DR. KOCH'S METHOD OF TREATING CONSUMPTION. 619 



easy as to the consequences of this, even in some cases of lung 

 tubercle in its early stages, and especially in tubercle affecting 

 the larynx, where the swelling, which is part of the effect of the 

 remedy, might conceivably prove dangerous. Experience has, 

 however, shown that, in the considerable number of such cases 

 already treated, no serious risk has arisen. It is a fact that the 

 mucous membranes of the tubercular larynx, while under this 

 treatment, do not swell to such an extent as to interfere very seri- 

 ously with respiration. Even in advanced cases of lung tubercle, 

 with excavation of considerable portions of lung tissue, there 

 have been no ill effects from the treatment when it has been con- 

 ducted with careful attention to the regulation of the dose of the 

 remedy. 



The remedy is a transparent, reddish-brown fluid, not unlike 

 brown sherry in appearance. It has no sediment, and when un- 

 diluted does not readily decompose. When diluted with distilled 

 water it is, on the contrary, apt to decompose. Bacterial growths 

 quickly appear in it, and it becomes turbid. In this condition it 

 is unfit for use. Its decomposition in dilution is prevented by 

 boiling it, but that process is not necessary if the dilution be 

 made with a half-per-cent solution of carbolic acid in distilled 

 water. It should be remembered that both by the frequent boil- 

 ing of the dilution, as well as by the mixing of it with carbolic 

 acid in the way described, the vigor of action of the remedy is 

 impaired, and therefore fresh dilutions ought only to be used. Ex- 

 perience has, however, shown, I am told, that a one-per-cent dilu- 

 tion of the remedy made with distilled water containing one half 

 per cent of carbolic acid remains efficient at the end of one week. 

 The remedy is introduced into the body subcutaneously by means 

 of a syringe which Koch devised for his bacteriological work. It 

 has no piston or washers, and consists of four parts an India- 

 rubber ball, with a small hole in it. This ball is fixed upon a 

 hollow metal stem furnished with a stopcock ; into the other end 

 of the metal stem there fits a glass tube, pointed at the farther 

 end, and graduated to one cubic centimetre, each division repre- 

 senting a milligramme. Upon the pointed end of the glass tube 

 there fits a hollow needle. In using this syringe the glass tube, 

 with the needle affixed, is detached from the metal stem and filled 

 with absolute alcohol. The metal stem and ball are then replaced 

 in position, and the alcohol gently expelled. Every day before 

 using the syringe I think it well to disinfect the metal stem and 

 the India-rubber ball. Alcohol, however, causes cloudiness in 

 the dilutions of the remedy, and therefore it is necessary to get 

 rid of it as much as possible. For that purpose I wash out the 

 syringe with a little distilled water. 



The dose of the remedy has been sufficiently well fixed for 



