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DR. KOCH'S NEW CONSUMPTION TREATMENT. HIS DESCRIPTION OF HIS LATEST EXPERIMENTS. The Daily News Berlin correspondence forwarded on Wednesday night, the follow- ing abstract of Professor Koch's article, giv- ing particulars of his improved tuberculin, appearing in the 'Deutsche Medicinische Wochenschrift,' edited by Professor Eulen- burg:— About five years have elapsed since Dr. Koch's comsumption cure' caused so much sensation. The disappointment that fol- lowed is within the memory of everybody. Dr. Koch, however, did not himself lose faith in his discovery, and for five years he has been endeavouring to improve it. Now he brings it forward again, and although the memory of five years ago must make us sceptical, it must at any rate occur to one that a man like Dr. Koch does not expose himself without precaution to a second de- feat of the kind. And, indeed, the disco- verer expresses himself in his article with the greatest reserve. He avoids the word cure,' and confines himself to speaking of considerable improvement.' Moreover, he states that his remedy is not effective un- less used in the early stages of consumption; and it will occur to one that many cases of consumption, if diagnosed and treated at an early stage, are already cured without tuber- culin. Professor Koch begins his article with some introductory remarks on the possibil- ity of rendering men proof against tuberu- losis, and his experiments with tuberculin. Speaking of the lymph as he first introduced it, he claims for it that it proved efficacious as a means of diagnosing the disease even at so early a stage that clinical observations and physical examination were of no avail. Concerning the difficulties encountered by him in seeking a lymph which would render the human subject immune, Dr. Koch says that solutions with dead bacilli caused bad abscesses. When he filtered the fluid it had no better effect than his first tuberculin. When after several years of experiments, he came to the conviction that the bacilli in an unchanged, or, exactly speaking, in an undestroyed state, could not be absorbed, he sought for means to destroy them mechani- cally, without destroying their characteris- tic properties, as was done by dissolving them by a chemical process. In former ex- periments he had found that the bacillus contained two peculiar chemical substances, both of which were non-saturated sebacic acids. The one is soluble in diluted alco- hol, and is easily saponified by carbon- ate of soda lye, the other only in boiling alcohol or ether, and is not easily saponified. Both assume the so-called tubercle-bacillus tint, and keep this tint after being treated with diluted nitric acid and with alcohol. These sebacic acids form, as the microscopic picture of the dyed bacillus shows, a con- nected layer in its body. They protect the bacillus against attacks from the outside, and render resorption difficult. The object, therefore, was to destroy this integument. All the first experiments failed. Only when well-dried cultures were taken, and worked about for a long time in an agate mortar, without any admixture, one could see that the bacilli decreased in number, and that finally only a few remained. In order to remove these, Dr. Koch diluted the sub- stance thus obtained Iwith distilled' water, and worked it about by means of a very powerful centrifugal machine, which made four thousand revolutions in a minute. The fluid was in about half -an hour divided into a whitish opalescent, but quite transparent upper layer, which contained no more bacilli, and a muddy sediment sticking fast to the bottom. The latter was dried again, then worked in the mortar, and by the machine, and was divided as before. This manipula- tion was continued till finally nothing re- mained but a series of completely clear fluids. This experiment was the basis of Dr. Koch's further work. At first he convinced himself by experiments on animals, and later on on human beings, that the prepara- tions so gained were-all completely resorb- able,' and never caused abscesses. It was further shown that though the first fluid differed considerably from the others, these were all alike. Dr. Koch called the upper layer Tuberculino,' abbreviated T. 0,' and the bottom layer T. R' (tuberculin remain- der). Treated with glycerine, T. R. showed that it chiefly contained the ingredients in- soluble in glycerine, whilst T. O. contained those soluble in it. This was confirmed by experiments on animals and men. T. O. is very much like the ordinary tuberculin or tubercle-antitoxin, but it causes no absces- ses. The T. R., however, hds a decidedly immunising' effect. It certainly alscf causes some reaction if too large a dose is given, but its effect is quite independent of these reactions. Whilst in using ordinary tuber- ctilin or tubercle-antitoxin, or T. O., reac- tion must be purposely provoked in order to obtain healing effects, Dr. Koch in using T. R. endeavours to avoid such reaction. For this purpose he tried, by gradually in- creasing the doses, which were made to fol- low each other as quickly as the patient's condition allowed, to make him insuscepti- ble to the effects of a larger dose—that is to sty, render him immune against T.R, and against the tubercle bacilli themselves. If a man can be rendered proof against T. R. he is proof against the bacillus itself. Pro- fessor Koch adds that he made such numer- ous experiments with T. R. that no doubt can exist about the correctness of his state- ment. The treatment is very simple. Injections "are made as with the tuberculin, on the back with a syringe. The fluid contains in one cubic centimetre eight milligrammes of solid, find by dilution with salt solution the proper dose is obtained. One five-bundrqfltn of a milligram is given first. This is such a small: dose that only very rarely reaction sets in. When this is the. case it must be still meredl- i luted. The injections are made about every second day, and the dose is increased so slowly that increase of the temperature above half a degree is avoided. The rising of th« temperature, if caused by the injec- tionsj must have completely dissappeared befoie resuming the injections, As a rnie, the dove tip. to SO ] • I* • AM'I if no' fwrt:GTi ceptible he ceases to inject, or only does so after longer pauses. He has gained the impression that complete immu- nity is attained about two or three weeks after the application of large doses. The cure of tuberculous guinea-pigs, the disease taking a very rapid course with them, suc- ceed only if the treatment is begun early. This is the same with human patients, The preparation has been applied by Dr. Koch in a great number of suitable cases, especially of lupus, and he Las achieved without exception an improvement far greater than that gained with tubercle-anti- toxin. I say improvement,' says Dr. Koch, though many of the cases may be regarded as cured, in the ordinary sense of the word, but I think it permature to use the word cure before a sufficient time has passed with out a relapse.' Dr. Koch emphasises the fact that in none of the numerous cases he trea- ted with T. O. were evil after effects ob- served. The patients felt well, they steadily increased in weight, and what was especially striking, their temperature did not show the well-known variations in consumptive pa- tients The Professor says he does not ven- -ture to regard his lymph as the best possible. He intimates that experiments are being made with a new serum which may prove still more efficacious, but he is convinced that the preparation of the tubercle cultures cannot be brought to greater perfection. He concludes with the words :—' Whatever may be done with tubercle cultures can be done with these.' Interesting is Dr. Koch's reference to the great danger of his experiments. The cul- tures used for the preparation of the T. O. must be as fresh as possible, and an investi- gator must not forget that it is the most virulent living tubercle bacilli which he has to deal with, and that they are worked upon in a dried state, so that dust cannot be avoided. I do not,' he says, think the danger connected with these experiments to be little, and I must confess that I often had the feeling as if I were dealing with ex- plosives.' A chemical factory at Hochst, which pro- duces Behring's diphtheria serum, is now selling the new tuberculin.


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