Chapter 1

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PROF. KOCH'S

_METHOD TO CURE_

TUBERCULOSIS

_POPULARLY TREATED_

BY

DR. MAX BIRNBAUM.

_TRANSLATED FROM THE GERMAN_

BY

DR. FR. BRENDECKE.

_With an Appendix being Prof. Koch's First Communication on the Subject, translated from the_

_DEUTSCHE MEDICINISCHE WOCHENSCHRIFT_

_and explanatory notes by the author._

MILWAUKEE, WIS., H. E. HAFERKORN, PUBLISHER. 1891.

COPYRIGHT 1890, BY H. E. HAFERKORN.

PRESS OF THE HARTMANN PRINTING CO., 126 Reed St., MILWAUKEE, WIS.

Translators Preface.

Consumption is curable. From time to time the news of some great discovery rushes over the land like a mighty wave; but never before has the intelligence of a great achievement been received with such universal delight. There is hardly a man, woman or child that does not bewail the loss of some dear relative taken away by Tuberculosis, the most terrible of all foes. More terrible because it stealthily creeps into the system and takes a firm hold before its presence can even be surmised.

Now the appearance of a deliverer is hailed as would the advent of the Messiah. Koch, formerly a poor and obscure student, being especially interested in bacteriology has plodded and worked for years. Even in the year 1882 he has made known to the world the evil spirit in describing the tubercle-bacillus as the specific generator of tuberculosis. We then knew the enemy but had no weapon to fight him. Now Koch has also manufactured the sword with which to combat the evil genius. The experimental tests thus far have not tended to lessen the merits of Koch's remedy. Added applications have resulted in additional success. The investigations are not yet complete; only meager particulars have thus far been given to the public from authorized sources. To guard against misleading representations the translator has undertaken to give to the American public only what has actually been achieved. He felt himself called upon to do this not only because he has followed the progress of Koch's labors with the keenest interest, but also because he himself has worked and labored on this field for many years.

Justly has a vast excitement taken hold of all classes of the people, an excitement that has caused all other contemporary events to fall back. The search for an actual remedy for that exceedingly ravaging disease, tuberculosis, has at last been crowned with success, and even the most uneducated will be able to estimate the significance of this event.

We need but consider, that pulmonary consumption, the most frequent form of tuberculosis, annually demands over 30,000 victims in the cities of the German Empire over 15,000 inhabitants, and out of every 100 deceased 12-13 have fallen prey to this sickness.

The number of sufferers from pulmonary consumption can not nearly be determined, it certainly exceeds all other diseases by far. In the case of many people we can only infer from their appearance and hereditary tendencies, before visible signs can be discovered, that they will succumb to this terrible disease.

And this disease is now curable. Millions of people who have considered themselves doomed, will be given back to life; their regained strength will greatly increase the national wealth. In short, we look forward to an era, such as was not dreamt of even by the most vivid imagination only a few years back. But rather than be carried too far by our enthusiasm, let us study Koch's new method to cure, as far as we are now enabled to pass judgement on it.

First of all we must explain: _What is tuberculosis? What relation does it bear to pulmonary consumption?_

Pulmonary consumption is only one form of tuberculosis, by far the most frequent. This is the reason why pulmonary consumption, pulmonary tuberculosis, consumption and tuberculosis are used as _synonymous_ terms.

Tuberculosis is the _general_ expression. By that we understand a disease which is generated by a certain kind of organism belonging to the class of bacteria. These organisms are the tubercle bacilli, which were discovered by Koch in the year 1882.

Now these tubercle bacilli settle most frequently in the lungs and here cause serious derangements of the lung tissue. _Pulmonary consumption_ is the result.

But the tubercle bacilli will also settle in any other portions of the body and cause tuberculosis.

Frequently the tubercle bacilli nestle in the _larynx_ and the result is _laryngeal consumption_.

They may infect the mucous lining of the tongue and nasal passages and cause the rarely occurring diseases--_tuberculosis of the tongue and nose_.

More frequently tuberculosis of the intestines results, the well-known _intestinal consumption_.

The spreading of tuberculosis in the brain is of especial importance on account of the importance of this organ. Very frequently small children are attacked by _tuberculosis_ of the _cerebral membranes_, a disease that has heretofore unexceptionally resulted in _death_.

Much oftener than is generally supposed the _kidneys_ are the seat of tuberculosis; and also the _suprarenal capsules_, whose functions are as yet entirely unknown, have in postmortem examinations been found to be tubercularly degenerated.

In the diseases of the _bones_ and _joints_ tuberculosis forms an important part. Those infinitely small and weak tubercle-bacilli have the power to destroy the hard and firm substance of the bones, to soften it and change it to pus. Whole portions of bone may disappear in this way.

Tuberculosis can also destroy parts of the _skin_. In this case it is called _Lupus_.

Finally tuberculosis is found in the _generative organs_. Tubercular derangements are frequently met with in the _testicles_ of men, less often in the _ovaries_ of women.

The well known children's disease _Scrofula_ is considered a preceding stage of tuberculosis by many physicians. This much is certain that Scrofula inclines to tuberculosis.

Let us study the several forms of tuberculosis after this general synopsis; we will begin with pulmonary consumption.

Pulmonary Consumption.

Even before the discovery of the tubercle-bacillus by Koch, different scientists had claimed that pulmonary consumption was caused by the immigration of bacteria into the lungs, and several of them had found bacteria of that kind. But it remained for Koch to bring light upon the conjectures of other scientists, and he established the fact, that the bacillus discovered by him was the real generator of pulmonary consumption. Millions of these bacilli exist in the lungs of the diseased, and millions of them are thrown out with the sputum.

If we take a very small quantity of this thrown out matter and examine it with a microscope, we will find a greater or smaller number of these tubercle bacilli. Of course the preparation to be microscopically examined must previously be colored with some coloring matter, otherwise it is very difficult, well nigh impossible, to detect the infinitely small bacilli. The method of coloring now generally in use consists in discoloring the preparation after the coloring has been completed, it is found that the bacilli tenaciously cling to the coloring matter, and in this way it is easy to recognize the tubercle-bacilli under the microscope.

These bacilli are infinitely minute, they are 2/1000 to 8/1000 millimeters long, and about 5/100000 millimeters in width. Therefore it is absolutely impossible to recognize them with the naked eye. Generally they are somewhat bent, sometimes slightly nicked at one end.

The temperature of boiling water destroys the vitality of the bacilli under all circumstances. Even a temperature of 70 deg. C. is able to lessen the efficacy of the bacilli. Unhappily this temperature is too high to be applied against the tubercle-bacilli in the human body without causing the most serious injury to it. Nevertheless it has been tried, we will speak of this later on.

Then the drugs that kill the bacteria, such as Carbolic Acid, Alcohol, Iodoformether, Ether, Sublimate, Thymol, destroy the tubercle-bacilli so slowly and only in such high concentrations that their application is impossible without endangering the patient. Therefore the prospects of directly destroying the bacilli in the human body had to be given up as impossible.

We are now confronted with two questions:

1. In what manner does the tubercle-bacillus enter into the human organism?

2. Under what conditions is the tubercle-bacillus able to generate pulmonary consumption after it has entered the human organism?

All investigations, both of earlier and later date have established the fact that the tubercle-bacillus is inhaled with the air, and then it is mainly the foul air which is accused. But foul air is especially found in such places where people congregate, as in rooms, barracks, factories, etc. As it is a fact that there are always several consumptives among a number of people, so in this case there will always be occasion to inhale the tubercle-bacilli that have been cast out by the consumptives. Therefore it is not the foul air in itself which generates pulmonary consumption, but the circumstance that in this connection there are always people present which are able to spread and scatter the bacilli.

Luckily the physical qualities of the tubercle-bacilli are such that they mostly adhere to the ground or floor and are rarely scattered in the air as dust; otherwise pulmonary consumption would be much more frequent than it is at present. Unfortunately the bacilli are very often spread through uncleanliness of the people, because they touch objects with their fingers to which the tubercle-bacilli chance to stick and then they touch their mouth or nose with these fingers. In this way bacilli can be taken into the system especially easily with the food. Children are particularly exposed to contamination, crawling about on the ground, on which, perhaps but recently, a consumptive has spit, and more so because they often have the habit to put all sorts of things and also the generally dirty fingers into their mouth.

On the other hand there are various obstacles in the way of tubercle-bacilli entering the lungs. The distance from the mouth to the lungs is long and narrow; all sorts of projections check the further penetration of the bacilli. The trachea and the air-passages of the lungs possess equipments arranged for the purpose of ejecting small foreign substances, thus also to throw out the bacilli. In short it is not too easy a matter for the bacilli to penetrate into the lungs.

And yet this happens only too often. For instance, in some people the passage from the mouth down may be a wide one, so that the bacilli can enter more easily; the protective arrangement by which foreign substances are removed may be deranged, it may be wanting in some place or its functionary qualifications may be bad; especially frequent this is the case after enfeebling diseases, which are associated with severe cough, as measles, whooping-cough, etc. This is the reason why pulmonary consumption is strikingly often observed to follow just these diseases.

But the tubercle-bacillus can also enter the body with the food, as stated before. The acid gastric juice is a protective agent which considerably lessens the danger of infection by tuberculosis.

It has not been definitely decided at the present time whether the drinking of milk from tuberculous cows brings with it the danger of tuberculosis for mankind. It will certainly be best to avoid such milk, especially when the cow's udder is found to be tuberculously diseased or when tubercle-bacilli can be traced in the milk.

The use of meat as food may also become dangerous to man, but this is a rare occurrence. It is particularly dangerous to eat the liver, kidneys and lymphatic glands of tuberculous animals. The boiling heat while cooking generally destroys the bacilli contained therein and so lessens the danger from this source. It is of no little importance, to call particular attention to the fact that our chickens are very often severely infected with tuberculosis.

The question, whether a consumptive can _infect his surroundings_, may be answered thus, that this does _not_ happen as a rule. Several unhappy circumstances must come together to make this possible. Above all things a direct transmission of tubercle-bacilli in some way into the body of the healthy person, then the bacilli must cling and propagate in the same, which is only possible when there is an inclination to this disease, of course this inclination is quite common.

Pulmonary consumption is _not hereditary_ in the strict sense of the word. Only an inclination to this disease is transmitted. As the danger of contagion of those having such disposition is very great, so as a rule the disease makes its appearance sooner or later.

On the other hand it must be considered that the penetration _only_ of the tubercle-bacilli into the body is _not_ sufficient to generate tuberculosis. If they do not find the ground adapted to their nourishment and propagation they perish. It may be assumed that every person is placed in such circumstances at some time that he will take in tubercle-bacilli; but only a certain percentage will get consumption. In the remainder the bacilli perish without leaving even a trace.

Very often the inclination to pulmonary consumption may be recognized from the external characteristics. As a rule the respective individuals have a slight body, thin lean skin, weak muscles, delicate skeleton, a long, narrow, flat chest, flattening of the regions over and below the shoulderblades, wide intercostal spaces, a winglike projecting of the scapulae, long neck, clubby, knoblike appearance of the ends of the fingers.

Furthermore it has been found, that pulmonary consumptives on an average have a _smaller heart_ than is essential to a healthy body. On the other hand the volume of the lungs of consumptives is very often abnormally large.

There are a large number of _diseases_ that predispose to pulmonary consumption. It is mainly the _enfeebling_ action of the same, which brings about such results. For this reason the _chronic_ diseases contribute so much toward the multiplication of the number of consumptives, because they stipulate a continuous weakening of the organism and an emaciation of the system. To these belong Bright's disease, which very often turns into pulmonary consumption, greensickness or chlorosis, anaemia, continued febrile diseases, severe chronic suppuration, chronic catarrh of the stomach, frequent pregnancies, childbed diseases. Thus we may often see young chlorotic girls afflicted with consumption, especially when they marry young and enjoy the honeymoon to its utmost limits. Then also women will easily become consumptive when they give birth to a child every year, especially when the social conditions in which they live are of an unfavorable nature, and they are perhaps inclined to consumption already. Childbed on the whole inclines to arousing the dormant inclination toward pulmonary consumption.

Of other diseases we have mentioned measles and whooping cough, as diseases that are only too easily succeeded by consumption. To these may be added typhus, especially when it is of a more protracted nature, and the reconvalescence is slow and incomplete.

Furthermore all those workmen that have to do with dust, are exposed to the danger of being stricken with pulmonary consumption. The dust enters the lungs, irritates and injures the same and so produces a favorable soil for any tubercle bacilli that may happen to penetrate. On the whole metal dust is more injurious than mineral dust. Workmen, that are exposed to animal dust, as furriers, saddlers, brushmakers, fall prey to consumption much oftener than those, that fulfill their vocation in air pregnant with vegetable dust. According to statistics workingmen are stricken with pulmonary consumption as follows: of glass workers 80 per cent., needle grinders 70, filemakers 62, stone cutters 40, mill grinders, lithographers, cigarmakers, brushmakers, stone-polishers 40-50, millers 10, coal workers 1 per cent.

Pneumonia may culminate in pulmonary consumption: but on the whole this rarely happens. Much oftener it is the case with Pleurisy. But it is assumed and rightly, that most people who are attacked by pleurisy, are already consumptive.

A hemorrhage of the lungs may nearly always be considered a sure sign that consumption has taken hold of the respective individual; but such a hemorrhage certainly forms considerable danger to falling a victim to tuberculosis, if the individual is as yet free from the same.

Age has a particularly decided influence on the origin of consumption; it is extremely rare before the third or fourth year, from that to the seventh it is more frequent; it most frequently occurs in the age from the fifteenth to the thirtieth year, and from there on the chances are again fewer. In very old age it is again very rare.

There seems to be no essential difference as regards sex.

_Insufficient_ or _defective nourishment_ acts as a promoter in various ways. Even the nourishing of infants with poor milk, with bread or flour-pap increases the disposition to pulmonary consumption. If this defective nourishment is continued, scrofula will surely follow and this is a stage antecedent to consumption.

Pulmonary consumption is relatively more frequent among the _poorer_ than the _well to do people_, this is partly due to the meagre and scanty food of the poorer, and that they are obliged to subsist almost exclusively on vegetable diet. The higher the meat prices rise and the less the majority of the people can afford to procure meat, the larger will be the number of consumptives. The poorly nourished offer a good soil for the tubercle bacilli in consequence of their weakness. The tissue offers little or no resistance to the growth of the bacilli, these propagate and destroy the powerless and yielding organism with fearful rapidity.

The _frequency_ of pulmonary consumption increases with the _size of the cities_, or, which is the same, with the number of proletarians. Extreme hunger and want are less frequent in the country than in the city.

That the climate has an important influence on the appearance of pulmonary consumption has long been known. In certain elevated regions this disease seldom or never appears. This experience has been attained in Switzerland and many other mountain regions. Furthermore the Plateaux of Peru and Mexico are considered free from consumption, but also lowlands like Iceland, the Kirgheez steppes and the interior of Egypt are known to be exempt.

_Damp and windy climate_, especially with very high temperature, or abrupt changes in the temperature promotes consumption; on the other hand it is less frequent in the more moderated climates, especially if they are dry.

Now when the tubercle bacilli have settled in the lungs, they cause various symptoms. One of the most frequent is _cough_. In the beginning of the disease a short, clear but light, very often dry cough appears. During the further development of pulmonary consumption the cough becomes more periodic; it appears early after awaking, in the afternoon after dinner, and evenings at lying down; it may disappear entirely in the meantime or may be light only; but then as a rule it is no longer dry, but may be attended by expectorations of a varied nature.

The tubercle bacilli destroy the lung tissue and change it into pus, which is coughed out. In this way larger and smaller cavities are formed in the lungs; finally the cavities may even take more space than the remaining lung tissue. When cavities have already been formed, coughing comes easy and with abundant expectoration. Toward the end of life the coughing and spitting stops as a result of the extreme feebleness and weakness.

The violence and frequency of the cough depends mainly whether the larger bronchial tubes and the trachea are affected; the more this is the case, the more violent the inclination to cough. Further the strength of the cough depends on the excitability of the patient; the greater this is, the more as a rule will he cough. Sometimes the position of the patient is of influence; if he lies mostly on the diseased side the expectoration becomes more difficult and coughing increases.

Coughing is generally that symptom which soonest attracts the attention of the patient and his surroundings. For that very reason consumption is in its beginning stages easily confounded with such other diseases as are also accompanied by cough.

At the same time we know of exceptional cases where cough was entirely absent in the first stages of the disease, or was at least so slight that it was overlooked, and under such conditions the pale and poor appearance and reduced strength is mistaken for chlorosis or some other anaemic affection, also the existing febrile excitements are wrongly judged, or on account of lack of appetite or light derangements of the stomach a stomachic affection is surmised, until suddenly a hemorrhage of the lungs clearly defines the true nature of the ailment.

On the other hand the cough may become so violent that vomiting is caused at the same time. Nevertheless many consumptives describe their cough as very unimportant on account of their innate sorrowless nature, and they will not even be discouraged by the gravest symptoms. Often however it is fear that induces the patients to make light of their coughing, their spitting blood, their losing flesh and to place but little importance on these circumstances. A _hoarse_ cough is a sure sign of a diseased _larynx_.

Many consumptives complain of cutting pains between the shoulderblades, under the clavicles or in the side; but these are rarely intense and are often entirely wanting. Unfortunately it is unknown to the average layman that the internal organs may suffer extensive tearing down without an indication of pain.

The _Expectoration_ of consumptives which is thrown out by coughing with great exertion, is but scant in the beginning, as a rule phlegmy, glassy transparent and sticky. It is one of the suspicious symptoms of developing pulmonary consumption if this lasts for any greater length of time. Sometimes sharply defined, yellowish stripes, at times branching, appear in the same. Later on the expectoration becomes more purulent, and of greenish-yellow or greenish-gray color.

Still later the patients throw out rounded lumps of greenish yellow or yellowish green color, which flatten out like a coin in the spittoon. They sink in water which is a sign of forboding evil.

_Blood_ appears in different quantities in the sputum of consumptives. Bloody streaks are of no importance; they may appear with every violent cough. On the other hand the casting out of _pure blood_ is indeed serious.