The morning call. [volume] (San Francisco [Calif.]) 1878-1895, 1890-12-11
KOCH'S METHOD.
Report by One of the Staff of the
Medical Record of New York.

The Medical Record, published in New
York, in the issue OF the 9th inst. pub fishes
a cablegram, dated Berlin. the 4th, from one
of its staff who was sent to investigate the
Koch method. Among other matters, the
correspondent telegraphs:
At the City Hospital. which has been
Designate as the central station for Koch's
method, the Director, DIR. Guttmann, has
set apart ninety beds 1or cases to be treated
10y NEGOTIATIONS, and DR.. Koch comes there
personally to witness the results. Very
exact graphical records are kept, showing
the various symptoms of the stage of re-
action and also of the number of tubercle
bacilli in the expectoration, which is ex-
amined daily by Professor Ehrlich, who has
taken charge Of the psychological labora-
tory. There Director Guttmann demon
Stiates great many cases daily, aud his
observations coincide with those of Pro-
fessors Gerhardt and Ewald in every par
ticulur.
Fro III all this it may be seen that the state
of affairs concerning this work and its clini-
cal features is simply that of gradual accu-
mutation Of experience and Wedge, and
the opinion is here very general that visit
ing physicians will be able to learn and see
much more three or four months hence than
at the present time. Patients certainly
should be discouraged from coming here,
especially since in a very short time the
treatment will be carried out in American
institutions, but, above all, because nothing
Is as yet certain or settled as to The results.
In the Deutsche MedciniSche Wochen-
schriit of December 4th the following new
Investigations on the influence Of Koch'S
medium on tuberculosis are published:
observations on the reactions which ap-
pear after the use of KOcl's medium" by
o. Rosenbach of Bresleu. Rosenbach ad-
vSes the following classifcations: (D Sus-
piclous cases, e. g., catarrh Of the apices,
without bacilii in the sputum, and phthisical
cases. e. g., vomici and old excavations and
with bacilli. o. With absence of bacili but
clinically Of phihi>ical nature. (c) Phthisi-
cal infiltrations with bacili appearing dur
ing long period Of observation, but with
either no fever or very slight fever. (dD Joint
affections of dubious character. (e) Clint
caly undoubtedly tubercular. On Affections
of the bowels. 81 Affections of the iarynx.
Having examined all these species, al
though necessarily but for short period,
Rosenbach arrives at the following conclu-
sions: First-lt is always advisable to be-
gin with small doses, namely, one MILL
gramme, and. If there be no reaction fever,
to increase the dose by degrees. After the
patients have become used to small doses
they can be Increased gradually, with long
intervals between each dose, and always
with the greatest canton. Seeond-In
phthisis of the larynx there was reaction in
only one case. Third-The time at which
the injection is administered has an infu-
ence on the febrile reaction, the temperature
rises quicker and higher If the injection be
made at the time when the fever usually
comes on. Fourth-The injection is maize
by PravaZs hypodermlc syringe containing
one cubic centimetre of Koch's fluid, which
must be diluted with one-half per cent solu-
ton OF carbolic acid before the injection is
made. The best place Tor making the in
lection is the cuts of the abdomen.
Z. Won Noorden OF Berlin, Gerhardts
lntaIlr hun nlu
Changes IN the Lung, Under the Influence
OF koch's Method OF Treatment" A female
patient with lupus Of the nose was treated
by koch's method. The lungs and other
organs we're apparently in a normal
condition. On November 2lst the first in
lection was made of five milligrammes of
KOch's fluid. In the evening tie tempera-
ture r0se.t0 3S.o' c., the respirations were
fortY-twO and the pulse no; The lupus spot
on the nose became redeemed and swollen,
the commencement of liberation became
evident in the larynx and the patient com
planned of pains in the right side of the
chest. November 22d the fever con-
tinued, temperature 3go c., pulse 100.
respiration tfty-eignt Over the lung there
was exceedingly loud breathing Expecto-
ration, which had not existed before
now came on profusely and was
of muco purulent character; there
were no bacilli. November Esd: apices.
anteriorly dizziness and fine rates; respira-
ton, 30; temperature normal. November
oath: Cough less. no expectoration: the
dizziness and raies were lessened. Novem-
Der 18th: AT 10 o'clock in tie morning one
afternoon there was chill, cough and ex-
pectoration; temperature, 40 degrees C. ::
pulse, 132; respiration, 60; again dullness
and rales. November Goth: i he patient
was resting dnrIng the night; the tempera-
ture fell slowly to 1873 degrees c.; respira
tion, 6. In the morning, on the affected
portion of the lung, bronchial breathing was
found, with crepitant rales. The spot of
lupus on the nose became again swollen, but
not SO much as after the first injection.
November 27tn: The temperature fell to
365 degrees G. and the respiration to 30,
There was sweating and much dry cough.
The condition of the lung remained as he
fore, and there were no bacilli In the
sputum. November 2Sth and 10Th, showed
gradual decrease in the dulluess. No
vember Both, the dizziness had nearly dis.
appeared, and the breathing had become
normal.
The author describes four more similar
cases in which tuburculous spots could not
be recognized by physical signs before the
lnJectlon. Alter the injection they could be
the sffected part of the lung, after Injection
became more infiltrated and thickened.
Inc Time tor the appearances of these
changes varies twenty-four hours. Alter
their appearance they usually begin to de-
crease. The author also warns against
using kochs remedy in cases where large
portions OF the lungs are affected; for by the
thckening OF the lung after the Injection
there is diminulion Of space for the air in
the lung which might become fatal in these
advanced cases. These transitory infjltra.
tlons probably bring on the healing pro
cess ~
DIR. Il. Kromeyer of Halle examined nor.
tons OF lupus tissue excised from a patient
affected with that disease and concludes
that the injection brings on an inflammation
OF the structures surrounding the tubercia.
Which results In suppuration Of the same.