2. Koch's lymph, _Bacillinum_ and _Avian tuberculin_ must be studied separately, clinically as well as experimentally. _Bacillinum_ presents symptoms very different from those of _Avian tuberculin_, and especially from those of Koch's lymph; and I intend to divide my remarks into three parts, corresponding to these three substances, which have actually become h.o.m.oeopathic remedies.

At the time of the introduction of the ever-memorable Koch's lymph, there were included under the head of poisonings by this drug vascular lesions, as I have mentioned above, acute arteritis, arterio-sclerosis, changes in the vessels of the heart and the kidneys, and acute nephritis. Apropos of acute nephritis, the supposition was that the kidney became congested because of the presence in that part of certain tubercular islets, and that the kidney responded, like the tuberculous lung, under the influence of the _Tuberculin_, by acute congestion.

However this might be, these vascular lesions drew attention to the h.o.m.oeopathicity of Koch's lymph in nephritis. Dr. Jousset has experimented in it with encouraging results, using h.o.m.oeopathic dilutions, in Bright's disease; and at the meeting of the Societe h.o.m.oeopathique Francaise on April 18, 1895, Drs. Tessier, Silva and Jousset, father and son, mentioned the diminution of alb.u.men in cases of chronic and incurable nephritis, and the appearance of that substance in acute cases.

Dr. Arnulphy, in a series of articles in the Chicago _Clinique_, which I have read attentively, speaks favorably of Koch's lymph in h.o.m.oeopathic dilutions in cases of tuberculosis. Personally I have not used it, and I am loth to pa.s.s judgment on observations recorded in every good faith. I would merely remark to my honorable colleague that Koch's lymph was used in our school in all the h.o.m.oeopathic dilutions possible at the moment of its far-resounding discovery--a fact which he should know as well as myself. To mention only one instance--Drs. Simon, V. L. Simon Boyer and Chancerel used the drug at the Hahnemann Hospital in Paris at the time of the arrival in France of the first consignment of lymph from Germany; and I am nearly certain that there is not at this time a single country where h.o.m.oeopathists have not used this remedy in all the infinitesimal dilutions. h.o.m.oeopaths and allopaths have actually taken pretty much the same side as regards the primitive formula put forward by Koch (I am not now speaking of trials of new tuberculins); and Dr. Arnulphy would be fortunate enough were he able to revive its credit after its several years' oblivion as a cure of tuberculosis.

Clinically this lymph of Koch has led to wonderful cures in lobular pneumonia, for it produces pneumonia, broncho pneumonia, and congestion of the lungs in the tuberculous patient. Its h.o.m.oeopathic action would thus appear more trustworthy than its isopathic, and Dr. Arnulphy makes this remark: "I make bold to state that no single remedy in our materia medica, not excepting _Ipecac_, _Iodine_, _Tartar emetic_, and even _Phosphorus_, approaches the singular efficacy of _Tuberculin_ in well-authenticated cases of that affection (broncho pneumonia, be it) in the child, the adult, or the aged. Its rapidity of action in some cases is little short of wonderful, and all who have used it in this line are unanimous in their unbounded praise of its working."

The four cases quoted by Dr. Mersch (_Journal Belge d' Homeopathie_, November, 1894, January and May, 1895) are very instructive:

The first is that of a member of the Dutch Parliament who had contracted a pneumonia which reached a chronic stage. While undergoing a relapse his expectoration a.s.sumed a rusty-red color, which color disappeared completely in three days on treatment with _Tuberculin_ 30th.

The second case is that of a person who was seized, after an attack of measles, with broncho-pneumonia. On the fifth day Dr. Mersch prescribed _Tuberculin_ 6th. In a day or two the condition of the chest was completely altered.

In the third case an old lady was likewise attacked with broncho-pneumonia, together with digestive troubles, and was for a long time in a serious state. After the lapse of a single night, which was a rather distressing one, under the action of the remedy the amelioration was great, and it was with difficulty that Dr. Mersch found a touch of bronchitis in the very place where the day before he had heard nothing but the tubular _souffle_. The prescription ran: _Tuberculin_ 6th, eight packets of ten globules each, one to be taken every two hours.

Finally, in a fourth case, the patient was a lady of vigorous physique, and twenty-five years of age, who had capillary bronchitis, combined with the symptoms of angina pectoris. Dr. Mersch had once more had an opportunity of viewing with astonishment the rapidity with which the therapeutic action of _Tuberculin_ may be manifested in such cases.

_Bacillinum_ deserves study from two points of view, isopathically in the treatment of tuberculosis, h.o.m.oeopathically in the treatment of affections of the respiratory organs without tuberculosis. To fully understand its action it is necessary to know with exactness its composition. Dr. J. Compton Burnett has christened it _Bacillinum_, because he recognized in its lower dilutions the presence of Koch's bacilli. As a matter of fact, _Bacillinum_ contains in its elements everything that a cavity of a tuberculous lung is capable of containing; that is to say, many other things besides Koch's bacillus. The bacillus of Koch is feebly pyogenetic, and the purulent contents of the cavities include pyogenetic staphylococci and streptococci, to say nothing of the organic products which play a large part in the production of the hectic fever of tuberculosis. It is a combination of toxins, then, which const.i.tutes _Bacillinum_, and especially of toxins of a purulent nature.

I lay stress upon this last fact, as it goes to sustain the opinion that I hold on the action of _Bacillinum_.

The infinitesimal dose of h.o.m.oeopathy is in no way inimical to the entrance of all the elements const.i.tuting a substance into its materia medica. The salts of pota.s.sium owe their effect to their base as well as to their acid; _Graphites_ is a.n.a.logous to _Carbo_ and _Ferrum_, because it contains both carbon and iron; _Hepar sulphuris calcareum_ acts by reason of its sulphur as well as of its lime. _Bacillinum_, then, combines in its action all its const.i.tuent products, owing its efficacy to its suppurative microbes as well as its inclusion of Koch's bacillus.

This method of viewing the matter, which is peculiar to myself, permits me to include in one and the same category the action of _Bacillinum_ in consumption and its action in non-tuberculous bronchitis.

I have studied conscientiously the action of _Bacillinum_ in tuberculosis, and I must confess that I am looking out still for an authentic case of cure by this remedy. Nevertheless, in the midst of the paucity of drugs for the treatment of tuberculosis, I am happy to state that _Bacillinum_ has produced in my hands considerable amelioration of the symptoms of this disease. Perhaps in certain cases it produces what Bernheim would call "la treve tuberculeuse." But sooner or later the drug, after ameliorating the symptoms, loses its effect, and the disease again gets the upper hand. I wish I could be as optimistic as Dr. J.

Compton Burnett in his interesting book, "A New Cure for Consumption;"

but that is impossible.

In looking over my observations I find that the symptom which has always undergone the greatest mitigation has been the _expectoration_. When _Bacillinum_ acts on tuberculosis the sputum is less abundant, less purulent, less green, and more a[=e]rated. It is this which has always struck me most in the action of _Bacillinum_. It is rarely that a patient satisfied with the remedy fails to remark, "I expectorate less."

In cases of dry cough at the beginning of tuberculosis I have noticed that the drug evidently arrests the tubercular process.

I would most severely criticise, as well for myself as for others, cases of so-called "cure of tuberculosis." There certainly are persons in whom the disease does not develop. These may have been accidentally infected, and their phagocytes may have struggled against their microbe foe. But in the case of an individual in whom the tubercle finds a suitable field for development, it is the merest chance that he entirely recovers without ulterior relapse; mostly it is a seeming cure, caused by a time of pause in the microbian pullulation.

Last year I had under my care, at the Hospital St. Jacques, a truly extraordinary case. It has been followed out by Dr. Jousset, by Dr.

Cesar, head of the hospital laboratory, and by the house-physicians. It was that of a woman who entered the hospital suffering from influenza, and who, a few days after a slight amelioration of her symptoms, was attacked with a pulmonary congestion, clearly localized in the top of the left lung, and accompanied by all the clinical symptoms of tuberculosis--rales and moist crepitation, dulness, exaggeration of the thoracic vibration, nummular expectoration, fever, perspiration, spitting of blood--everything was there. Examination of the sputa showed distinctly the presence of Koch's bacilli. Everyone at the hospital diagnosed tuberculosis, myself the first. I gave her _Avian tuberculin_ and in three weeks all the symptoms had disappeared. That woman left the hospital completely cured, and _a year afterwards_ her health was still perfect. In my opinion this patient never had consumption; she was attacked with pseudo-phymic bronchitis, a complication which is very often found with influenza, and which may very easily be mistaken for tuberculosis; and in spite of the presence in the sputa of Koch's bacillus I would not register it as a case of tuberculosis, because, in contradistinction to that single case, I could mention twenty cases of tuberculosis whose symptoms neither _Avian tuberculin_ nor any other such drug has cured.

There is absolutely no connection between the clinical evolution of real tuberculosis and observations based on the autopsies of old persons whose lungs contain cavities, but whose death was not due to tuberculosis. To admit, with Professor Brouardel, that three-fourths of those who have died a violent death are possessed of tuberculous lesions, whose existence was not suspected while the subject was living, would be running absolutely counter to clinical experience. The time is probably at hand when the different kinds of tuberculosis will be distinguished and separated, as we distinguish and separate the varieties of serious pleurisy and purulent pleurisy, of broncho-pneumonia arising from the presence of pneumococci, of streptococci, or of staphylococci.

Mala.s.sez has already described cases of pseudo-tuberculosis, or zoogleic-tuberculosis, whose existence has only been acknowledged of late years. Courmont has discovered a pseudo-bacillosis of a bovine origin. We have a pseudo-bacillosis of a strepto bacillar origin, not to mention the "professional" tuberculoses, such as that to which persons are exposed who have to breathe the fumes of charcoal.

To return to _Bacillinum_, I consider this remedy as a powerful moderator of the muco-purulent secretion of consumption. While diminishing the secretion it modifies the auscultation; there is less thick sputum, the cavities are drier, the peri-tuberculosis congestion less intense. The clinical symptoms follow those of the auscultation; as the patient expectorates less he is less feeble, coughs less, gains strength, and regains his spirits; but the tubercle remains untouched.

The peri-tuberculous congestion only is diminished, as one may observe with the naked eye when Koch's lymph is employed in the amelioration of lupus. The peri-tuberculous inflammation disappears; the skin seems healthy, but the yellow tubercle remains as it was, and the patient is still uncured. Such are the limits I a.s.sign to _Bacillinum_ in its action on consumption.

Far more potent is the part played by _Bacillinum_ in non-tuberculous pulmonary affections, for the simple reason that the struggle is with a less redoubtable opponent. Ebersole, Young, Zoppritz, Burnett, James, Holmes, Jousset, Steinhauf have published cases of the cure of acute bronchitis, influenza diarrhoea, syphilitic eruptions, cyst.i.tis, ringworm of the scalp, nephritis, idiocy, r.e.t.a.r.ded dent.i.tion, cretinism, gout, rheumatism, etc., with _Tuberculin_ or _Bacillinum_.

If we wish to prescribe _Bacillinum_ successfully in non-tuberculous affections, we must observe, on auscultation, symptoms a.n.a.logous to those which are perceptible in tuberculosis. The peculiar characteristics which indicate _Bacillinum_ for non-tuberculous maladies of the respiratory organs are, in my opinion, the two following: The first is _oppression_; the second, _muco purulent_ expectoration. These two phenomena show themselves always in the last stage of tuberculosis; that is to say, together with the products contained in the preparation of _Bacillinum_. _Dyspnoea resulting from bronchial and pulmonary obstruction caused by a super-abundant secretion from the mucous membrane is marvellously relieved by Bacillinum._ I put forward this fact, not on the evidence of a single isolated observation, but on that of several cases conscientiously studied. Such expectoration leads to the auscultation of sub-crepitant rales, sounding liquid and gurgling, having some a.n.a.logy to the moist sounds of tuberculosis.

This power of _Bacillinum_ to relieve oppression in pulmonary catarrh is in no way surprising from the point of view of the law of similars; for in the acute and infectious stage of tuberculosis the dyspnoea is a characteristic symptom, and is far more distressing than the cough. I have read with pleasure in the work of Dr. Mersch, of Brussels, on _Tuberculin_, of a fact which corroborates my statement as to the influence of _Bacillinum_ over catarrhal dyspnoea. After the sixth dose the patient, who was suffering from bronchial asthma, was seized with violent intercostal pains, with augmented cough; but the oppression entirely disappeared after the first day, and did not return even three months after the treatment had ceased.

In _L' Art Medical_ of January, 1894, and in the _Hahnemannian Monthly_ of July, 1894, I published the case of an old man of eighty years of age, suffering from broncho-pneumonia, who, in the last stage of asphyxia, had been saved by _Bacillinum_. Two years ago I was called upon to treat another octogenarian who, as the result of a cold, developed an obstruction in the bronchial tubes, and at the basis of the lungs. He pa.s.sed sleepless nights in a sitting posture, striving to draw deep inspirations. _Phosphorus_, _a.r.s.enic_, and _Stibium_ produced no relief. I gave him _Bacillinum_ 30th, and he slept the whole night through. Doses of this remedy, administered _at longish intervals_, always produced a remarkable amelioration. Last year I was called to the house of an upholsterer. He preferred not going to bed at all to pa.s.sing the night in bed without closing his eyes. He had humid asthma with incessant cough, which ended by causing him to eject thick yellow and puriform mucus. For eight days he took _a.r.s.enic_ and _Blatta_, and for a whole week he pa.s.sed the nights without sleeping. From the day he took _Bacillinum_ he was able to sleep. I saw him again this year in good health. Once or twice he was attacked with the same bronchorrhea, and had my prescription made up at the chemists, with the same success. This year, too, I have given _Bacillinum_ to several patients at the Hopital St. Jacques for the same symptoms, and it has never yet failed me.

When I am called upon to treat a patient suffering from an obstruction of the bronchial tubes occasioned by mucus, which is frequently thick and opaque and puriform--an obstruction extending to the delicate bronchial ramification, and causing oppression more frequently than cough, I turn my thoughts at once to _Bacillinum_. _Bacillinum_ is a drug for old people, or, at any rate, for those whose lungs are old; for those chronically catarrhal, or whose pulmonary circulation is enfeebled without regard to the age of the subject; for those who have dyspnoea, and who cough with difficulty from inaction of the respiratory ducts; for the humid asthmatic, the bronchorrheal, who feel suffocated at night; and, finally, for those who, after taking cold, are straightway attacked with pulmonary congestion. Here, I believe, is the exact sphere of action of _Bacillinum_ as a h.o.m.oeopathic remedy.

_Bacillinum_ has been stigmatized as an unstable product. I consider this reproach ill-founded. _Bacillinum_ is no more unstable than _Psorinum_, which is an approved remedy in h.o.m.oeopathy. Typical tuberculous lungs contain practically almost invariable elements. Do not the microbes produced by cultivation and the animal extracts show any variation in quality, and do they not change in the long run?

Like most h.o.m.oeopathists who have made use of _Bacillinum_, I think it is best given in the high dilutions and at long intervals. Dr. J.

Compton Burnett and Van der Berghe recommended the higher potencies--the 1000th, 100,000, etc., whereas I content myself with the 30th, which satisfies every requirement. As regards the intervals which must elapse between the doses, certain writers recommend from one to two weeks. In acute cases I generally give six globules of _Bacillinum_ 30th every two or three days; and in chronic cases of tuberculosis, etc., one dose about twice a week.

We are no longer permitted to include in the same description the tuberculosis of birds and that of mammals. Although the two bacilli, as far as form and color are concerned, are absolutely identical, the evolution of the two forms of tuberculosis presents characteristics so different that we are forced to study them separately. At this day the debate is a question of words, and experts discuss whether there are two distinct genera or merely two different species.

It is this characteristic of non-transmissibility from mammals to birds, and _vice versa_, which forms the chief difference between the two kinds of tuberculosis. Strauss failed in his endeavor to inoculate a fowl with tuberculosis by injecting fifty kilogrammes of tuberculous human sputa, whereas the fowl, absolutely impervious to human tuberculosis, became infected when treated with a very slight quant.i.ty of the avian tuberculosis. The guinea-pig, so sensitive to the human microbe, presented encysted abscesses when treated with the virus of birds; it dies of cachexia, but never, as far as the naked eye can discern, of generalized tuberculosis. Rabbits are more sensitive to the avian infection. Dogs are absolutely refractory. The monkey, so delicate in our climate, and which almost invariably perishes from tuberculosis, is uninjured by inoculation from avian virus. The parrot is a remarkable exception to the general rule; it is the only bird which resists avian tuberculosis, while, on the other hand, it is sensitive to that of man.

Such facts as these irrefutably differentiate the two kinds of tuberculosis.

[H] _Tuberculosis of Birds._ _Tuberculosis of Mammals._

Aspect of Extreme softness on Human tuberculous cultures. glycerine jelly or growths are adherent, on serum. hard and difficult to break up even with a strong platinum wire on glycerine jelly as well as on serum.

Medium of Transferred from a Cultivation more difficult.

cultures. solid to a liquid medium the bacillus grows rapidly, having the appearance of rounded grains.

Temperature. Develops at a Ceases to develop at temperature of 45 C. temperatures under 41 C.

Odor. Somewhat sour. More subtle and fresh odor.

Duration. Takes longer to develop, Is with difficulty generated and may remain again at the end of six for a year or months. At the end of thereabouts. eight or ten months loses its vegetable character.

Seat of the In animals usually In the lung, generally in tubercles. on the liver, the men, and in certain animals; spleen, the intestines, in the spleen, the and the peritoneum. liver, and the glands in rabbits and guinea-pigs.

Transmissibility.

Only from one bird Mammals are unaffected by to another, except the tuberculosis of birds, in the case of the and _vice versa_.

parrot.

[H] I have tabulated shortly their various characteristics.

Ever since this variety of tuberculosis has been distinguished, attempts have been made to inoculate or cure human tuberculosis with that of birds. In our school the thing has been attempted at the Hopital St. Jacques, where _Aviaire_ has been administered in h.o.m.oeopathic dilutions, in potions or through punctures in cases of consumption. As a matter of fact, neither allopaths nor h.o.m.oeopaths have succeeded in obtaining a formula which will cure consumption with the virus of birds.

Amelioration has been noted as with other remedies, but never a series of authenticated cures. Nevertheless, in every country experiments are continually being made; we must hope that they will end in a more decisive success than is at present the case.

Hoping to profit by the h.o.m.oeopathicity of an active virus, I was, I think, one of the first who employed _Aviaire_ in non-tuberculous respiratory affections on the lines of _Bacillinum_, and I am bound to say that up to the present my faith in the law of similars has not been shaken by my experiments.

In _L'Art Medical_ (August, 1895) I published a number of cases in which I successfully treated localized bronchitis, generally the result of influenza, and reproducing the symptoms of tuberculosis, with _Aviaire_.

The most characteristic of all these observations is that of which I have spoken above. The patient was restored to health as if by magic with _Aviaire_ within three weeks. Dr. P. Jousset, antic.i.p.ating my observations, thus expressed himself in the number of _L'Art Medical_ preceding the one which contained my remarks: "A young woman entered the Hopital St. Jacques at the end of January, 1895, with feverish influenzal bronchitis. At first the patient was treated with small doses of _Sulphate of Quinine_, and a little later she took _Ipecac_ and _Bryonia_ alternately. The fever disappeared and the general condition improved considerably, and the sub-crepitant rales became confined to the top of the left lung. The patient continued to expectorate thick nummular and puriform sputa, as in the influenza. After some days the disease resumed its sway, the bodily forces diminished, the emaciation made great progress, and local and general signs indicated rapid consumption. Bacteriological a.n.a.lysis led to the detection of numerous Koch's bacilli. I gave over the case at this time, and some weeks afterwards I learnt with surprise that the patient was well and growing fat, and that the inoculation of the sputa had produced no effects. The cure has been maintained for three months, and the young woman has resumed her employment." I had prescribed _Aviaire_ 100th, five drops a day, during the whole period of the disease, unaccompanied by any other remedy.