TUBERCULOSIS. 24I 



cells, and of the cells of the different parts of the spleen, and 

 that they also set up certain changes in the circulation, the 

 result of which was seen in marked congestion of the lungs, 

 kidney, spleen, &c. These experiments Were no doubt sug- 

 gested by the similar changes that are met with in the 

 human subject in the course of tubercular disease, even in 

 those organs that are not directly affected by the tuberculous 

 infiltrations. Recently he has confirmed and extended his 

 former observations ; and it will be interesting to see whether 

 the conditions met with in patients injected according to 

 Koch's method, are similar to those observed in animals 

 experimented on by Maffucci's method. 



How far the object of Koch's endeavours will be attained 

 still remains to be seen, and his method has been, and will 

 be, put to most severe tests for it involves the question of 

 life or death to thousands, nay, tens and hundreds of thou- 

 sands. There appears little doubt that in lupus (a tuber- 

 culous skin disease) the process has been checked, and, in 

 some cases, at any rate, it has not again broken out for a 

 considerable period after the treatment had been stopped. 

 There also appears to be pretty reliable evidence in favour 

 of his contention that there is an amelioration of the condition 

 of the patient and an improvement in the disease in certain 

 other forms of tuberculosis ; but the use of the remedy has 

 not been sufficiently prolonged to allow of our arriving at 

 any very definite conclusion, however favourable our opinions 

 may be. Virchow, the greatest pathologist of the age, has 

 found, in a number of cases that have come under his obser- 

 vation — a comparative small number when the enormous 

 number that have been injected is taken into consideration 

 — that the characteristic degeneration of the tissues of the 

 young tubercle is not always brought about, that the locali- 

 zation of the disease is not by any means perfect, that there 

 is a tendency of tubercle material that should be " thrown 

 off" to continue the infection and even increase its 

 rapidity of spreading, especially in the lungs, and that 

 in some cases the bacilli, instead of being rendered inert, 

 appear to take on greater activity, and to be carried in 

 the various currents in the body, even to parts situated at 

 some distance from the original tuberculous focus. We 

 must bear in mind, however, that almost all the cases that 

 up to the present have been brought to the post-mortem 



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