NA TURE 



1 29 



THURSDAY, OCTOBER 3, 1912. 



THE SPECIFIC TREATMENT OF 

 TUBERCULOSIS. 

 The Treatment of Tuberculosis hy means of the 

 Immune Substances (I.K.) Therapy. An in- 

 troduction to Carl Speng-ler's work on Im- 

 munity and Tuberculosis. Bv \\'alter H. 

 I-'earis. With a Foreword by Dr. Carl 

 Spengler. Pp. xx + 206. (London: John 

 Murray, 1912.) Price 6s. net. 



rHOSE who turn to this book for an account 

 of Speng:ler's work and records will, we 

 are afraid, be sorely disappointed. The opinions 

 of an enthusiastic admirer of Dr. Carl Speng-Ier, 

 his school, and its work are here in abundance, 

 but any detailed description of much that is 

 peculiar to Spengler's method is wanting. 



We are told, however, that in man tuberculous 

 infection is a symbiotic infection, and that with 

 rare exceptions two antagonistic types of tubercle 

 bacilli are found : — (i) Typus humanus b^evis, 

 Koch ; (2) humano-longus , Spengler, this latter 

 differing from the Typus bovinus only in that it 

 branches more and forms pigment, that it is less 

 acid-fast, is more sensitive to the action of dis- 

 tilled water, is more highly pathogenic to cattle, 

 rabbits, guinea-pigs, and adult human beings, 

 and that there are differences between the two 

 as regards certain optical properties. It is in- 

 teresting to note that Spengler believes that 

 although the two types, bovmus and humano- 

 longus, are morphologically identical, their patho- 

 genic action is. markedly different; still, he rejects 

 experiments on animals as being of little or no 

 value in helping to distinguish between the 

 different types. 



It is insisted that the toxins of the true bovine 

 bacillus are antagonistic to those formed by 

 Koch's Bacillus brevis and the converse, and also 

 that whilst the toxins of the true bovine bacillus 

 act as vaccins towards man, those of Koch's 

 Bacillus brevis, with rare exceptions, act as toxins ! 

 towards man. Whatever may ultimately be ac- ' 

 cepted as to this and other points, the arguments 

 as here put forward are scarcely convincing. Much 

 of the latter part of the book is devoted to an at- 

 tempt to prove that Dr. Carl Spengler was chiefly 

 responsible for the development of Koch's tuber- 

 culin treatment, and that, following this up, he 

 has devised a method for the production of an 

 immunity in which are combined both active 

 and passive elements. 



This method depends on the production of 

 certam im.mune substances or antibodies in the 

 sheep or ralibit, whence, apparently, the\- can 



NO. 2240, VOL. go] 



be transferred to the human subject, these 

 immune bodies sometimes being used along with 

 tuberculin, but, in certain cases, alone. Bacterio- 

 logical methods of examining sputum, &c., of 

 determining the amount of antitoxic sub.stance in 

 the "I.K.," special methods of inoculation, dry, 

 subcutaneous, intramuscular, and the like, are 

 described, and a series of directions for treat- 

 ment are given, the most important of which 

 (noted after long descriptions of systematic treat- 

 ment) appears to be— watch the condition of the 

 patient, and then inject just as may be thought Rt. 

 .\ rapid precipitation method used in determining 

 the approximate immunity value of a sample of 

 blood is mentioned, and figures bearing on these 

 \alues are given, but nowhere is anything said 

 about the method itself. 



r>om this, and from other features of the 

 book, one cannot help feeling that the work before 

 us is the outcome of observations and discussion 

 amongst a set of enthusiastic workers at a sub- 

 ject concerning which the author, at least, _ is 

 content to accept e\-erything that is put before 

 him, whether he understands it fully or not. This 

 somewhat serious statement is made after due 

 consideration, though it may be that the author is 

 so full of the rnethods here suggested that he is un- 

 aware of the ignorance of mariy of us "outsiders " 

 of what, in the circle in which he moves, is common 

 knowledge. Nowhere is this more marked than 

 in connection with the reports of different 

 physicians who are recorded as giving evidence 

 for and against "I.K." treatment. There may 

 be a very great field for this treatment, and this 

 book may stimulate those interested to a further 

 study of Carl Spengler's methods, but in it are 

 collected such a mixture of elementary details 

 and imperfect accounts of very difficult and com- 

 plicated questions that it will certainly fail in 

 its main object, i.e., to be "of real practical 

 value to the physicians who may desire to ad- 

 minister this treatment." 



In • an introductory note Dr. Carl .Spengler 

 writes: "Obgleich mir das \orliegende Buch nur 

 in seiner Disposition bekannt ist. . . ." This is 

 well for Dr. Spengler if he be a fairly modest 

 man, but whether it is equally good for the book 

 is another matter, and we suggest that in the 

 larger work that is promised by the author an 

 attempt should be made to cut out a nu:r.hcr of 

 the "Carl" Spenglers, "I.K.'s," and the almost 

 endless repetitions by which the pages of this 

 book will appear, to most readers, to be dis- 

 figured. Indeed, man\- will be so irritated by 

 this constant repetition and reiteration that there 

 will be great risk of any real merit in the work 

 beinsr o\erlookcd. 



