

TUBERCULOUS DISEASES. 



joint tuberculosis were similarly treated, with 

 large doses at long intervals, with like results. 

 Persons with decidedly pulmonary tuberculosis 

 were found to be much more sensitive to the 

 remedy than those with surgical tuberculous 

 affections, and the injection doses were dimin- 

 ished to O'OOl cubic centimetre, to be increased 

 gradually, as the reactions weakened, to the full 

 dose. The action of the remedy in case of phthi- 

 sis generally showed itself by a slight increase 

 of cough and expectoration after the first injec- 

 tion, then gradual diminution, and ultimate dis- 

 appearance in the most favorable cases, the ex- 

 pectoration also losing its purulent character and 

 becoming mucous. The number of bacilli begun 

 to decrease as the expectoration became mucous, 

 night sweats ceased, the appearance of the pa- 

 tients improved, and they increased in weight. 

 Patients under treatment for the first stage of 

 phthisis were regarded as cured after from four 

 to six weeks. Patients with cavities not yet too 

 highly developed improved considerably, and 

 were almost cured ; but in a further stage of cav- 

 ities, while the expectoration decreased and the 

 subjective condition improved, no improvement 

 could be traced objectively. The combination 

 of this treatment with other curative methods 

 such as surgical operations, mountain climate, 

 fresh-air treatment, special diet, etc. is sug- 

 gested as an additional method of relief in se- 

 vere cases. Prof. Koch further insists on the 

 value of this remedy it having effect only where 

 tuberculosis exists as an indispensable aid in 

 diagnosis, as a measure of supposed cures, and 

 as a detective whether there may not still be left 

 in the system diseased spots whence tuberculosis 

 may again arise. Later experiments, however, 

 show that the degree of the general reaction is 

 not invariably proportionate to the amount of 

 tubercular disease present ; but that in some few 

 obviously tubercular cases no reaction has been 

 produced after considerable doses, while in others, 

 where the disease is apparently limited, the reac- 

 tion has been most severe, and in some cases where 

 patients have been tolerant of the injection during 

 several trials they have suddenly become suscepti- 

 ble to it. While the protective power of the remedy 

 as regards beasts has been established by Prof. 

 Koch's experiments, evidence has not yet been 

 collected to establish the immunity of the human 

 patient from tuberculosis after a course of treat- 

 ment. Attention was called by Dr. G. A. Heron, 

 in a lecture delivered by Prof. Koch's request at 

 the City of London Hospital for Diseases of the 

 Chest, to the possibility of the living bacilli in 

 the dead tubercular tissue which are not af- 

 fected by the remedy finding a nest for them- 

 selves in' the body and setting up fresh centers 

 of tubercular disease; and the possibility was 

 assigned as a reason for continuing the treatment 

 for a considerable time. This point has been made 

 prominent by Prof. Virchow, in a communication 

 to the Berlin Medical Society and published in 

 the " Berliner Klinische Wochenschrift," respect- 

 ing a immberof cases that proved fatal after treat- 

 ment which had come under his observation. 

 In many of those cases new tubercles had been 

 formed, "the origin of which was ascribed to the 

 action of the remedy by which the tubercular 

 masses having been broken down, tubercle bacilli 

 were thrown into the circulation and carried, 



TURKEY. 



BOi 



in one case, to the pericardium. In consequence 

 of these and other similar observation-. 

 Vircho w came to the oonchuion that UK- n 

 should not be employed in c;t-cs m which difli'- 

 culty might be expected in excreting tin- tuU-r- 

 cular matter set free by the treatment. The 

 lesson is enforced by this observation, which had 

 already been suggested by evidence gradually 

 accumulated in the clinio .,f Merlin. thai In". 

 Koch's remedy, at lnt.-t under th.- |. re-cut meth- 

 ods of administration, is not as well suited a- it 

 had been hoped it might prove to I.e. f..r ad- 

 vanced cases of phthisis. The fact that under 

 some circumstances the use of the remedy pro- 

 motes the tuberculous procc .. ami is therefore 

 injurious, has been admitted in a later communi- 

 cation published by Dr. Koch, in which In- aN< 

 gave a partial explanation of the nature of the 

 remedy and the mode of preparing it. It is t here- 

 in described as consistingof certain uukix wn sub- 

 stances extracted by means of a 40 or 50 per 

 cent, dilution of glycerin from a pure culture* 

 of the tubercle bacillus. While some of tin- 

 physical properties of the substance had been as- 

 certainedas that it is not soluble in alcohol, 

 but is precipitable by it the precise nature of 

 the active principle was still unknown to the 

 author. It seemed to him to be an alburnenoid 

 derivative, but not to belong to the so-called tox- 

 albumens, from which it differs by withstanding 

 high temperatures and bypassing readily through 

 the membrane of a dialyzer. It is estimated to 

 constitute less than 1 per cent, of the solution. 

 TURKEY, an empire in southeastern 



and western Asia. The Sultan is the eldest 

 prince of the house of Osman. Abdul Humid 

 II, the rejgning Sultan, born Sept, 22, 1842. suc- 

 ceeded his elder brother, Murad V, who was de- 

 posed on Aug. 31, 1876. The Sheikh-ul-lslam, 

 or director, under the Sultan, of religious and 

 judicial affairs, is Omer Lufti Effendi; and tin- 

 Grand Vizier, or chief of the civil administra- 

 tion, is Kiamil Pasha, who presides over the* 

 Council of Ministers, which was composed in 

 1890 of the following members: Aariti I'a-ha, 

 President of the State Council; Said Pasha, 

 Minister of Foreign Affairs; AH Saib Pasha, 

 Minister of War : Hassan Pasha, Minister of Ma- 

 rine ; Munir Pasha, Minister of the Interior: 

 Raif Pasha, Minister of Public Works, Com- 

 merce, and Agriculture; Riza Pasha, Minister 

 of Justice; Agob Pasha Kaza/ian, Minister of 

 Finance and the Civil List ; Munif Pasha, Min- 

 ister of Public Instruction; Zihni Pasha, lu- 

 tendant of Evkafs. 



Area and Population. The Ottoman Em- 

 pire has a total area of 1,652,533 square miles 

 and a population of 34,322,008. of whom S 

 376 inhabit the countries under the immediate 

 rule of the Sultan and 11,519,632 the trilmtary 

 states and protectorates. The census of 1 

 taken in European Turkey, makes the popula- 

 tion 5,575,025. Constantinople had 873,565 in- 

 habitants. The Asiatic vilayets had a popula- 

 tion of 16,271,252. 



Finances. The receipts for the financial year 

 1888-'89 were estimated at 18,500,000 Turkish 

 liras, and the expenditures at 21,400.00C 

 For 1889-'90 the deficit was expected to b 

 1,700,000 liras, or nearly $8,500,000. 



In accordance with an arrangement with the 



