The Indianapolis journal., 1891-01-12
THE TREATMENTOF DIR. KOCH
Experiments in America Have as Yet
Proven Nothing of a Definite Nature.
Patients Show Some Improvement. However,
and None Are Growing Worse-Local Reac-
tions-Dr Theodore Potters Second Letter.
correspondence of the Indianapolis Journal.

Correspondence OF the Indianapolis Journal
NEW YORK, Jan 9.-When the new treat
ment was announced publicly by Koch, in
November the University of Pennsylvania
sent representative to Berlin to look into
the matter in its home. and appointed
commission to investigate it and to super
intend the test in the University hospital.
A supply of the lymph was received and
the treatment begun about the middle of
December. Through the courtesy of
friend and classmate of the writer, who Is
member of this commission, full oppOr-
tunity was given to study the whole pro-
cedure. Here it was that first saw and
handled the much talked-of lymph, and
learned practically the method of its ap-
plication. Owing to its. powerful and
somewhat mysterious nature. it was deter
mined from the start to use every precau-
ton and to follow strictly the directions
given by Koch. In only one particular was
q deviation made. in the use of the ordinary
hypodermic syringe in place OF the more
complicated instrument advised and used
by Koch. But at the time of my visit
even this VAS being changed and the Koch
syringe used. The strictest precautions of
q bacterilogical kind were carried ont to
prevent contamination of the original and
of the diluted fluid, and the instruments
we're dlsinfected or ''sterilized" after each
use. All this because 1t Is necessary and
in order to avoid unfortunate accidents
which might bring disrepute upon the treat
ment at the start.
A part of the original lymph is diluted
with an antiseptic fluid up to ten percent.
solution. This is kept as "stOck" for q
week or more. and from 1t are made the
weaker solutions for the injection. This
final dilution Is made W. hen needed for use,
since it is liable to spoil if kept any length
of time. The method of making the injec-
tions has often been described, and the de-
scription need not be repeated. 1t differs
in no way from the ordinary use or the
hypodermic needle, except that more strict
antiseptic precautions are taken, and Is of
interest only to ply sicians.
STUDYING THE EFFECT.
The cases for treatment are divided here
as elsewhere, into two classes, medical aud
surgical, the latter including the now we'll
known lupus. The latter form of tuber-
culous disease affords the best pppor-
tunity for studying the effect of the
are directly under observation, and because
here, on the free surface of the skin, the
agent can show it's typical action not only
In destroying, but In casting of the de-
L
for humanity, unfortunately for the pres
ent experiments. lupus is q rare disease and
but few cases can be gathered for observa-
ton. There We're none In the University
hospital until the last day of my VISIT
when one doubtful case came In and was to
have diagnostic injection the next day.
As preliminary to the treatment careful
observations are made for one or more days
lDon the general condition, weight, pulse,
Temperature, etc., and as full history of
the patient as possible is taken in order
that a correct Judgment may be formed
upon the changes following the injections.
And, In general. every means Is used to as
certain the previous and present condition
of the patient. to rule out mere subjective
! conditions and to place the test as
nearly as possible upon an objective and
strictly physical basis.
A considerable number of cases of pull
monary tuberculosis had been under treat
ment from one to three weeks. These had
all been selected and the diagnosis estab-
lished by the detection of the tubercle
bacilli with the microscope. No case was
accepted for treatment in which this proof
OF the tubercular nature of the chest
trouble had not been applied. Minimum
doses were invariably used at the start and
theincrease gradually and cautiously made.
most cases. quite typical but very moderate
in degree. In some it was almost imper-
ceptlble. and only aroused by large dose.
No attempt was made TO call out a violent
In the lungs to such an extent as to occa-
sion alarm or cause danger. Moreover.
some unrecogniZed tubercular spot in a
vital organ. as the brain, might fash up
unexpectedly under the influence of the
lymph, and disaster result. Sufficient ex-
perience has not been accumulated upon
these points as yet, and the conservative
course Is, therefore. the wise one.
A PRONOUNCED REACTION.
The most pronounced reaction which saw
occurred in a young woman having a mum.
Der of tubercular, so-called scrofulous
glandular enlargements in the neck. These
had been operated upon several times, bu {
the lymph injections showed tubercular
tissue still present marked general and
local reaction took place. and followed
each treatment, After a number of iniec-
tions the local disease seemed to be subsid-
ing. Another interesting point was brought
out in this case. The lymph caused we'll
defined local reaction In another part of
the body, showing another focus of hitherto
unsuspected tuberculosis. similar. but
still more striking phenomenon was seen in
case here to-day. Surgeons will under
stand how this throws light upon cases
which have not pursued favorable course
after operation upon a tubercular lesion.
lt Is this local reaction, whether in the
lungs or external, rather than the general
symptoms following the application of the
lymph. which, has seemed to indicate its
specific working power. And this it is
which, fortunately. will serve test of
the genuineness and activity of o given
preparation. and will prevent spurious ar
ticies and unprncipled or shallow persons
from decelving the profession and the
public This, happily for all concerned,
IL 1T be kept In mind. will shut
out the quack. the more respecta BILE
but meaner rascal, who is sometimes called
by the more polite French term charlatan,
and the individual who discovered the
same thing long ago." Already these classes
of persons. especially the latter. have begun
to affiict the public. both East and West
but If they fail &c stand the test of the local
reaction their claims will usually be found
to consist chiefly of words.
lt Is TO be remembered that the treatment
has now been under way in Berlin for more
than three months, and that therefore the
most reliable and most instructive reports
OF results Will for some time at least come
from there. As to the results in Philadel-
phia, the experiments have been of too short
duration 10 warrant much in the way of
conclusions. There as elsewhere. the most
pronounced effects had been seen in the So
called surgical cases. What the ultimate
curative results will be time only can tell.
and no one would venture anything like a
positive prediction. And for this con-
servatism there is the best of reasons-no
one knows In the pulmonary cases mini
mum doses. as stated, having been used.
no very marked changes had occurred
There were, however, some objective
signs of improvement. and on the
principle of '.sInall favors thankfully re-
ceIved." every one was hopeful. but no one