It can not yet be said that the exact status of Koch's remedy is fixed; nor can we even yet say with certainty that this much-heralded cure is destined to survive among established methods at all. The most that is claimed for it by its most ardent advocates is that it seems capable of depriving the bacillus of the material in which it thrives best—i. e., of disintegrating and destroying tuberculous tissue. There has been no claim that it has any direct effect upon the existence of the bacillus, nor that it, having deprived the bacillus of its food, tends in any way to remove that parasite from the body, and thus to eliminate the possible source of danger of subsequent or more general infection. Under its influence in some forms of local tuberculosis—especially of the skin—it has been shown that tissue which was of the very lowly organized variety characteristic of the disease has been at first in part and then wholly replaced by a tissue of higher organization, and one that is likely to be permanent.
In regard to tuberculosis of the lungs, there can be no question that improvement in the patient's general condition and also evidence of improvement at the site of the disease have followed the use of this remedy. The general improvement manifests itself by a gain in weight, lessening of fever, increased appetite, better sleep. The local improvement is surmised from certain changes to be observed by auscultation and percussion, together with a diminution in the severity of the cough and in the amount of the expectoration, and also a diminution in the number of the bacilli in the expectoration or their complete disappearance from it. This has not always been the case. In not a few instances no improvement has resulted, and in other cases direct and most damaging results, including hæmorrhage and even death, have been brought about by it. In the treatment of tuberculosis of the bones and joints results seem to have been widely different. It is certain that some cases have been benefited, and equally certain that others have not.
Quite startling testimony to the possible causation of bad effects in a miscellaneous group of cases has recently been adduced in Berlin. This testimony is in the shape of the results of twenty-one autopsies made by Prof. Virchow of the bodies of patients who had been treated by Koch's fluid. Of these twenty-one cases sixteen were cases of consumption in the ordinary sense—that is, cases in which the disease was either wholly or chiefly in the lungs. The others included bone disease, chronic pleurisy, and tubercular meningitis. Some of the diseased changes described in important tissues and organs—in the lungs, heart, brain, intestines, and elsewhere, which can be directly ascribed to the influence of the "lymph"—make one feel that the remedy is quite as potent for evil as it is for good. Some of these effects were very disastrous in their results, even though the cases had, as a rule, been carefully selected by competent physicians as being appropriate subjects for the new treatment. Virchow shows how the process of consumption in the lungs can be made to spread and involve greater areas by the gradual loosening of masses of tubercular tissue from their original sites and their transference elsewhere. He shows how the disease in the larynx can be caused to take a sudden and very serious turn in consequence of the local swelling produced by the treatment. This may be so great as to prevent the entrance of air to the lungs, and cause death at once by suffocation. He shows how a fresh eruption of tubercles may be caused by it, and demonstrates their presence in the coverings of the brain and of the heart and elsewhere. He explains these occurrences by the hypothesis that the new remedy is capable of disturbing a localized tubercular focus and setting free the virus of the disease
