says, to be 

 much more frequently practiced than it is to-day in Germany. 

 Speaking from an experience in that direction which is not small, 

 I venture to say that this remark of Koch's applies with at least 

 quite as much truth to England as to Germany. Now that we 

 have the means, in this new remedy, of holding out to our patients 

 who are in the early stages of tuberculosis whatever form the 

 disease may assume the highest probability of a cure of their 

 condition, it will, in my opinion, be a very grave reproach to any 

 medical man who neglects to make an early diagnosis of tubercu- 

 losis, and, having done so, postpones needlessly the systematic 

 use in those cases of Koch's remedy. 



Koch has said that the action of his remedy consists in the 

 destruction of living tubercular tissue. The destroyed tissue 

 must be thrown off or absorbed. We might, perhaps, feel un- 



