AN INTERVIEW WITH DR. LOMAX SMITH.

Press, Volume XLVIII, Issue 7870, 22 May 1891, Page 6

AN INTERVIEW WITH DR. LOMAX SMITH.

(by our special reporter.)

A good deal of correspondence has taken place recently with regard to the Koch cure for consumption, and as Dr. Lomax Smith and Dr. Prins were the first medical men here to introduce the lymph into Cantermember of our staff had an interview yesterday with the former gentleman. The points upon which information was sought to be gained were—(l) The nature of the lymph; (2) its action upon the patient; (3) the present aspect of the question.

Dr. Lomax Smith, on being waited upon, intimated his willingness, so for as he could, to give the information sought for, and accordingly the three heads given above were submitted for his opinion. " Before saying anything on the subject," said he," I should like to preface my answers to the questions you have submitted to mc by the statement that I can speak with the weight of no special authority, and confess to no more knowledge of this mode of treatment than any one else who has had equal opportunities of following the literature of the subject. At the same time I think it is of great importance that the,question should not be prejudged or that any obstruction should be thrown in the way of a fair and impartial trial of the issues raised. The truth of the matter can only be arrived at after a long and patient investigation of all the facts and by a carefully collected and selected series of experiments. These experiments are now being tried on a large scale with varying results in Europe, and it remains for us to see whether the same or different results are obtainable here. Having said so much by way of preface, I will now proceed to answer your first question, viz., as to the

NATURE OF THE LYMPH.

To understand the nature of the lymph it is necessary to state that the leading feature of all tuberculous processes is the presence of the tubercle bacillus. This organism, which is the invariable concomitant, and in all probability the cause of tubercular disease, whether in the lungs or elsewhere, is a minute protoplasmic body, measuring about one-thousandth of an inch. This little mass of protoplasm has the power of indefinitely propagating itself in congenial surroundings, and is the cause of all those varying symptoms which are met with in the group of tubercular affections. The lymph of Dr. Koch, which he has only lately presented to the world after a series of most beautiful t and delicate experiments, extending over j ten years, is what is called a cultivation in glycerine of the tubercle bacilli, together with several other albuminoid extractives. i The action of this lymph by an inflammatory I process is to destroy the diseased tissues in ' which the bacillus at once finds food and lodging. The bacillus itself is not killed, I but his dwelling is, so to speak, burnt up I over his head, leaving him entangled in the debris. When the tubercular disease is situated on the surface, as in lupus, j what happens is that the whole of the dead tissue is cast off in a slough, leaving the part beneath practically healthy, or in a much more favorable Condition for healing. i When, as happens in diseases of the lungs, the tissue affected is not on the surface, it is ' necessary, for the complete success of the treatment, that it should by removed by expectoration or otherwise rendered inert. | The " re-action," which is such a prominent feature of the injection, is the technical term for the fever which accompanies the inflammatory process set up by the lymph. This i fever sometimes ranges as high as 105 F., but generally subsides within twenty-four hours. Here, perhaps ob a result of the wonderful purity of the atmosphere, | i we have not had such marked reactions, and this in itself is interesting. As a proof of the extremely powerful agency at work, I may mention that an ordinary dose of one milligramme contains only a millionth part of the undiluted fluid. The J lymph as sold consists of the thou- | sandth dilution of the pure extract. The patient is treated with the same dose so long as he has any re-action at aIL Larger doses are then gradually administered until a certain point is reached, when, if no further reaction takes place, the pateint is for all practical purposes either cured or susceptible of no further treatment by the lymph. What I have said under this head answers your questions Nos. 1 and 2. RESULT OF CASES. You now ask mc what is my opinion of j the action recently taken by the Medical Society of Christchurch, which has created some amount of discussion. Well, I do not think it is becoming for mc, not being a member, to express an opinion on that point. If they thought that the public was in any danger of being misled on the subject they were fully justified in "putting the whole weight of their authority" into a timely word of warning. But as my partner and myself are the only, medical men in Canterbury who have used the lymph, I think I need hardly say that we have never attempted to mystify the public or to raise false hopes in the minds of any patients who have subjected themselves to the treatment. On the contrary we have been at great pains to point out how the case ties. We -have stated, of which there is incontrovertible proof, that whilst very many cases have been greatly benefitted by the treatment and a few have been accounted cured, many others have been unimproved and some have even been made worse. We have then let the patient decide for himself, and I can assure you that when a man is suffering from what he knows to be an incurable disease he is not human if he does not often grasp at what may make him a great deal better, even though he runs the risk of being made somewhat worse. Speaking of the treatment of cases by this method, here is an abstract of a report of over 1700 cases treated in Germany—cases in all stages of tuberculosis. Of these cases 28 are reported cured, 319 very much improved, 431 imsroved,5 roved, 884 unimproved, whilst 55 have ied. Thus you see 778 cases stand to the credit side of the treatment, 884 are left as they were, whilst 56 only are found on the debit side of the list. I think you will agree that in the case of a disease previously held to be beyond the reach of any drug, these figures speak for themselves. Further than this the List undoubtedly includes many cases that should never have been operated upon at all, and which now with our improved knowledge of the action of the lymph would have Deen rigidly left alone. Most of the deaths, as the reports before you show, occurred in cases of such an advanced stage of the disease that they would have ended fatally in a few weeks or months. You will thus be able to see how far the statement authorised by the Medical Society here that the "treatment had proved a lamentable failure hitherto " is correct. The record of the cases I have shown you is contained in the official report of Koch's treatment in Prussia. No doubt the greatest difficulty has been in the proper selection of cases, and you will understand that naturally enough so eager have patients been to try the new "cure" that doctors have often been persuaded, even in desperate cases, to operate against their better judgment. But given a fit case, I should have no hesitation whatever in recommending a trial of the lymph. REPORTED DANGER OF THE LYMPH. You ask mc whether it is so, as stated by a medical gentleman in a letter, that the operation with the lymph may be followed by the " propagation of colonies of tubercle bacilli in the body " ? Well, I would refer you to the facta elicited by Professor Virchow, the great pathologist, from a study of post-mortem cases treated by Koch's method. The discovery, which is of great interest, practically amounts to this, that where the dead tissue acted upon by the lymph cannot be got rid of, there is a danger of its infecting other parts of the body. The tubercle bacillus itself, as I have said, is not killed by the lymph, but only the neighboring tissues in which it Lives and upon which it feeds. Should these patches of dead tissue containing living bacilli be removed to other parts of the body (as from one part of the lung to another by air suction in breathing), there is a danger of the bacilli spreading afresh. But this, from the nature of the case, can only happen in advanced stages of consumption when cavities have been formed and

these cases, as Koch has pointed out- from the first, are quite unsuitable for treatment. This very interesting fact, discovered by Virchow, only emphasises the great need of caution in selecting proper cases. Where the dead tissue can be thrown off, the bacilli are of course thrown off with it; but in other instances where from the situation of the disease this tissue cannot be so disposed of, it is the contention of Koch that the subject is left in a much better condition for the destruction of the bacilli by means of their natural enemies, the. socalled "phagocyte" cells of tho human economy. These wonderful cells, as has bean well said, act the part of physiological police, and possess in health the powsr of destroying those countless noxious organisms and germs which are for ever entering our bodies. There is another fact to which I should like to call attention, and that is that the lymph has other than therapeutical and curative aspects. It is an agent of great and almost infallible diagnostic powers. While a non-tuberculous person is not affected by a large dose, the minutest particle of tubercle present in the subject operated on, so small as to be undetectable by any other means, is at once exposed by the inquisitorial lymph, and made to " stand and deliver." To Koch's axiom--" no reaction, no tubercle"—there has so far, I believe, been no exception. It is obvious to the most ordinary mind how important is this function of the lymph when it is recollected that by simply changing the climatic surroundings of a patient in the very early stage of the disease a complete cure has often been effected.

CONCLUSION.

In conclusion I may say that the lymph is still upon its trial, and will be for many months, perhaps years, to come. Under these circumstances it is of the greatest importance that its mode of action in various parts of the globe should be accurately ascertained, and I cannot help thinking that the difference of climate may have an important effect on the results of treatment. So wonderfully aseptic is the climate of Canterbury, as is shown by the remarkably good results of operations performed in Christchurch, that I am of opinion that the use of the lymph here may be attended by more favorable results than is the case in the germridden atmospheres of Europe. What we require to elucidate the facts are arguments and not strings of names, however eminent the owners of them may be, and it must be remembered that there are as eminent names to be quoted in favor of Koch's treatment as there are against it.