koch’s method with tuberculosis 
193 
often do we see one or two calcified tubercles, in a system 
the subject of acute tuberculosis. Prima facie , therefore, it 
would seem as if tuberculosis did not belong to that class of 
diseases for which a personal immunity of a reliable kind 
could be acquired. But if so, is not benefit from Koch’s 
method to be limited in the main to the process of local ne¬ 
crosis of superficial tubercle, and of such deeper formations 
as can be safely reached and removed by surgical means ? It 
seems that the great bacteriologist himself is aware of this, 
and is calling in the aid of von Bergmann for the subsequent 
resection of the diseased joints. If the bacillus escapes from 
the necrosed tubercle into the adjacent living tissue the vi¬ 
tality and antagonism of which is reduced by contact with 
ptomaines, there is everything to favor the formation of a new 
colony. 
Even the alleged value of the injection as a means of diag¬ 
nosis is now falling into doubt. The febrile reaction some¬ 
times occurs in the non-tuberculous, and some unquestion¬ 
ably tuberculous subjects do not show it. Koch justly claims 
a diagnostic value for the local reaction only. This may be 
itself incapable of diagnosis in internal tubercle. 
On the whole there seems to be good reason for moder¬ 
ating the extravagant expectations with which Koch’s tuber¬ 
culosis treatment was heralded. Much of the unreasonable 
claims made for him was doubtless due to the high reputa¬ 
tion of the author of the method, and his known habits of 
carefulness and thoroughness, but in this case his, perhaps 
too precipitate, launching of the fact of his discovery, and the 
mystery with which he surrounded its real nature fostered 
hopes and generated surmises, which he himself did not liter¬ 
ally claim, and which have been to a greater or less extent 
doomed to disappoint. That Koch has inaugurated a method 
of great value for a limited number of cases of tuberculosis 
(the superficial, the incipient and those that can be supple¬ 
mented by surgical measures) is undoubted, but for another 
class of these cases its value seems to me extremely apocry¬ 
phal, and to expect from it an acquired and permanent im¬ 
munity would seem to contradict the nature of the disease. 
