Vice-President’s Address. 21 
statement that he has been able to obtain a substance which, 
when injected into the human subject, brings about disintegra- 
tion or degeneration of any tissue that forms a nidus for the 
tubercle bacillus, that it is impossible to restore lost tissues, 
although by Koch’s treatment we may be able to localise the 
diseased patches. Here the success of the treatment is 
supposed to depend, not upon the fact that the tissues of the 
patient become accustomed to the action of the poison 
produced by the tubercle bacillus (though it is possible that 
even this may play a part in the process of cure), but rather 
to the fact that the diseased area is so sharply defined by 
the reaction set up on the introduction of the lymph that the 
tuberculous mass becomes encapsuled; the bacilli are 
confined to this area; they gradually use up the pabulum 
that it contains, die of starvation, and eventually may be 
removed along with the rest of the dead tissues. 
If all this be true, the era of surgical interference with 
tuberculous masses may be said to have dawned, especially 
should it be found on further experience that the separation 
of the dead from the living tissues is as distinctly brought 
about as Koch assumes. Up to the present, the treatment 
has been most successful in cases of lupus, a tuberculous 
disease of the skin, and Koch has not the slightest doubt as 
to the ultimate success of his treatment in this class of cases. 
After weekly injections for three or four weeks of full doses 
of the lymph, introduced at some distance (usually in the 
back) from the ulcerating surface, the disease appears to be 
cured, and cicatrisation or scar formation takes place, even 
where the disease has been of several years’ standing. From 
the nature of the changes that take place in lupus, we may 
assume that the lymph acts immediately on the tubercular 
granulation tissue, of which the surface of the ulcer is com- 
posed; the lupus spots become red, and begin to swell, 
showing that there is an increase of fluid in the blood-vessels, 
and probably also in the lymph spaces. This commences 
before the rigor or shivering, which is a characteristic feature 
in tubercular cases, sets in. During the fever that follows, 
the swelling and redness increase, and finally become so 
marked that small brownish spots of dead tissue are formed 
