ZOOLOGY AND BOTANY, MICROSCOPY, ETC. 
771 
investigations are not complete. But so much is certain that there is no 
question of a destruction of the tubercle bacilli in the tissues, but only 
that the tissue inclosing the tubercle bacilli is affected by the remedy. 
Beyond this there is, as is shown by the visible swelling and redness, 
considerable disturbance of the circulation, and, evidently in connection 
therewith, deeply seated changes in its nutrition, which cause the tissue 
to die off more or less quickly and deeply, according to the extent of the 
action of the remedy. 
To recapitulate, the remedy does not kill the tubercle bacilli, but 
the tuberculous tissue ; and this gives us clearly and definitely the limit 
that bounds the action of the remedy. It can only influence living 
tuberculous tissue ; it has no effect on dead tissue, as, for instance, 
necrotic cheesy masses, necrotic bones, &c., nor has it any effect on 
tissue made necrotic by the remedy itself. In such masses of dead 
tissue living tubercle bacilli may possibly still be present, and are either 
thrown off with the necrosed tissue or may possibly enter the neigh- 
bouring still living tissue under certain circumstances. If the therapeutic 
activity of the remedy is to be rendered as fruitful as possible, this 
peculiarity in its mode of action must be carefully observed. In the 
first instance, the living tuberculous tissue must be caused to undergo 
necrosis, and then everything must be done to remove the dead tissue as 
soon as possible, as, for instance, by surgical interference. Where this 
is not possible, and the organism can only help itself in throwing off the 
tissue slowly, the endangered living tissue must be protected from fresh 
incursions of the parasites by continuous application of the remedy. 
The Dose . — The fact that the remedy makes tuberculous tissues 
necrotic and acts only on living tissue, helps to explain another 
peculiar characteristic thereof, namely, that it can be given in rapidly 
increasing doses. At first sight, this phenomenon would seem to point 
to the establishment of tolerance, but since it is found that the dose can, 
in the course of about three weeks, be increased to 500 times the original 
amount, tolerance can no longer be accepted as an explanation, as we 
know of nothing analogous to such a rapid and complete adaptation to 
an extremely active remedy. The phenomenon must rather be explained 
in this way, that in the beginning of the treatment there is a good deal 
of tuberculous living tissue, and that consequently a small amount of the 
active principle suffices to cause a strong reaction ; but by each injection 
a certain amount of the tissue capable of reaction disappears, and then 
comparatively larger doses are necessary to produce the same amount of 
reaction as before. Within certain limits a certain degree of habituation 
may be perceived. 
As soon as the tuberculous patient has been treated with increasing 
doses for so long that the point is reached when his reaction is as feeble 
as that of a non-tuberculous patient, then it may be assumed that all 
tuberculous tissue is destroyed. And then the treatment will only have 
to be continued by slowly increasing doses and with interruptions, in 
order that the patient may be protected from fresh infection while 
bacilli are still present in the organism. 
Whether this conception and the inferences that follow from it be 
correct the future must show. They were conclusive, as far as I am 
concerned, in determining the mode of treatment by the remedy.” 
