Popular Science Monthly/Volume 38/April 1891/Editor's Table
THE very great importance of the subject of the cure of consumption, the enormous extent of the malady and its great fatality, would naturally be the means of attracting universal attention to any remedy which was supposed to possess curative powers over it. To one who is familiar with the writings of Koch on this subject it need not be said that he is not properly to be held responsible for the exaggerated ideas which have been received of the efficacy of the new agent; nor, indeed, are any of the numerous scientific men who have carefully observed its effects in different countries. But many visionary persons in the medical profession, and many not in it, became imbued early with the impression that there had at last been found a means of working miracles. Moreover, a few designing and unscrupulous doctors intentionally aided, to a slight extent, in the propagation of this idea; but probably the most generally operative cause of the exaggerated notions that have obtained with regard to the potency of the new remedy lies in the popular inclination toward a belief in the supernatural. People who wish to be deceived often begin by unintentionally endeavoring to deceive themselves.
That the public should derive an idea of the potency for good of this remedy far beyond what Koch has ever claimed for it, or what any experience with it would warrant, is not surprising—such has often been the case before with new and relatively untried remedies. Not only the public, but the doctors, are often deceived by the heralding of new cures. It is but a few years since the benzoate of soda was published by reputable physicians in high places in Austria as a means of curing consumption. Medical literature teemed with accounts of its powers for a few months, and then it sank rapidly into oblivion. A few years later there came to us from the Riviera most startling accounts of cures of consumption and various other pulmonary diseases by means of the introduction into the blood of sulphureted hydrogen dissolved in carbonic acid. These accounts were most circumstantial, and the truth of them was vouched for by several men of good standing in the medical profession. So brilliant were the results claimed that the method of treatment soon became common. Many doctors tried it in many cities, and after a fluctuating existence of a few months the Bergeon treatment, as it was called, quietly died and was decently interred among many other therapeutic procedures that had once had their day. Some years ago the world was startled by the assertion that in South America a cure for cancer had been found in the bark of a climbing plant called condurango. The sensation created by this announcement is remembered by many doctors who are still young. It was tried in that year here and in various European capitals, and was discarded as inert and useless. Condurango was then supposed to be dead as a therapeutic agent beyond all possibility of revival, when suddenly the serenity of the medical world was again rudely shocked by a publication which emanated from the Professor of Medicine in the University of Heidelberg, two years later, in which he reported the cure of a cancer of the stomach by the use of this drug. Since then evidence has accumulated to show that condurango does seem to possess a curative power in some forms of cancer of the stomach; but it is known to be inert as regards cancer elsewhere. It would be easy to adduce evidence in favor of the importance of receiving encomiums upon new and marvelous cures with the utmost caution.
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 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.
The recent prosecution of the Rev. Howard MacQueary for heresy has brought out in a striking manner the fact that the sympathies of the public in a case of this kind are, as a rule, strongly with the defendant—with the man who is striving to obtain recognition for intellectual rights as against arbitrarily imposed dogmas. We do not say that the prosecutors in such a case are to be blamed. Their motives may be, and doubtless in general are, of the purest, and their logical position may be very strong. Still, they labor under the disadvantage of administering and striving to enforce a system in which authority takes the place which, in other fields of thought, is only assigned to proved and still provable results of investigation. Long ago men were led to think and believe so and so: no otherwise must they think and believe to-day. Such is the principle that governs adhesion to theological standards—a principle that has had its uses in past times by giving stability to institutions under which the forces of society were being organized and the sympathies of men developed. Manifestly, however, this principle is becoming more and more out of harmony with the spirit of the age. Men now know that, apart from constant—not re-assertion, but—re-verification, the opinions of their ancestors are not to be depended on for guidance; and they do not see why this should not apply as much in the theological region as in any other. The creeds may be all true, and it is certainly no part of our business to say they are not; only in these days it is almost impossible for intelligent men not to hold them subject to such verification as their nature and alleged evidences admit of. Subjective impressions, we all know, are just as liable to error as objective ones; and because a man, many centuries ago, held that he had received a supernatural communication we can not feel absolutely certain—unless collateral proofs of considerable cogency are forthcoming—that he really received such a communication and was not under the influence of illusion. In saying this, our object is not in any way to weaken the hold which theological doctrines may have upon any mind, but merely to explain how it is that so much public sympathy seems to be accorded to those who seek to escape from what, to them, has become the bondage of authority. In our institutions of secular learning the putting forward of a new theory or the discarding of an old one, far from subjecting a man to forfeiture of office, gives a certain additional interest to what he has to say, and he is allowed the freest possible scope for developing his thought and his conclusions. Of course, he must run the gantlet of criticism; but this is just what a man who thinks he has discovered new truth desires. We do not blame our ecclesiastical friends for not acting at once on similar principles, for we know they can not do so, and we are very ready to believe that many of them at least, if not most of them, are doing the best they can in their several positions, and acting fully up to their lights. But none the less do we maintain that verification is the only charter on which beliefs of any kind can be properly or safely held, and that this truth must eventually be recognized in every field of thought and speculation.