EDITOR'S TABLE. 



843 



under such circumstances that it is ca- 

 pable of disseminating tubercle in otber 

 parts. He also shows tbat it is capable 

 of causing intense congestion and haem- 

 orrhage. Virchovv is not the only critic 

 of Koch's method, though he is the most 

 prominent one. Others in Berlin and 

 elsewhere have related cases in which 

 the disease extended while the patients 

 were under treatment. 



No one who has tried it carefully at 

 all questions its powers ; but the most 

 competent observers agree that its gener- 

 al or indiscriminate employment would 

 be most unsafe. Furthermore, compe- 

 tent observers here have concluded that, 

 even though the cases be selected ever 

 so carefully, if the dose of the fluid be 

 not most accurately adjusted to the con- 

 dition of each individual case, serious 

 general disturbances may be caused and 

 local changes at the site of the diseased 

 tissue may be so marked as to produce 

 dangerous results. These results are 

 among those described by Virchow as 

 due to the sudden dislodgment of tu- 

 bercular masses in the lungs of such 

 large size that they can not be coughed 

 up, and their falling into more depend- 

 ent places in the lungs and becoming 

 lodged there and giving rise to new iu- 

 fection which may develop rapidly. 



On the whole, it seems fair to say 

 that before conclusive results can be ob- 

 tained in the treatment of so chronic a 

 disease as consumption time must elapse 

 time measured by months or years 

 before the present method can be said 

 to have been thoroughly tried and as- 

 signed to its definite place in the thera- 

 peutic armamentarium. It may be a boon 

 to mankind in comparison with which 

 vaccination is a trifle; and it may yet 

 be relegated to the dimly lighted region 

 where rest many once promising meth- 

 ods whose day is long since forgotten. 

 Meanwhile the treatment of consump- 

 tion is by no means hopeless without 

 Koch's fluid. Exactly the kind of cases 

 that are doubtless often capable of be- 

 ing benefited by it have long since been 



known to be greatly improved and often 

 cured by hygienic and dietetic treat- 

 ment. It is within the experience of 

 the writer that several such cases have 

 been permanently cured at the Saranac 

 sanitarium in the Adirondacks when 

 they seemed to be gravely ill and after 

 they had developed some of the symp- 

 toms which are usually regarded as 

 most alarming. Many other equally 

 good resorts are to be found in elevated 

 regions in different parts of the country. 

 Many cases that are not permanently 

 cured in these mountainous regions are 

 greatly improved, so that life may be 

 indefinitely prolonged if one is willing 

 to make his home considerably above 

 sea level. It is a matter of common ex- 

 perience to every pathologist to find in 

 the bodies of people who die from wide- 

 ly different causes, often in those who 

 die from surgical injuries or accidents, 

 perfectly unmistakable evidence of con- 

 sumption. Old tubercular deposits in 

 the upper parts of the lungs are exceed- 

 ingly common in people who ceased to 

 cough or present other symptoms of the 

 disease years before they died. In many 

 of these cases no especial care could 

 have been taken, certainly no system- 

 atic and intelligent treatment could 

 have been followed, for these patients 

 die in hospitals after long lives of toil, 

 privation, hardship, or excesses. Thus 

 not only is the disease often curable by 

 care, as we have said, but it often gets 

 well wholly without care and even with- 

 out proper food and shelter. In the ab- 

 sence of positive proofs of the general 

 efficacy and safety of the new treat- 

 ment, and in view of the fact that it is 

 still accessible to but very few of our 

 consumptives, those who are threatened 

 with consumption or who are actually 

 suffering from it should not allow their 

 hopes of relief by the new cure to take 

 the place of those hygienic measures 

 which, if rightly applied, may serve to 

 ward off many of the most serious 

 symptoms of consumption, and some- 

 times even to cure the disease. 



