Evening star. [volume] (Washington, D.C.) 1854-1972, 1890-12-06

Description u the Liquid and the Phsno0
ena Attending the Injection.


From the London Lancet
The liquid, whatever be its nature, n, In
physical properties, . brown, viscid huid, some
what like . dilute solution Of iodine in color
and about the consistence Of thinnish sirup.
It 10 supplied to hospitals for clinical pur-
poses in white glass bottle, containing about
40 or 80 grammes, which ID corked. One
gramme 10 added to 100 grammes Of sterilized
distilled water for use, and the doses vary from
gramme Of this l-l00 dilution TO minute frac-
tons OF that quantity. The injection may be
made with any simultaneous syringe, but
here the notifications known as Koch's own il
used. The fluids may be injected into any part
of the body. But Koch suggests that under the
skin between the scapule is the best place, as
action occurs at the place Of incubation, and ii
goes without saying that the injection is made
with antiseptic precautions. The patientexpe-
riences no effects whatever for some time after
the incubation, but at the end of about four
hours the temperature begins to rise rapidly,
accompanied usually with rigors, as is the case
almost always when there is a rapid increase of
the bodily temperature. There is also vomit-
ing. The temperature may rise even to 41.2
degrees G. QO6.2 degrees r This tremend-
GUS rise IL reached in about two hours from
the commencement Of the febrile reaction.
rule, but the speed Of the fall depends
on the extent Of the tissue affected by
the tuberculsr matter. According to Koch the
injected liquid does not kill the bacilli them
selves, but only the tissue which has been re-
Gently modified by the vital action of the
bacili. II the tissue thus affected be extensive,
the temperature will remain high for o much
longer time than il only a small amount be af-
fected. Where the tubercular affection is linn
tied, as in lupus, the temperature will reach its
NM vA,-o Al
and the patient will feel free from malaise. Pa
tients suffering from tubercular affections Of
the joints. larynx, &c, even felt better at the
end OF the period Of reaction than they did be-
fore the incubation was made. In the case Of
tubercular glands, the rise Of temperature is,
as rule, delayed considerably and may not
reach its maximum for about twenty -four
hours. While the temperature is thus rising
the pulse also corresponds, increasing to 120 or
even 16O beats per minute; vomiting frequently
occurs at the acme Of the fever. The rapidity OF
the pulse diminishes along with the fall in tenn
quite alarming, with dysphea, and in one case
OF lupus the strongest restoratives had to be
employed to bring the patient round. Stimuli
taneously with these phenomena Of general
constitutional affection there occur certain
very marked and characteristic symptoms in
all parts OF the body, under the influence of
recent tubercular virus. The local swelling be-
gins earlier than the rise Of temperature. Old,
cheesy deposits present in q part do not lead to
the production of these local phenomena after
incubation. Such cheesy matter is TO be re-
garded as already necrossed; and Is Koch ex-
plains that only living tissue is affected by his
incubation material, we understand why local
reaction does not occur where cheesy matter
alone is present. The local phenomena consist
in general of swelling of the affected parts,
which may be considerable, more or less red
ness, and in some cases lessened pain.
l.. - la l.
structive of the forms Of tubercular disease
which have been treated up to the present. 1t
is indeed to Koch that We are indebted for the
knowledge that lupus Is really tuberculosis of
the skin. In cases Of this disease the phe-
nomens are visible, and we can judge of the
the subjective evidence Of the patient.
Take as typical case Of treatment one of
lupus affecting the nose and face, several of
which have been under treatment in Berlin
during the last five or six weeks. With the rise
of temperature the patient is already suffering
from some malaise, and il asked whether he is
i'll, will answer that he has some headache and a
feeling Of "tightness' or tension in the affected
part. The part has become slightly redder and
Of brighter color and swollen. These changes
keep on increasing in intensity until the reac-
ton has reached its height. The rapidity and
extent OF the swelling ara almost incredible in
some cases. The nose may attain twice or
thrice its original size. the cheeks become
swollen, and It may be quite impossible to
open the eyes. The extent Of the swelling il
to be taken as significant of the extent of the
tubercular disease at the place affected. This
Is frequently far more extensive than could be
concluded from the mere extent of the actual
lupus ulcer or Of the tissue which presents the
appearance OF disease from the existence OF
cicatrices. When cases of lupus recur, after q
lupus ulcer has been healed, the fresh outbreak
OF disease occurs only in rare cases in the cica-
frr~ nalf hr,% 10 Ia
border, in tissue which to all appearance was
healthy. The recurrence Of the disease In this
tissue must be taken to indicate that it was not
healthy, as it seemed to be, but that il really
contained tubercle bacilh in quantities too
small to produce changes recognizable by the
lead to fresh outbreak Of lupus i'm the course
Of time. Some ten or twelve hours later the
tubercular nodules in the affected area, those
which were distinctly visible to the eye before
incubation and also others which were not be-
come much more distinct, they being the por-
inoculated liquid. This is an illustration of
the fact mentioned by Koch in his communica-
ton, that it il the tissues and not the bacili in
them which are affected by the incubation.
A very characteristic and peculiar feature ID
the border. varying from quarter to a third
Of an inch in width, which becomes visible
(after inoculation) around the affected part,
where the scabs begin to form. This margin
is whitish in color, apparently owing to edema,
and outside it there lies an area Of skin which
presents all the characteristic appearances of
erysipelas, except the usual prominence of the
papile Of the skin. 1t is pulled and elevated
above the tissue outside its own margin.
Sometimes skin presenting the same appear
ance may be traced proceeding in narrow lines
outside this erysipeloid area, along paths
which may be regarded as the course Of the
lymphatics. These lymphatics may be sup
posed to contain tubercular material.
Later on, the inoculated liquid having had
time to emphasize its local action, the diseased
surface becomes covered with scabs, arising, no
doubt, from oxidation as necrosis Of the tuber-
cular tissue proceeds These scabs are very
like amber in appearance and. like it, may be
quite light or dark. They gradually turn dark
brown. They are very sdherent but their re-
moval may be accelerated by soaking them
with oil, and after they haye fallen of the It's
sue Is found marvelously changed in appear
shiny, brownish-red, unhealthy looking tissue,
with its nodules shining through, the skin APP
pears tender, young, rose colored and uniform
In texture, soft to the touch.
That such results should be obtained at the
end Of few days, and through the medium of
some half dozen or 30 subcutAneous painless
NEGOTIATIONS lin slight cases only the first ha wing
severe resction), will appear astounding and
most gratifying. Cases in this stage are re-
garded as cured, as they do not show any reac-
ton to further incubation. go 80
In tuberculosis Of internal organs, joints,
bones, lymphatics, TO-, it is reasonable to as
lation are similar in their main features to
those which occur in visible tuberculosis
Qupus). The reactionary temperature and
ACCOMMODATING symphonic are the same as in