30 
POPULAR SCIEI^OE ^EWS. 
[FEBRnARY, 1891. 
shows a strange change. It becomes hard and 
assumes a darker coloring, which is not confined 
to the inoculation spot, but spreads to the neigh- 
boring parts until it attains a diameter of from 
0.05 to 1 ctni. 
In a few days it becomes more and more mani- 
fest that the slsin thus changed is necrotic, finally 
falling off", leaving a flat ulceration which usually 
heals rapidly and permanently without any in- 
volvement of the adjacent lymphatic glands. 
Thus the injected tubercular bacilli quite diflfer- 
ently affect the skin of a healthy guinea-pig, from 
one affected with tuberculosis. This effect is not 
exclusively produced with living tubercular ba- 
cilli, but is also observed with the dead bacilli, the 
result being the same whether, as I discovered by 
experiments at the outset, the bacilli are killed by 
a somewhat prolonged application of a low tem- 
perature, or boiling heat, or by means of certain 
chemicals. This peculiar fact I followed up in all 
directions and this furthur result was obtained — 
that killed pure cultivations of tubercular bacilli, 
after rinsing in water, might be injected in great 
quantities under healthy guinea-pig's skin without 
anything occurring beyond local suppuration. 
Such injections belong to the simplest and surest 
means of producing suppuration free from living 
bacteria. 
Tuberculous guinea-pigs, on the other hand, are 
killed by the injection of very small quantities of 
such diluted cultivations. In fact, within six to 
forty-eight hours, according to the strength of the 
dose, an injection which is not sufficient to pro- 
duce the death of the animal, may cause extended 
necrosis to the skin in the vicinity of the place of 
injection. If the dilution is still further diluted 
until it is scarcely visibly clouded, the animals in- 
oculated remain alive, and a noticeable improve- 
ment in their condition soon supervenes. If the 
injections are continued at intervals of from one 
to two days, the ulcerating inoculation wound be- 
comes smaller and finally scars over, which other- 
wise it never does ; the size of the sw ollen lym- 
phatic glands is reduced, the body becomes better 
nourished, and the morbid process ceases, unless 
it has gone too far, in which case the animal 
perishes from exhaustion. By this means the 
basis of a curative process against tuberculosis 
was established. 
Against the practical application of such dilu- 
tions of dead tubercle bacilli, there presented it- 
self the fact that the tubercle bacilli are not ab- 
sorbed at the inoculation points, nor do they 
disappear in another way, l)ut for a long time re- 
main uuelianged, and engender gn^ater or smaller 
suppurative foci. Anything, therefore, intended 
to exercise a healing effect on the tuberculous 
process, must be a soluble substance which would 
be liberated to a certain extent t)y the fluids of the 
bodj' floating around the tut)ercle bacilli, and be 
ti-ausferred in a fairly rapid manner to the juices 
of the body ; while the substance producing sup- 
piiration apparently remains behind in the tuber- 
cular bacilli, or dissolves but very slowly. The 
only important point was, tlierefore, to induce 
outside the body the process going on inside, if 
possible, and to extract from the tubercular bacilli 
alone, the curative substance. This demanded 
time and toil, until I flually succeded, with the aid 
of a forty to fifty per cent, solution of glycerine, 
in obtaining an effective substance from the tuber- 
cular bacilli. With the fluid so obtained I made 
further experiments on animals, and finally on 
human beings. These fluids were given to other 
physicians to enable them to i-epeat the experi- 
ments. 
The remedy which is used in the new treatment 
consists of a glycerine extract, derived from the 
pure cultivation of tubercle bacilli. Into the sim- 
ple extract there naturally passes from the tuber- 
cular bacilli, besides the effective substance, all 
the other matter soluble in fiftj' per cent, gly- 
cerine. 
Consequently, it contains a certain (luantity of 
mineral salts, coloring substances, and other un- 
known extractive matters. Some of these sub- 
stances can be removed from it tolerably easily. 
The effective substance is insoluble in absolute 
alcohol. It can be precipitated by it, though not, 
indeed, in a pure condition, but still combined 
with the other extractive matter. It is likewise 
insoluble in alcohol. The coloring matter maj' 
also be removed, rendering it possible to obtain 
from the extract a colorless, dry substance, con- 
taining the effective principle in a much more con- 
centrated form than the original glycerine solu- 
tion. For application in practice this puriflcatioy 
of the glycerine extract offers no advantage, be- 
cause the substances eliminated are unessential 
for the human organism. The process of purifi- 
cation would make the cost of the remedy un- 
necessarily high. 
Regarding the constitution of the more eft'ective 
substances, only sui-mises may for the present be 
expressed. It appears to me to be derivative from 
albuminous bodies, having a close affinity to them. 
It does not belong to the group of so-called toxal- 
bumins, because it bears high temperatures, and 
in the dialyzer goes easily and quickly through 
the membrane. The proportion of the substance 
in the extract to all appearance is very small. It 
is estimated at fractions of one per cent., which, 
if correct, we should have to do with a matter 
whose effects upon organisms attacked with tuber- 
culosis goes far beyond what is known to us of 
the strongest drugs. 
Regarding the manner in which the specific ac- 
tion of the remedy on tuberculous tissue is to be 
represented, various hypotheses may naturally be 
put forward. Without wishing to affirm that my 
view affords the best explanation, I represent the 
process myself in the following manner : The tu- 
bercle bacilli when growing in living tissues, the 
same as in artificial cultivations, contain certain 
substances which variously and notably unfavor- 
ably influence living elements in their vicinity. 
Among these is a substance which, in a certain de- 
gree of concentration, kills or so alters living pro- 
toplasm that it passes into a condition that 
Weigert describes as coagulation necrosis. In 
tissue thus become necrotic the bacillus finds such 
unfavorable conditions of nourishment that it can 
grow no more and sometimes dies. 
This explains the remarkable phenomenon tbat 
in organs newly attacked with tut)erculosis, for 
instance in guinea-pig's spleen and livei', wiiich 
then are covered with gray nodules, numbers of 
bacilli are found, whereas they are lare or wholly 
absent when the enormously enlarged spleen con- 
sists almost entirely of whitish sulistance in a 
condition of coagulation necrosis, such as is often 
found in cases of natural death in tul)erculous 
guinea-pigs. The single "l)acillus cannot, thei-e- 
fore, induce necrosis at a great distance, for, as 
soon as necrosis attains a certain extension, the 
growth of the bacillus subsides and therewith the 
production of the necrotizing substance. A kind 
of reciprocal compensation thus occurs, causing 
the vegetation of isolated bacilli to remain extra- 
ordinarily restricted, as, for instance, in lupus, and 
scrofulous glands. 
In such eases the necrosis generally extends 
only to a part of the cells, which then, with 
I futher growth, assumes the peculiar form of 
riesenzelle, or giant cell, llms interpretation, 
follow first the explanation Weigert gives of the 
production of giant cells. 
If now one increased artificially in the vicinity of 
the bacillus the amount of necrotizing substance 
in the tissue, the necrosis would spread a greater 
distance. The conditions of nourishment for the 
bacillus would thereby become more unfavorable 
than usual. 
In the first place the tissue which liad become 
necrotic over a larger extent would decay and de- 
tach itself, and where such were possilde woidd 
carry oft' the inclosed l)acilli aud eject them out- 
wardly, so far disturliing their vegetation that 
they would much more speedily be killed thau un- 
der ordinary circumstances. 
It is just in looking at such changes that the 
eft'ect of the remedy appears to consist. It con- 
tains a certain quantity of necrotizing substance, 
a correspondingly large dose of wliich injures cer- 
tain tissue elements even in a healthy person, antl 
perhaps the blood-corpuscles or adjacent cells, 
thereby producing fever and a complication of 
symptoms ; whereas with tuberculous patients a 
much smaller quantity suffices to induce at cer- 
tain places — namely, where tubercle bacilli are 
vegetating and have already impregnated the 
adjacent region with the same necrotizing matter, 
— more or less extensive necrosis of the cells, with 
the phenomena in the whole organism which r( - 
suit from and are connected with it. 
For the present, at least, it is impossible to ex- 
plain the specific infiuence which the remedy, in 
accurately defined doses, exercises upon tubercu- 
lous tissue, and the possibility of increasing the 
doses with such remarkable rapidity, and the 
remedial eft'ects which have unquestionably been 
produced under not too favorable circumstances. 
Of the consumptive patients who have been 
described as temporarily cured, two have been 
returned to the Moabit Hospital for further ob- 
servation. 
No bacilli have appeared in their sputum for 
the past three months, and their phthisical symp- 
toms have gradually and completely disappeared. 
[Specially Compiled for Popular Science News.] 
MONTHLY SUMMARY OF MEDICAL 
PROGRESS. 
by maurice d. clarke, m. v. 
The Rational Treatment ok Pneumonia.— 
The medical profession hears with languid inter- 
est of reports of new and curative drugs in pneu- 
monia. When, however, an ingenious, logical, and 
sensible application of known physiological data 
is made to the therapeutics of this disease, a more 
scrutinizing attention is called for. An article by 
Dr. Andrew H. Smith, on "Acute Obstructive 
Diseases of the Lungs,'' (American Journal of the 
Medical Sciencv^), has all the characterii just men- 
tioned. Dr. Smith shows that in an obstructive 
lung disease like pneumonia it is the right heart 
that bears the chief burden. The physician 
ought, therefore, to watch it with even more care 
than tlie radial pulse. Tlie pulmonary aortic 
pulse cannot be felt, but its strength and that of 
the right heart can be gauged by the intensity of 
the pulmonary aortic valvular sound. 
In au obstructive pneumouia the blood is 
dammed back into the veins, and there is venous 
congestion, while the arteries are not full enough. 
The therapeutist should aim, therefore, to distri- 
bute the blood more evenly. This may be done by 
taking away blood from the veins by venesectjou. 
But a safer method is to use such drugs as nitro- 
glvcerine and the other nitritites. Alcohol is also 
