under such circumstances that it is capable of disseminating tubercle in other parts. He also shows that it is capable of causing intense congestion and hæmorrhage. Virchow is not the only critic of Koch's method, though he is the most prominent one. Others in Berlin and elsewhere have related cases in which the disease extended while the patients were under treatment.
No one who has tried it carefully at all questions its powers; but the most competent observers agree that its general or indiscriminate employment would be most unsafe. Furthermore, competent observers here have concluded that, even though the cases be selected ever so carefully, if the dose of the fluid be not most accurately adjusted to the condition of each individual case, serious general disturbances may be caused and local changes at the site of the diseased tissue may be so marked as to produce dangerous results. These results are among those described by Virchow as due to the sudden dislodgment of tubercular masses in the lungs of such large size that they can not be coughed up, and their falling into more dependent places in the lungs and becoming lodged there and giving rise to new infection which may develop rapidly.
On the whole, it seems fair to say that before conclusive results can be obtained in the treatment of so chronic a disease as consumption time must elapse—time measured by months or years—before the present method can be said to have been thoroughly tried and assigned to its definite place in the therapeutic armamentarium. It may be a boon to mankind in comparison with which vaccination is a trifle; and it may yet be relegated to the dimly lighted region where rest many once promising methods whose day is long since forgotten. Meanwhile the treatment of consumption is by no means hopeless without Koch's fluid. Exactly the kind of cases that are doubtless often capable of being benefited by it have long since been known to be greatly improved and often cured by hygienic and dietetic treatment. It is within the experience of the writer that several such cases have been permanently cured at the Saranac sanitarium in the Adirondacks when they seemed to be gravely ill and after they had developed some of the symptoms which are usually regarded as most alarming. Many other equally good resorts are to be found in elevated regions in different parts of the country. Many cases that are not permanently cured in these mountainous regions are greatly improved, so that life may be indefinitely prolonged if one is willing to make his home considerably above sea level. It is a matter of common experience to every pathologist to find in the bodies of people who die from widely different causes, often in those who die from surgical injuries or accidents, perfectly unmistakable evidence of consumption. Old tubercular deposits in the upper parts of the lungs are exceedingly common in people who ceased to cough or present other symptoms of the disease years before they died. In many of these cases no especial care could have been taken, certainly no systematic and intelligent treatment could have been followed, for these patients die in hospitals after long lives of toil, privation, hardship, or excesses. Thus not only is the disease often curable by care, as we have said, but it often gets well wholly without care and even without proper food and shelter. In the absence of positive proofs of the general efficacy and safety of the new treatment, and in view of the fact that it is still accessible to but very few of our consumptives, those who are threatened with consumption or who are actually suffering from it should not allow their hopes of relief by the new cure to take the place of those hygienic measures which, if rightly applied, may serve to ward off many of the most serious symptoms of consumption, and sometimes even to cure the disease.
