802 



TUBERCULOUS DISEASES, KOCH'S REMEDY FOR. 



One hundred veins are known, varying in thick- 

 ness from a foot to more than 50 feet. 



Tin is also found in Idaho. The tin mines of 

 California have lately been sold to an English 

 company. The ore is said to average 10 per cent, 

 of metallic tin. The United States tariff of 1890 

 having discriminated against foreign tin plate, 

 numerous companies have been chartered in 

 Chicago, Pittsburg, St. Louis, Brooklyn, Balti- 

 more, Minneapolis, and other cities, for the man- 

 ufacture of tin plate in this country ; but the 

 process of mining and establishing manufactur- 

 ing plants is slow. The tariff does not go into 

 effect until July 1, 1891, and it will cease to have 

 any effect on Oct. 1, 1897, unless it shall be 

 proved to have had the effect of so stimulating 

 American manufactures as to result in the pro- 

 duction by American works of one third of all 

 the tin plates used in the United States. 



TUBERCULOUS DISEASES, KOCH'S 

 REMEDY FOR. In an address delivered before 

 the International Medical Congress in August, 

 1890, Dr. Robert Koch spoke of his experiments 

 in search of a remedy for tuberculous disease 

 by inoculation, and said that, after several fail- 

 ures to discover a culture the reactions of which 

 could be depended upon, he had at last found 

 one which would check the growth of tubercle 

 bacillus, equally in the test tube and in ani- 

 mals. It had been his intention to complete the 

 research and gain experience regarding the ap- 

 plication of the remedy in practice and its pro- 

 duction on a large scale before publishing any- 

 thing on the subject; but distorted and exag- 

 gerated accounts of the matter having reached 

 the public, Dr. Koch published in the " Deutsche 

 medicinische Wochenschrift " of Nov. 14 a re- 

 view of the position of the inquiry at that time 

 The investigation had then been carried on, un- 

 der Dr. Koch's direction, on human patients, and 

 these formed the subject of his communication. 

 The remedy, the precise nature of which was not 

 yet revealed, was described as a brownish, trans- 

 parent liquid, which did not require special care 

 to prevent decomposition, and must be diluted 

 for use. Introduced into the stomach, it had no 

 effect ; but, to insure beneficial results, it should 

 be injected subcutaneously, and for this purpose 

 a syringe adapted to bacteriological work was 

 used, and, when kept aseptic by absolute alcohol, 

 with perfect security from danger of the forma- 

 tion of abscesses. The injection was made in the 

 skin of the back, between the shoulder blades and 

 the lumbar region, that haVing been found to be 

 the spot where it led to the least local reaction 

 and the least pain. The human subject proved 

 to be much more sensitive to the action of the 

 preparation than the guinea pigs on which it 

 had been first tried. On the healthy man and 

 on patients suffering from other diseases than 

 tuberculosis it reacts hardly at all ; but, in cases 

 where the disease is tuberculosis, the general 

 reaction sets up at once and is obvious. It con- 

 sists in an attack of fever, which, usually begin- 

 ning with rigors, raises the temperature above 

 39 C., and even up to 41 C., accompanied by pain 

 in the limbs, coughing, great fatigue, often sick- 

 ness, and vomiting. In some cases a slight icteric 

 discoloration was observed, and occasionally an 

 eruption like measles on the face and neck. The 

 attack usually began four or five hours after the 



injection, and lasted from twelve to fifteen hours.. 

 The patients were little affected by the attack, 

 and soon recovered their normal or an improved 

 feeling. The specific reaction could be plainly 

 observed in cases where tuberculous affection 

 was visible, as in lupus, where the anti-tubercu- 

 lous action was demonstrated in a surprising de- 

 gree in parts of the body remote from the place 

 of application. The end, after the usual course 

 of feverish swelling and healing, was the entire 

 disappearance of the lupus affection, which does 

 not return to its original condition, but is de- 

 stroyed to a greater or less extent. The specific 

 reactions in cases of tuberculosis of the glands, 

 bones, joints, etc., while less striking, were still 

 perceptible to eye and touch. The reaction of 

 the internal organs, especially of the lungs, was 

 not at once apparent, except in the increased 

 cough and expectoration of consumptive patients 

 after the first injections, but Dr. Koch felt justi- 

 fied in assuming that here, too, changes take 

 place similar to those seen in the lupus cases. As 

 far as the character of the action of the remedy 

 has been ascertained, it appears to take place no*t 

 by killing the bacilli in the tissues, which it does 

 not seem to affect directly,but by killing the tuber- 

 culous tissue. Beyond this there are, as is shown 

 by the visible swelling and redness, consider- 

 able disturbance of the circulation and, evidently 

 in connection therewith, deep-seated changes in 

 its nutrition, which cause the tuberculous tissue 

 to die off more or less quickly and deeply, accord- 

 ing to the extent of the action of the remedy.. 

 The remedy can only influence living tubercu- 

 lous tissue. It has no effect on dead tissue, or 

 on tissue which has been made necrotic by itself. 

 In such masses of dead tissue living tubercle ba- 

 cilli may possibly still be present, and are either 

 thrown off with the necrosed tissue or may un- 

 der certain circumstances enter the still living- 

 tissue. If the therapeutic activity of the remedy 

 is to be rendered? as fruitful as possible this pe- 

 culiarity in its mode of action must be carefully 

 observed. In the first instance the living tuber- 

 culous tissue must be caused to undergo necrosis, 

 and then everything must be done to remove the 

 dead tissue as soon as possible, by surgical inter- 

 ference if necessary. When this is not possible, 

 and the organism can only help itself in throw- 

 ing off the tissue slowly, the endangered living 

 tissue must be protected from fresh incursions of 

 the parasites by continuous application of the 

 remedy. The fact that the remedy makes tuber- 

 culous tissue necrotic, and acts only on living tis- 

 sues, helps to explain the fact.that it can be giv- 

 en in rapidly increasing doses ; for when there 

 is much tuberculous tissue to be dealt with a 

 strong reaction is readily provoked ; but as on 

 each injection a certain amount of the tissue ca- 

 pable of reaction disappears, comparatively large 

 doses are necessary to produce the same amount 

 of reaction as before. The full dose of injection 

 in the case of lupus was O'Ol cubic centime- 

 tre. The reaction having been allowed to come 

 to an end after a week or two the injection 

 was repeated ; and the process was repeated in 

 the same way, the reactions becoming weaker 

 and weaker with each repetition till they ceased. 

 The cases improved in proportion to the dura- 

 tion of the treatment, with speedy recovery in 

 recent and slight cases. Glandular, bone, and 



