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the Medical Congress, of the results of his investigations aito the cure of tuberculosis, gave little idea of the extent o:

his expeiiments in that direction. He did not make itdistinctly understood that animals may be made refractoryto tubercle by treatment with his liquid before they hav(been inoculated with tubercle. There is reason to believethat this is the case. He did state in tffect, at the Congress,that animals infected with tubercle had been cured. Witbhis habitual caution he did not use the word "cure," theexpression used by him being, "At last I have found sub.stances which are capable of checking this growth, not onlyin the test-tube, but also in the animal."Professors Fraenzel and Runkwitz, who have been engaged

in experiments with Koch’s lymph, and have inoculatedmany patients since September last, have published some oftheir results. They have found that in healthy persons asmall injection produces no reaction whatever. In fourcases of advanced phthisis, however, they found that thetemperature rose to 39° C. (102.2° F.) ; but they do notconsider that the progress of the disease was materiallychecked by the inoculations. In the necropsies of two caesin which the inoculated patients succumbed to phthisis thelungs presented no signs of healing. From investigation ofeight cases in which the disease was less advanced theProfessors noted that the number of bacilli was markedlydiminished after inoculation; sometimes indeed they com-pletely disappeared. Their conformation was also found to bechanged as a result of the inoculation, many of thembecoming shorter and thinner, others presenting a dumb-bellappearance. Thefeverand nightsweatsof phthisis ceased,and the cough became greatly reduced. There was also amarked improvement in the appetite and in body weight.These observers are of opinion that the debilitated bacillimay ultimately revive and reinfect the tissues. Regarding thesafety of the operation, Dr. Levy reports a case in which onepatient remained unconscious forthirty-sixhours afterinocu-lation. Professors Koehler and Westpbal announce as theresult of their observation that non-tuberculous patientsafter inoculation suffer from headache and sleeplessness,the temperature sometimes rising to 38’6" C., accompaniedwith marked pain in the limbs and loss of appetite. Non-tuberculous wounds and cicatrices, on the other hand, remainunaffected. Many cases of phthisis have undoubtedly im-proved under this treatment.

To the Editors of THE LANCET.SIRS,-Professor Koch has requested us to demonstrate

in London his method of treatment of tuberculosis, and hassupplied us with a small quantity of fluid for this purpose.Due notice will be given of the time and place of thedemonstration. We may state that as the amount of fluidat present available is very small, Professor Koch has onlybeen able to supply us with a quantity suflicient for thepurposes of this demonstration.

We are, Sirs, yours trulv,G. A. HEROX.

Berlin, Nov. 17th, 1890. ____ W.WATSON CHEYNE.

To the Editors of THE LANCET.SIRS,-Mr. Heinemann informs me that a London medical

journal has published a translation of Dr. Koch’s report onhis discovery of the cure of consumption, and it seemsthat this has also been copied by some of the daily journals.At his request I send you this note, which I hope you willpublish, to say that he will issue the only authorisedversion of Dr. Koch’s report, for which he has for sometime past made arrangements with me.

I am, Sirs, yours obediently,GEORG TIIIEMF,

Publisher of the " Deutschen Medicinischen Wochensehrift."Leipzig, Nov. 17th, 1890.

G. A. HERON.

W. WATSON CHEYNE.

GEORG THIEME,Publisher of the "Deutschen Medicinischen Wochenschrift."

DEMONSTRATION OF CASES TREATED BYKOCH’S ANTI-TUBERCULAR LIQUID.

BY PROF. VON BERGMANN, BERLIN.

(FROM OUR SPECIAL COMMISSIONER )

ON Sunday evening last Professor von Bergmann de-livered in the lecture theatre at the Clinical Hospital inBerlin a lecture on this subject. The lecture naturallycreated great curiosity and excitement on the part of allwho knew of it. Professor von Bergmann has been using

I the liquid for some weekf, but not so long as some members’ of the stafl’ of the Charité Hospital. Some of the most emi-inent medical men in (Germany were present, among them

von Ziemesen (Munict)), Eberth (Halle), Helferlich (Greifs-wald), Professor Bramann (Halle), Geh. Rath Hahn; Geb.Ilath Olshausen (Berlin), Thiersch (Leipzig), Israel (Berlin),Oberstalsarzt Kohler, and others. Dr. Hime of Bradfordand Mr. Malcolm Morris, Dr. lladeliffe Crocker, Dr. G.Heron, and Mr. Watson Cheyne of London, were alsopresent. Kultns Minister von Uossler, who has taken a,

great interest in the whole matter, and has frequent inter-views with Koch, also attended the lecture.

In a few introductory remarks the lecturer said theywould all regret the absence of the great man to whom allthe credit was due, but it was quite in accordance with hisretiring nature not to wish to be present when his namewould be so frequently mentioned. In the course of thelecture over forty patients were exhibited, most of whomwere wheeled into the theatre in beds. Among them wasthe English patient Edgar Neal. The patients were suffering,or had previously been suffering, but were now regarded aspractically cured, from various forms of tuberculosis affectingthe skin (lupus), glands, joints, bones, lymphatics and in-ternal organs. The operator was Dr. Pfiilil, who, being anarmy surgeon, was present in uniform. It was mentionedalso by the lecturer with great satisfaction that Minister vonGossler had exerted himself to secure to Germany the firstfruits of Koch’s great work, and that the liquid should befirst used in the Fatherland. No less than thirteen casesof lupus were exhibited. This disease was explained to beparticularly interesting as afield of observation, inasmuch asbeing an external and visible manifestation of tubercular mis-chief, the changes were more readily noticed by a spectator.Five of these cases were shown in succession, as having

received their first inoculation in the morning, and wereseen to be experiencing in various degrees the reactioncaused by the lymph. They had been inoculated with1 centigramme of a 1 per cent. solution of the mother liquid,The most striking of the early after-effects of the inocula-

tion was the almost invariable occurrenceof fever of aregular,typical character, accompanied by rigors. One patient,whose temperature at 8 A.M. (before the inoculation) was36.2°C. (97 2°F.), had at 8 P.M. a temperature of 38.6°C.( 101.5° F). ). Vomiting also was one of the characteristic-phenomena of this reactive fever. In all cases in whichtuberculous disease is present this reaction occurs after theinjection of Koch’s fluid.The first case shown was lupus of the face, affecting the

right side uf the nose and the cheek. In the morning, priorto the inoculation, the face was pale and not swollen, butwhen exhibited there was considerable redness, easilyapparent around the nose, extending beyond the right side,.and involving a great portion of the left side of the cheek.

In the second instance, a boy of fourteen was shownsuffering from ulceiating lupus of the nose, affecting theleft ala (which was considerably destroyed), the nasalseptum, and the right ala to a less extent. There was no

swelling or redness in the morning. At 8 P.M. the patientwas seen to be suffering from very severe reaction, histemperature bavirg during twelve hours risen from 36.5°C.(97-7°F.) to 41° C. (105.8° F.) at 8 o’clock in the even-ing. It was characteristic that in young cases the reactionw as most severe. This boy had severe rigors as the reactionbecame established. It was noteworthy that not only didthe nose and face, the visibly affected parts, activelyparticipate in the reaction, but a bright redness of the skinunder the chin seemed to indicate to all present thetubercular implication of several of the sub-mental glands.The lips, cheeks, and lower eyelids were much swoller.The third case was that of a young man, twenty years

of age, suffering from superficial lupus of the face of longduration. His face was red and swollen from the reaction.A spot which had cicatrised showed no tubercular reactionto the injected iluid. This patient’s temperature displayeda steady ascent from early morning, when it was 36.4°C.,until, at 8 o’clock in the evening, it was 412° C. Thetemperature was taken every two hours ; the above areobservations made at selected hours. Commencing theinoculation of the patient with the low temperature namedabove in the morning, rigors were observed to occur, andthe temperature rose to 36 -8° C. The highest point, 41.2° C.(106.2° F.), being reached in twelve hours, showed whattremendous changes may occur in that space of time.The next case was that of a woman with superficial lupus

of the right forearm, involving nearly the whole of its cir-

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cumference. It exhibited the peculiar white zone surround-ing the affected part always present in cases of markedreaction.The fifth case came from London. The patient was a

young man twenty-two years of age, and suffering fromlupus of the nose and palate, which exhibited very charac-teristic appearances. He, like the preceding cases, had beeninoculated for the first time in the morning, and like themhe exhibited severe symptoms of reaction. His tempera-ture in the morning, before inoculation, was 3G ’70 0.; inthe early afternoon it rose to 38.1° C.; and in the eveningit rose to 40.2°C. (104°F.). On the next day (Monday)the patient was already recovering from the attack offever. His temperature had fallen to 37.6° C. (99-7° F.),nearly five degrees, and he was feeling quite free frommalaise and taking food well. He expressed himself asvery happy, and grateful for the way he had been treated.In whatever part of the body tubercular matter had beendeposited there were exhibited symptoms of inflammation.This must, no doubt, be taken with the reservation that itrefers to living tissue thus affected.The next case was that of a child suffering from lupus of

right cheek of eleven years’ standing. Both knee-jointswere also affected with tubercle, and there were some spotsof disease on the legs also. This child was inoculatedbefore the assembled medical men by Dr. Pfuhl.A child of thirteen was next shown, which had been

suffering for three years from lupus of the nose, a large partof the left side being already destroyed, and the disease hadbecome very extensive. This child was inoculated withonly one-half the full dose.The next case was a poor, wretched-looking, deformed

lad, eighteen years old, and who for fifteen years hadbeen suffering from tuberculosis of various parts. He hadhad abscesses opened in many places, and for several yearshad been under Professor Volkmann at Halle for the surgicaltreatment of his various manifestations of tuberculosis. Hewas inoculated with Koch’s liquid for distinct facial lupus,and at the same time for pulmonary tuberculosis.A young woman of twenty-three followed, with tuber-

cular disease of left ala of nose, left angle of mouth, and aspot on her right cheek. The action of the inoculatedliquid would quickly show whether the latter were tuber-cular or not, because the specific local reaction wouldbe established only in the event of its being of a tubercularnature. The patient was inoculated in the back, in thesame way as the former cases, in the presence of the medicalmen.

Another young woman of twenty-three was the nextpatient. She had been suffering for six years from lupus invarious parts about the face, particularly under the rightear.

The eleventh case was a patient aged twenty-eight,who had suffered for four years, and had already receivedfive injections. During the reaction following the firstinoculation his temperature had run up from 37°C. to 40°C.The first inoculation took place on Nov. 7. On Nov. llthhis temperature was 38’4°, and on the 12th it was 39°C.; sothat the reaction was not equal to what it had been. Hewas inoculated before the audience. According to the

recommendation the inoculations were to be continued fromtime to time, until they caused no reaction. The patienthad the whole of his nose affected by lupus and bothcheeks, a large number of nodules being perceptible in both.Already the skin, since the scales had fallen off, was foundsoft and more normal in texture. After the first inocula-tion the patient’s face and lips were greatly swollen, butthis was much less marked after the subsequent inocula-tions.The demonstrator said that attention should be specially

directed to the remarkable fact that the local reactive phe-nomena were manifested, as redness, swelling, &c., afterinoculation in places which did not present any appearanceof disease before inoculation. These local symptoms are tobe taken as proof of the reacting parts being infected bytubercle, although they did not appear so to the eye, norsuggest their being diseased when palpated.The next case, that of a young man, was a very interest-

ing one, and had been under treatment for some time. Itwas a case of tuberculosis of the palate. The familiar ap-pearance of disease had vanished, and the palate was nowclean, soft, and well skimmed over, and without one of theulcers which were previously present. After the first inocu-lation this patient exhibited marked reaction. After mall

- inoculation the temperature rose to 40° C.; after the second. and third inoculation the reaction grew less and less ; and

after the third, when he received a double quantity, the rise, was only from 37-1° to 37-7° (or by 1-06° F.). ).

The next case was a girl, who was inoculated on Nov. 6th,and showed considerable reaction. She had not been inocu-latpd since.The case of the woman who followed was one of very

pronounced lupus, and presented several important points.Her treatment had begun some little time ago. She hadlupus of the face, and after inoculation she showed markedreaction, her face, lips, and ears swelled considerably, her-eyes becoming invisible. Many distinct nodules were pre-sent also. These were now mostly all gone. Crusts and.scabs had formed over the reacting parts, which had fallen.off and showed vast improvement in the affected parts. Thepatient was a washerwoman, and in the performance of herwork had burned herself on her right wrist, a cicatrixexisting at the site of the injury. After she had beeninoculated for the facial disease, this part became red andswollen, a proof that it was affected with tubercle. Pain in.the course of the left flexor longus pollicis set in, as wellas in one knee, from which it is to be concluded that theseparts too were affected with tubercular disease, though upto the time of inoculation this fact was not suspected. Onthe other hand, it should be borne in mind that cica-tricial tissue, formed at the site of a tubercular ulcer, mayshow no reaction whatever after inoculation, indicatingthus its freedom from tubercular disease, according tothe theory expounded by Koch and the lecturer. Dr.von Bergmann next drew attention to what might be-called control experiments in the inoculation of the liquid imhealthy persons. These showed no reaction to small doses.As a typical case he mentioned that a strong, stout mansuffering from a growth in the left cheek had consulted manysurgeons, who differed in opinion as to its exact character.It was supposed to be carcinoma by most of those who.faw it. Koch and Pfiihl had inoculated the patient withthe anti-tubercular liquid, with the result that the specificreaction occurred with rise of temperature to over 40’C., since-which the patient had improved, and he was now free from.fever. The local redness resulting from the inoculation isvery similar to what Fehleisen has described after the in--oculation of erysipelas in parts affected with lupus. Twozones are to be seen clearly marked around the affectedpart-an interior whitish ring round the nodules, andoutside this a red area. Once the lecturer had a case whichpresented the remarkable phenomena of showing no febrilereaction to assist the doubtful diagnosis.As the first set of cases were confined mainly to lupus.

a second set exhibited consisted of three cases of tubercularaffection of lymphatic glands of the neck.A girl with characteristic scrofulous appearance, and a-

mass of enlarged glands of the neck, under left ear, wasinoculated with one centigram of the usual dilution of the-mother liquid. Her temperature rose from 37’i° to 40-0°,and she had rigOJ s and vomiting.A little girl with similar affection and Mepba.r-adeniti&.

was inoculated before the audience.The next patient had received five inoculations since:

Nov. 6th. She had less and less reaction after each.This patient exhibited very remarkable phenomena of a>

papalous roseolar exanthem over the shoulders after-inoculation.Eighteen cases of tubercular disease of the joints and

bones were also exhibited, mostly affecting the hip, knee, andankle. Some of these had already received several inocualations. Besides the general reaction common to all casesafter inoculation with Koch’s liquid, these cases showed,after several inoculations, diminution of swelling and pain.and increased mobility. One child with inflammatoryinfection of the knee-joint exhibited no reaction afterinoculation. The conclusion to be drawn was that,.assuming old tubercular deposit to have existed, it must.have become encapsuled and lost its virulence. In this.case he had not been content with the inoculation alone,but as specific reaction had not occurred, he had resortedto the usual surgical procedure and cut down and removedthe diseased tissues.Next were exhibited four cases of laryngeal tuberculosis,

one of which had been several times inoculated. During the.treatment of this case a tumour beneath the vocal cords.became neurotic and was coughed up. When microscopicallyexamined nt cells were found. The lecturer dwelt om

1122

the value of Koch’s inoculation for differential diagnosisof carcinoma and tuberculosis of larynx, which are often sodifficult to distinguish. In the case of a child with coxitis,accompn,nied by an abscess of long-standing, inoculation offour mrlligranrrnes had been used. After the exhibition ofthis immense number of patients, which occupied about anhour and a half, the lecturer concluded by asking the meetingto express by acclamation its interest in what they hadwitnessed, and their congratulations to Koch for his dis-covery. This was most cordially done. It may be mentioneden passant that on mention of Koch’s name during thelecture, an occasion which an English audience wouldhave taken the opportunity to applaud, the Germanaudience showed no demonstration whatever, not fromwant of enthusiastic admiration of their distinguishedcountryman, but owing to difference of custom.

THE ITALIAN MEDICAL ASSOCIATION.(Concluded from page 991.)

THE sitting of Oct. 21st opened with Professor E. deRenzi’s report on the Pathology cf the Blood, which sum-marised the researches hitherto made on the influence

exerted, chiefly in infective maladies, by the physico-chemical conditions of the circulation. He dwelt at con-siderable length on the antiseptic and bactericide action ofthe blood, illustrating his views with experiments of hisown. He showed with much fulness of detail how importantfor diagnosis in the present and also in the future bacterio-aogical examination of the blood must be, enlarging chieflyon the eplendid results obtained by such examination inmalaria. Therapeutics, moreover, cannot fail to profit bysuch researches, in proof of which he cited the intra-venousinjection of quinine proposed by Baccelli, as forming abrilliant prelude to their practical application.He was followed by Professor illaragliario, who began by

describing the want of certainty in our knowledge of theblood. He then gave a vivid sketch of the life and functionsof the " red globule," indicating its relations with thehaematopoutic organs, whether in normal or in pathologicalconditions, and concluded this section of his paper bydwelling on the anatomical alterations of the globules.Under this head he illustrated certain special alterations,partial or total, of the globules, the alterations consistingin contractile or amoeboid movements. He next pro-ceeded to describe the different chemical reactions of thered globule when in its normal state, or when endowedwith contractility. From this exposition he passed tocertain features - anatomico-pathological and semeio- logical-in relation to diseases of the biocd, particularly tomalaria. Having set forth the result of some experimentson the action ot the serum, normal and pathological, onthe "haematise," he concluded by hazarding the hypothesishat the various kinds of anaemia have as their cameabnormal conditions of the sanguineous serum.The paper was a very elaborate one, and listened to with

great attention, the more critical of the audience reservingtheir remarks on it till they could examine it carefully inits printed form.The discushion which followed took account of minor ques-

tions arising out of Professor Maragliano’s paper, ProfessorFeletti indicating a method of colouration by which hecould distinguish the malarial parasites from the degenera-tive forms of the blood ; while Professor Lucatello illus-trated the microbicide power of the sanguineous serum, andclaimed priority for his own researches and conclusions asto the activity of the serum in cases of disease.-Professorsde Renzi and Maragliano having replied to such objectionsas had been made to their positions, the Association rp-assembled in the afternoon to hear Professor Marchiafava’s" Observations on Pernicious Fever," particularly when theparasite 11 sporulates itself’ (si sporula) rapidly in the organs nd not in the circulation. Among the forms ot "perniciosa "

accompanied by symptoms attributable to the centralnervous system, special importance is claimed by thevarieties of bulbar paralyais. He had conducted investiga-tions on a case of the " bulbar pernicioqa type which hadterminated fatally at the Santo Spirito Hospital. In thebulb he found many plasmodi, in segmentation, in thelichly byperasmic capillary network of the nuclei of the

hypoglossal and facial nerves, with disturbance of the cir-culation and necrosis of the netvine elements.

Professor Feletti then explained a new method of his forcolouring preparations of fresh blood, but ProfessorMaragliano held that the method in question was not

capable of being so applied. Dr. Gualdi, moreover,maintained that the method could not yield resultssuperior to those obtainable by the Celli-Guarnieri method.If fresh blood had to be coloured, one would require tocolour it in the bloodvessels-a process unattainable on thehuman body. Otherwise, he believed it necessary to fixthe preparations of blood with alcohol and ether, accordingto Nikikoroff, and then to colour them with eosin and bluemethylene.

Several interesting papers followed on malaria, particu-larly that of Dr. Dionisi on the numerical changes of thered and white globules in connexion with the malarialparasite ; and after Dr. Federici’s observations, tending toshow that clysters of blood serum augment the globularrichness of the blood, while clysters of blood itself augmentthe colouring matter of the blood, nothing of special noteoccurred, till the sitting was concluded for the day.On the 22nd the most difficult of the three subjects pre.

scribed for discussion by the Association-the various kindsof polyneuritis-was taken in hand by its "relatore"(reporter), Professor Crocco, Dr. Baccelli presiding. Pro-fessor Grocco began with a history of polyneuritis, treatingof its varieties and their classification. Entering into theirpathogenesis, he described its first beginnings, its course,and the complications with which it was beset; and then hegave a set of indications as a basis of diagnosis. He dis-cussed the relapses to which spontaneous polyneuritis wasliable ; then the multiple forms of neuritis, disseminatedand s3 stematised; and next went into their pathology.He concluded an able and elaborate paper by remarkingthat the study of the varieties of polyneuritis will con.

stitute at no distant date a special chapter in the patho-logv of the nervous system.Next came his coadjutor, Professor Rummo’s, share of

the report. He reduced all the varieties of polyneuritis toone single etiological factor. All these varieties, he said,are toxic, although the quality and the source of the toxicproducts are diverse-mineral poisons, poisons of animalorigin, such as the albuminous poisons &c. To demonstratethis position he adduced a series of arguments drawn frompathological anatomy, from experimental physio-pathology,from the uniformity of the symptoms in the different formsof polyneuritis, and from the indications which, in certaintypes, explain certain peculiar symptoms.The paper was an abstruse one, and its discussion was

prolonged into the afternoon sitting, the critics being Drs.Uiuffré, Sonnino, Di Pietra, and Bruni; but evidently theaudience was not prepared for more than desultory skirmish-ing, a more formidable attack on its positions being reservedfor the publication of the report.

Professor Queirolo read an interesting communication onDiapboresis in the Cure of Infective Fevers," in which headduced experiments of his own to prove that in acutemaladies there is an elimination of toxic matters by meansof the perspiration. He was thereupon asked by ProfessorRummo to consider whether the improvement succeedingsuch perspiration should not rather be attributed to thesubtraction of heat. Dr. Farina., of the Army Medical Staff,however, reinforced Dr. Queirolo’s position by his clinicalexperience in Africa, while Professor Rossoni desideratedstill further clinical observations in support of Dr. Queirolo’sview.An able memoir of Professor Luzzatto on the various

modes of accounting for vascular riles can only be referredto here, as lending peculiar interest to the forthcomingofficial report of the proceedings, an observation whichmust also be extended to Professor Masini’s "Cure ofPhthisis Pulmonalis with Injections of Creasoted Oil, vil’athe larynx, into the trachea and bronchi." An instrumentof his own invention ad hoc added greatly to the interest ofhis paper.On the 23rd the forenoon sitting was exclusively occupied

by the members of the Association in discussing its busi-ness matters, and arranging the programme for its fourthmeeting in 1891.

In the afternoon a number of subsidiary communications were read and criticised, some of them important enoughto occupy considerable space in the forthcoming report ofthe proceedings, and finally Dr. Guido Baccelli, the pre-