tissue; it has no effect on dead tissue, as, for instance, necrotic cheesy masses, necrotic bones, etc., nor has it any effect on tissue made necrotic by the remedy itself."
In dead tubercular tissue living tubercle bacilli are often found. If the organisms so situated do not escape in some way from the body, they may find a nest for themselves there, and so set up fresh centers of tubercular disease. This fact clearly indicates that the treatment of tuberculosis by this new remedy must be continued for some time. From what is now known, it seems likely that about six weeks will be required to rid patients in the early stage of consumption of the symptoms of their disease. Whether this does or does not mean the complete cure of the disease is at present a question which will be answered conclusively by patients treated in hospital wards. It is in the highest degree probable, as every bacteriologist will understand, that relapses will occur. They must be treated on the principles already laid down by Koch, and their importance as a factor in the ending of the case must be worked out in public hospital practice. This I can say concerning the success which attends the use of this remedy in tuberculosis. I have never seen in a considerable series of cases treated by any remedy such uniformly good results, nor results so favorable to the patients. I do not, in what I have just said, include cases of advanced lung tubercle. Of that class of patients I have seen too few treated in the new way to entitle me to speak of them from my own knowledge. What we have heard and read of such cases in connection with this treatment leads us to expect at most temporary amelioration of their condition. Attention can not be too forcibly drawn to what Koch says, in his paper of November 14th, concerning the grave responsibility which will in future rest upon medical men, who leave any means untried to diagnose tubercular disease in its earliest stages. To that end the examination of the sputum ought, he says, to be much more frequently practiced than it is to-day in Germany. Speaking from an experience in that direction which is not small, I venture to say that this remark of Koch's applies with at least quite as much truth to England as to Germany. Now that we have the means, in this new remedy, of holding out to our patients who are in the early stages of tuberculosis—whatever form the disease may assume—the highest probability of a cure of their condition, it will, in my opinion, be a very grave reproach to any medical man who neglects to make an early diagnosis of tuberculosis, and, having done so, postpones needlessly the systematic use in those cases of Koch's remedy.
Koch has said that the action of his remedy consists in the destruction of living tubercular tissue. The destroyed tissue must be thrown off or absorbed. We might, perhaps, feel un-