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Press, Volume XLVIII, Issue 7871, 23 May 1891, Page 6

TO CSS EDITOR OF THE PRESS.

Sir,—The result of the interview with Dr. Lomax-Smith, reported in this morning's paper, forces mc to put my position onoe and for all before the public. In the first place let mc acknowledge the credit due to Drs. Prins and Lomax-Smith, as the first to obtain tuberculine, and to the latter fentleman for having so favorably stated .och's case In a few words, sir, I will state a few

salient facts about consumption and its relation to Koch's lymph :— 1. Consumption is a chronic infectious disease, probably local in its origin, which produces general illness in proportion to the extent aud severity of the local mischief. This is subject to variation, both from individual idiosyncraoy and seat of disease. 2. The disease is caused by the bacillus tuberculosis.

3. The evil effects are produced, not so much by the bacilli themselves, as by certain noxious substances produced by them. 4. The only effect immediately attributable to these Substances is death of the surrounding tissue. 5. In this dead tissue the bacilli survive with difficulty. (This is Koch's assumption; if it prove untrue, then his treatment must prove a failure.) 6. Tuberculine when injected hastens this tissue-death, thus proving inimical to the bacilli (Koch's assumption again). Now three facts about this treatment :— 1. Tuberculine does hasten this tissuedeath.

2. The bacilli are not thereby killed. 3. They are scattered broadcast in all directions.

. Those that can be expelled from the system are probably thus got rid of; the others remain to be absorbed (?) or form new foci of disease. This point is beyond scientific doubt, having been conclusively demonstrated by the greatest of pathologists, Virchow. Although Dr. Lomax-Smith passes this over so lightly, Virchow's demonstrations were in reality the most complete and solemn denunciation of this treatment. The telegram published May 12th, " Virchow declares that not a single cure is being effected by tuberculine; in all reported l cases a serious relapse followed," sufficiently emphasises this. With regard to the statistics given of 1700 cases, are we really asked to believe this . Are we seriously to understand that the cases improve, remain as they are, or die 7 Is there is no intermediate stage ? To mc the word " unimproved " is evidently used by the compiler to bracket together cases it would be inconvenient to classify more accurately. I will supply Dr. Lomax-Smith with other statistics, the truth of which he. can verify any day he cares to call on mc. They-are the record of the cases reported at the Berlin Medical Societies. Dr. Ewald, 114 cases, 7 deaths, 10 worse, the others improved subjectively but not physically. Dr. Israel, 25 cases, 2 deaths, no other details. Dr. Furbinger, 40 cases, 7 deaths, 5 worse, 10 the same, 15 better (subjectively). Dr. Frankel, 83 cases, 2 deaths, 16 wprse, 21 same, 28 better (subjectively again), 3 cured. These cases were treated only 28 days- Dr. Hensch, 20 cases all unfavorable. Dr. Lazarus, 43 cases, 5 deaths, 16 worse, 9 same, 13 better. Dr. Stucker, 56 cases, 9 (?) cures, no other details. Now, of these, I will assume that every patient who is not otherwise mentioned, ,or who is marked subjectively better, has really improved—what are the results:—3Bl cases, 23 deaths, 67 worse, 40 same, .236 improved, 15 cured. Suppose, however, we create a new category into which to place. these cases, and label them "doubtfuL" We have, deaths 23, worse 67, same 40, improved 56, cured 15, doubtful 183. (FrankeVs cases are misleading, as he reports 83 cases, but only accounts for 70). Read in any way, however, these figures tell a very different tale to the 1700 cases, with bad results in only 56, so comSlacehtly offered by the official statistics. >ne thing more. Half, or more than half, qf these 1700 cases, were patients suffering from lupus—a disease that does not kill, and does not even injure the health for years. These cases should at least be subtracted to ascertain the death rate.

Kaposi reports eighty cases lupus results unfavorable. The Hospital St. Louis, in Paris, reports thirty-eight cases lupus results unfavorable. Jonathan Hutchinson, speaking for English specialists, says so far no cure of lupus has been effected in England. Cases reported cured in Berlin have relapsed. Shall we bring this testimony forward to witness to the efficiency of the treatment? It has over and over again been pointed out that a percentage of phthisical patients will be cured with any treatment, and that they are peculiarly liable to subjective improvement from mental causes only. Good food and hygiene will produce temporary improvement in nearly any case hitherto under disadvantageous conditions. Every treatment then has its " cures " to boast of, as many in proportion as Koch's, though none that I have ever heard of has had in such a short time such a death rate.

I will trespass no longer on your space. The subject is one that cannot be handled in the lay press; it leads so far and in so many directions; but I.should like to conclude by pointing out that "no re-action no tubervle has also been proved false, reaction having occurred in a number of other diseases. The con verse—tubercle present, hut no reac. on-rfWhich also is contrary to Koch's dictuAr is proved by Jacobi'a treatment of eigne? tuberculous children, only two of whom showed reaction. Finally, Sir, I would draw attention to tha point that in the medical papers of the last few weeks an ominous silence has reigned, very unlike the chorus of victory chanted last December.—l am, yours, ke., E. Jennings.