AWAY WITH KOCH’S LYMPH ! 
SENN. AWAY WITH KOCH’S LYMPH ! 
BY 
NICHOLAS SENN, M.D., Ph.D., 
Professor of Practice of Surgery and Clinical Surgery in Kush Medical College; 
Attending Surgeon Presbyterian Hospital. 
BEING 
A Paper Read by Special Request before the Chicago Medical Society, 
May 18th, 1891. 
Reprinted from The Chicago Medical Recorded, Chicago, June, 1891. 
press of 
1R. 1R. .McCabe 8, Co. 
144 Monroe Street, Chicago AWAY WITH KOCH’S LYMPH ! 
Historical Introduction—Action of the Lymph on Tubercu- 
losis of the Skin—Action on Tuberculosis of Joints— 
Action in Otitis Media Tuberculosa—Action on Tubercu- 
losis of Lymphatic Glands—On Tuberculosis of Lung and 
Larynx—In Pulmonary Tuberculosis—General Remarks. 
When, six months ago, the telegraph operator at Berlin 
touched the key of his instrument and flashed to all parts of the 
civilized world the joyful tidings that a cure for tuberculosis had 
at last been discovered, the people and the profession felt that the 
millennium in medicine had come. For days and weeks the public 
press devoted a liberal space to telegraphic messages, editorials, 
and interviews with medical men relative to the new treatment. 
For months the medical journals in all countries rivaled each 
other in bringing the latest reports from Berlin and other large 
medical centres in the way of telegrams, correspondence, editorials, 
and original contributions. 
The first announcement of the discovery brought thousands 
of patients and doctors to the German capital, the former to be 
cured of their tubercular disease, the latter to receive instruction 4 
and to make themselves proficient in all the details of the new 
treatment. No other event in the world’s history ever attracted 
so much attention, and no discovery in medicine or surgery ever 
found such ready introduction and universal acceptation. The 
discoverer, the distinguished Koch, the father of bacteriology, 
had scored so many victories on this modern field of research that 
every word he uttered brought conviction. His views were 
promptly adopted by the most prominent physicians and surgeons 
in Germany and other countries, and the new treatment was 
applied everywhere by the best men in the profession as fast as 
the precious remedy could be obtained. 
Within a few weeks the most enthusiastic and encouraging 
reports came from scores of prominent clinics and large hospitals. 
Within a few months volumes have been written on this subject; 
several special works on this treatment left the press and were 
translated into many languages. A new journal devoted 
exclusively to the treatment of tuberculosis with Koch’s lymph 
has come into existence and has a good subscription list from the 
very start. It is true that some of the more conservative mem- 
bers of the profession were a little slow in accepting the new 
doctrine and practice, but the great majority followed the current 
set in motion by the great Koch and his many eminent admirers 
and devoted followers. 
It was not long, however, before the glowing accounts of the 
results of the new treatment of tuberculosis came at longer 
intervals and in a more moderate tone, and were interspersed with 
the reports of cases from different parts of the world in which it 
proved a complete failure, and not in an inconsiderable number 
of cases it was charged with having caused a speedy fatal termi- 
nation. Then came the timely warning of the veteran pathologist, 
Virchow, who showed by numerous post-mortem examinations of 
patients who died under this treatment that death was caused by 
dissemination of the disease from a local focus acted upon by the 
lymph. The evidences proving this source of danger have been 
rapidly accumulating, and contributed largely towards subduing 
the first enthusiasm and limiting the scope of administration of 
the remedy. 
The disastrous consequences which followed the use of the 
lymph, perhaps often injudiciously and recklessly applied, 5 
induced a number of medical societies to condemn its use, and 
led some of the local governments to restrain its further applica- 
tion by legal enactments. 
Enough time has now elapsed to judge of the merits of the 
treatment of tuberculosis by Koch’s lymph, or, as it is now called, 
tuberculin. It has been put to test in the treatment of all forms 
of tuberculosis. 
Surgeons, physicians, gynecologists, obstetricians, dermatolo- 
gists, otologists and ophthalmologists have given the new treat- 
ment a fair trial, and the accumulated experiences from all these 
sources have shown beyond all doubt that its indiscriminate use 
is attended by many immediate and remote dangers, and that 
most cases in which it appeared to prove beneficial at first have 
relapsed, and after weeks and months were no better, or even 
worse, than when the treatment commenced. 
Men who first regarded the lymph as a specific in all forms of 
tuberculosis make this claim no longer. Many who were enthusi- 
astic in their praise of what they observed from the use of the 
remedy in the beginning have now suspended its use. Hospitals 
and wards set aside for the special treatment of patients suffering 
from tuberculosis are now deserted. The market is over-stocked 
with a supply of Koch’s lymph and Koch’s syringes. Not only 
the profession but the public has become aware that the claims 
made for the remedy only a few months ago are unfounded. It 
is left for Koch, or some other investigator in the future, to 
discover a substance or agent which will answer the expectations 
that were at first entertained for the lymph. 
Koch’s lymph has been a deceptive bubble which for a short 
time commanded the attention and admiration of the whole world, 
but which has been ruthlessly pricked by the critical scalpel in 
the hands of the father of modern pathology. The treatment of 
tuberculosis with Koch’s lymph and the numerous substitutes 
which have recently been forced on the attention of the profession 
will soon be only a matter of history. My “ Away With Koch’s 
Lymph!” is based upon my own observations made at the 
Milwaukee Hospital during the last four months’ service in that 
institution prior to my removal to this city. The material is not 
large, but the careful observations made entitle me to give a 6 
positive opinion and warn others against further experimentation 
with this remedy. 
The lymph first used I received through the courtesy of Dr. 
J. S. Billings, of Washington, and when this was exhausted I 
received an abundant supply direct from Dr. Libbertz, through 
the influence of my distinguished friend, Professor von Esmarch. 
The tubercular nature of the lesions in all cases that came under 
my own care, if any doubt existed in this regard, was established 
by microscopical examination and search for the bacillus. 
Tuberculosis op Skin. 
As lupus of the face was mentioned in the first reports from 
Europe as having been cured by Koch’s lymph, I was exceed- 
ingly anxious to commence treatment with this form of surgical 
tuberculosis. In all the cases reported below the local and gen- 
eral reaction was typical and corresponded with the descriptions 
given by von Bergmann, von Esmarch and others. 
Case 1. Lupus of face and nose; tuberculosis of right tarsal 
and ankle joints; incipient tuberculosis of left wrist joint. 
Augusta Jehnki, aged forty-four, German, married, was 
admitted to the Milwaukee Hospital January 22d, 1891, with the 
following history: 
Tuberculosis not hereditary in her family. Eighteen years ago 
the left nasal passage became partially obstructed, rendering 
breathing through that side of the nose difficult. The affection 
commenced, as near as she can remember, in the form of a papillo- 
matous swelling, involving the mucous membrane of the ala near 
its junction with the skin. At first no pain and no discharge 
from the nose. The swelling slowly increased in size, softened 
in the center, leaving an ulcerated surface which was usually 
covered with a dry crust. As soon as ulceration set in the 
disease extended rapidly to all of the structures of the nose and 
later to the soft palate, pharynx, and face. In the course of a 
few years almost the entire nose and a considerable portion of the 
nasal septum were destroyed. The ulcerated surface healed 
over, the scars almost completely occluding the nasal apertures 
on a level with the skin of the face. 
The patient states that after destruction of the nose the 
disease first extended to the right cheek and later to the left side. 7 
On the left side the eye became involved, sight being almost 
completely destroyed. The upper lip became involved six years 
ago. The skin of the face never ulcerated extensively; circum- 
scribed superficial erosions would form from time to time which 
healed under a crust, always leaving a thin red cicatrix. A year 
ago the right ankle and tarsal joints became tender and swollen. 
On admission the patient presented a somewhat anaemic 
appearance, general nutrition impaired. No evidences of the 
existence of pulmonary tuberculosis. Remnant of nose covered 
with thin red glistening scar. Nasal apertures nearly closed. 
Both cheeks and upper lip swollen, the skin covering them 
exceedingly vascular with here and there small defects covered 
with thin dry crusts. Left cornea opaque throughout. Nearly 
the entire soft palate absent and sides of pharynx in a state of 
ulceration. Right ankle and tarsal joints present the typical 
appearances of synovial tubercular arthritis. 
The following table shows dates, doses of the lymph adminis- 
tered, and its effect upon the temperature and pulse: 
Number of 
Injections. 
Date. 
Dose in 
Milli- 
grammes 
Temperature 
before 
Injection. 
Temperature 
during 
Reaction. 
Temperature 
after 
Reaction. 
Pulse before 
and during 
Reaction. 
1 
Jan. 
23 
3 
98 .9° 
103.8° 
98.2° 
80 
120 
2 
U 
26 
4 
98.2 
102 
99 
78 
120 
3 
U 
28 
5 
98.2 
102.2 
98 
76 
120 
4 
Feb. 
3 
4 
97 
101.6 
97 
74 
116 
5 
“ 
5 
4 
97 
98.4 
96.8 
82 
92 
6 
U 
7 
5 
97 
92.2 
97.6 
82 
90 
* 7 
a 
10 
10 
98 
102.2 
97 
88 
120 
8 
u 
14 
8 
97 
101 
97.4 
76 
104 
9 
“ 
17 
4 
98 
99.4 
98.4 
80 
96 
10 
a 
21 
8 
98 
106.6 
98 
82 
105 
11 
u 
24 
6 
97.8 
99 
97 
72 
90 
12 
u 
28 
6 
97.4 
92.2 
97.6 
68 
85 
13 
Mar. 
2 
6 
97.6 
100.4 
97.6 
76 
89 
14 
U 
5 
6 
97.6 
100.6 
97.6 
72 
90 
15 
u 
11 
6 
97.6 
100.6 
97 
76 
100 
16 
u 
21 
2 
97 
100.8 
97 
92 
74 
17 
u 
25 
4 
97 
101.8 
97 
84 
108 
During the reaction following the first dose the left wrist-joint 
became greatly swollen and very painful, but this condition lasted 
only for a day. The swelling and pain in the right foot also were 
greatly aggravated during and for some time after the reaction. 
The cheeks and upper lip became the seat of an active inflammation 
which resulted in great swelling and transudation of a serous 
fluid which on drying left nearly the whole surface covered with 8 
a yellowish crust. The local reactions gradually diminished in 
intensity, and almost ceased about the middle of February. The 
highest temperature, 106.6° F., was observed following the injec- 
tion of eight milligrammes, February 21st. The temperature 
usually commenced to rise about three to four hours after the 
injection and reached the highest point about three hours later. 
The temperature was often found subnormal eighteen hours 
after the injection. 
I was forced to abandon the treatment at the end of March, as 
the patient had become greatly emaciated and extremely anaemic, 
and the local lesions which in the beginning of the treatment had 
apparently undergone marked improvement had relapsed, pre- 
senting about the same conditions as when the treatment was 
begun. The skin covering the lupus remained red throughout, 
and showed no signs of fading when the patient left the hospi- 
tal. During the latter part of February the susceptibility to the 
action of the lymph appeared to have been nearly exhausted, as 
injections of six milligrammes produced only a slight rise of tem- 
perature, but this returned later as the last injection of four milli- 
grammes, March 25th, was followed by a temperature of 101.4° F. 
Case 2. Lupus erythematosus of right cheek and external 
ear. 
Dora Presentin, widow, aged forty-nine, entered the Mil- 
waukee Hospital February 5th, 1891, for the purpose of submit- 
ting to a course of treatment with Koch’s lymph for a lupus of 
the right cheek. No hereditary tendency to tuberculosis in her 
family. General health excellent. The skin affection commenced 
in the middle of the right cheek when she was twelve years old. 
She first noticed a prickling smarting sensation at the site of an 
elevated red patch about the size of a dime. This was treated by 
applications of preparations of iodine without benefit. The cuticle 
exfoliated leaving a raw surface which became covered with a thin 
dry crust. At the age of fourteen, the sore healed, and with the ex- 
ception of a prickling sensation at times, remained well for three 
years, when the sore spot again inflamed and the same conditions 
returned, and from that time the affection continued to extend 
over the right cheek, and during the last few years it has involved 
the lobe of the ear on the same side. Like in the preceding case, 
great improvement has always taken place during the summer 9 
months. The right cheek and external ear are of a bright red 
color, the disease evidently being limited to the superficial layers 
of the skin, as there is little or no swelling of the affected parts. 
Occasionally thin crusts form over circumscribed patches where 
exfoliation has taken place. She was at once treated by injec- 
tions with Koch’s lymph with results shown in following table: 
Number 
of 
Injections. 
Date. 
Dose in 
Milli- 
grammes. 
Temperature 
before 
Injection. 
Temperature 
during 
Reaetioif! 
Temperature 
after 
Reaction. 
Pulse before 
and during 
Reaction. 
1 
Feb. 5 
2 
98.4 
99 
98.3 
76 
80 
2 
C( 
7 
4 
98.3 
100.2 
97.3 
82 
90 
3 
U 
10 
4 
98.5 
99.9 
98.3 
74 
80 • 
4 
u 
14 
4 
98.4 
102.7 
97 
80 
100 
5 
u 
19 
2 
98.4 
100.3 
98.4 
74 
100 
6 
u 
21 
2 
98.3 
99 
99 
74 
80 
7 
a 
24 
4 
98.4 
100 
97.5 
76 
88 
8 
u 
28 
6 
97.5 
99.1 
98 
68 
84 
9 
Mar 
2 
8 
98.4 
101.1 
98.4 
78 
93 
10 
“ 
5 
10 
98.4 
101.2 
97.9 
84 
90 
11 
U 
10 
10 
98.4 
99.9 
97.5 
68 
90 
12 
U 
13 
10 
98.1 
98.9 
98 
69 
72 
13 
U 
16 
10 
99.1 
102 
98.4 
75 
82 
14 
a 
20 
10 
98.4 
99.5 
98.4 
72 
76 
The local reaction was always prompt in this case even when 
a small dose was used. The whole surface of the lupus became 
acutely inflamed, the copious transudation on inspissation form- 
ing an almost continuous, thin yellow crust. The intensity of 
the local symptoms gradually subsided, but the surface remained 
red and vascular to the end of the treatment, so that when she 
left the hospital the improvement, if any, was very slight. I 
have examined the patient on several occasions since she left, the 
hospital, but no material change has taken place in her condition. 
The general reaction in this case was much milder than in the 
preceding one, and with the exception of becoming more anaemic 
and having lost several pounds in weight the treatment left no 
further ill effects. 
Case 3. Lupus hypertrophicus of face; tuberculosis of submax - 
illary and cervical glands. 
Edward Rohrer, aged fifteen years, came to the hospital 
to undergo a course of Koch’s treatment for lupus of the face 
February 21st, 1891. His mother died of lupus of the cheek 
and pulmonary phthisis when he was three years old. Out of 
a family of nine children, six have died of some form of tuber- 
culosis. Soon after the patient was born a nodule was discovered 10 
in the centre of the right cheek. This was removed by caustics, 
but the resulting ulcer never healed. The disease extended quite 
rapidly over the entire cheek and later attacked the nose, the 
greater part of which was destroyed; finally it reached the left 
eye, the sight of which was completely destroyed when he was 
five years old. At the time he presented himself for examination 
and treatment the left submaxillary and cervical lymphatic glands 
were enlarged, showing conclusively that the tubercular lesion of 
the face had given rise to secondary glandular infection. The soft 
tissues of the nose had nearly disappeared, the mucous mem- 
brane of the nasal passages swollen and in places ulcerated, the 
lining of the external apertures covered with a dry crust. The 
whole face, forehead and both lips enormously swollen, the skin 
a dusky hue, and in spots covered with dry crusts; the swollen 
parts were very hard to the touch, the infiltration evidently extend- 
ing beyond the structures of the skin. Numerous hard nodules 
could be felt over the whole infected area; no trace of eyelashes 
and eyebrows on either side. All of the eyelids slightly ectropic 
and otherwise distorted. Appetite good, general condition fair. 
Before treatment was commenced the temperature was 97° F. 
He received the first injection of one-half of a milligramme of 
tuberculin the day he came into the hospital, which in four hours 
brought the temperature up to 101.2°, and it had not returned to 
normal after twenty-four hours. During this time he complained 
of headache, pain and a sense of burning in the affected parts, 
which had become much more swollen and red. The same 
profuse transudation appeared on the surface as in the other 
cases, forming a thin yellow crust which covered the greater part 
of the surface. The following table gives the number of 
injections and their immediate general effects: 
Number 
of 
Injections. 
Date. 
Dose in 
Milli- 
grammes. 
Temperature 
before 
Injection. 
Temperature 
during 
Reaction. 
Temperature 
after 
Reaction. 
Pulse before 
and after 
Reaction. 
1 
Feb. 21 
% 
97 
101.2 
100.2 
81 
99 
2 
U 
23 
1 
100.2 
100.3 
97 
99 
120 
3 
U 
28 
2 
97 
99.4 
98 
90 
106 
4 
Mar. 
2 
3 
98 
103 
97.8 
78 
108 
5 
(t 
5 
3 
97 
102 
98.4 
78 
102 
6 
U 
9 
3 
97.8 
102.5 
98 
75 
105 
7 
U 
12 
3 
98.8 
100 
98.6 
90 
106 
8 
U 
16 
3 
99.4 
101 
99.7 
88 
102 
9 
U 
21 
3 
98.2 
101 
97.4 
80 
102 
11 
“ 
25 
3 
99.2 
100.4 
98 
90 
98 11 
The enlarged glands became more swollen and tender after 
the first injections; later the local reaction ceased. During the 
first three weeks the condition of the face appeared to be under- 
going a decided change for the better. As the local reaction 
diminished and the crusts exfoliated, the swelling diminished 
considerably and the hardness partly disappeared, and, at the 
same time, the skin presented a more natural appearance. 
During the latter part of March, however, improvement came to 
a standstill and the parts gradually returned to their former 
conditions. The treatment has been continued until recently, 
and when I saw the boy a few days ago I became satisfied that 
his general health and strength had failed greatly since I first 
saw him, and the face showed no improvement whatever. 
Case 4. Tuberculosis of skin in both infra-patellar regions. 
Mary Howard, aged forty-three, married, housewife, was sent 
to the Milwaukee Hospital to be treated for an affection of the 
skin in both infra-patellar regions. No hereditary predisposition 
to tuberculosis in the family. General health excellent. Six 
months ago, without any apparent cause, she experienced pain 
and tenderness in the skin in the region of the left knee-joint at 
a point corresponding with the lower margin of the patella. A 
few days later she discovered two or three nodular swellings in 
the skin which slowly increased in size until they became as large 
as a split pea. The skin covering these swellings assumed a 
bluish color, when softening in the center of each nodule 
occurred, which resulted in the formation of small ulcers covered 
with flabby granulations. New nodules made their appearance 
in the same neighborhood and passed through the same stages. 
In two or three places several of these nodules became confluent, 
forming indolent ulcers the size of a nickel. Some of these 
ulcers healed, but the new skin never assumed a healthy color, 
remaining very vascular and of a brownish tinge. 
A few weeks before she came under my observation the same 
affection appeared on the opposite side and in about the same 
locality. At the time she entered the hospital about six nodules 
were found in the skin of the left infra-patellar region, some of 
them in a state of ulceration, others covered with dusky skin, 
while the most recent ones could be felt as circumscribed indura- 
tions in the deeper structures of the skin. The nodules below 12 
the left knee, three in number, had not ulcerated. As the 
diagnosis was somewhat obscure fragments of granulation tissue 
were removed, stained, and examined under the microscope with 
the result that numerous tubercle bacilli were found within and 
between the giant and epithelioid cells. The ulcers were dressed 
with iodoform and treatment with Koch’s lymph was at once 
commenced. The nodules and ulcers responded promptly to the 
injections, becoming swollen, vascular and tender after each 
injection. The temperature never reached quite 100° F., 
although the dose was gradully increased to ten milligrammes. 
Number 
of 
Injections. 
Date. 
Dose in 
Milli- 
grammes. 
Temperature 
before 
Injection. 
Temperature 
during 
Keaction. 
Temperature 
after 
Reaction. 
Pulse before 
and during 
Reaction. 
1 
Feb. 
3 
2 
98.4 
99.8 
98 
74 
82 
2 
U 
5 
2 
98 
99.2 
97.8 
72 
80 
3 
“ 
7 
3 
98.8 
99.6 
98 
68 
84 
4 
“ 
10 
6 
98.2 
99 
98 
68 
84 
5 
U 
14 
6 
98 
99.2 
98.2 
82 
88 
6 
u 
19 
6 
98.4 
99.6 
99.2 
84 
108 
7 
u 
21 
8 
99 
98.6 
99.4 
84 
100 
8 
u 
24 
8 
98.4 
99.6 
98.2 
72 
98 
9 
“ 
28 
8 
98.2 
99.2 
97 
84 
66 
10 
Mar. 2 
8 
98.2 
99 
97.8 
96 
60 
11 
U 
5 
10 
98.4 
99 
98.4 
84 
66 
During this treatment the nodules covered with intact skin 
first became swollen, hard and painful, and then gradually disap- 
peared. The ulcers soon assumed a more healthy appearance, 
the granulations becoming more vascular and firmer, followed by 
speedy epidermization. At the time the injections were sus- 
pended all of them had healed, and I flattered myself that a cure 
had been obtained, and allowed the patient to leave the hospital. 
Three weeks later I saw her again and found her in about the 
same condition as when the tuberculin treatment was commenced. 
Tuberculosis of Joints. 
It has been claimed by a number of eminent surgeons that 
in the absence of caseous foci and sequestra tubercular joints are 
amenable to successful treatment by lymph injections, and that 
in a fair percentage of cases not only a cure can be effected, but 
a perfect functional result obtained. The same authorities also 
maintained that in the event the disease had advanced to the for- 
mation of caseous deposits or sequestration the same treatment 
by limiting the extension of the tubercular process, would place 13 
the parts in a more favorable condition for subsequent successful 
operative interference. Although my experience with Koch’s 
lymph in this class of cases has been limited to three cases it has 
taught me that neither of these claims are well founded. 
Case 5. Synovial tuberculosis of knee joint; intra-articular 
injections of iodoform emulsion followed by Koch's treatment. 
Maria Gierswska, aged eighteen, born in Poland, housemaid, 
came under my care at the Milwaukee Hospital January 11th, 1891. 
No hereditary tendency to tuberculosis in the family. Patient is 
fairly well nourished, but somewhat anaemic. She has been a 
servant girl for several years and was required to do a greal deal 
of scrubbing, and to this part of her work she attributed a pain in 
the right knee-joint which made its first appearance about two 
years ago. The pain was worse at night, but did not prevent her 
from following her occupation until six months ago. At that 
time she noticed that the joint was swollen and tender on pres- 
sure. The swelling increased rapidly in size and the movements 
of the joint became impaired. Examination of the joint revealed 
the presence of a copious effusion with thickening of the capsule. 
No circumscribed points of tenderness over epiphyseal extremi- 
ties of the tibia and femur. Patient can walk without the aid of 
crutches. 
On January 12th, the joint was aspirated and six ounces of 
synovial fluid in which small fibrinous shreds were suspended 
was removed, after which an intra-articular injection of a ten 
per cent emulsion of iodoform in glycerine was made. The patient 
was allowed to use the limb. In the evening the temperature, 
which had been normal before the injection was made, rose to 
102.8° F., but was again found normal the next day. At the end 
of forty-eight hours the joint was swollen as much as before the 
aspiration. On January 17th aspiration and injection were 
repeated. No decided improvement had taken place, when the 
tuberculin treatment was commenced January 22d. The highest 
temperature produced by the first injection was reached at the 
end of two hours. On the following day the swelling had 
increased, the capsule was tense, and the joint tender and much 
more painful than after the iodoform injections. The injection 
of six milligrammes of tuberculin made January 26th was followed 14 
at the end of twelve hours by a temperature of 105.8° F., the 
highest temperature recorded in this case. 
The patient complained of headache and pain in the region 
of the stomach and spleen attended by diarrhoea. 
Number 
of 
Injections. 
Date. 
Dose in 
Milli- 
grammes. 
Temperature 
before 
Injection. 
Temperature 
during 
Reaction. 
Temperature 
after 
Reaction. 
Pulse before 
and during 
Reaction. 
1 
Jan. 22 
2 
96.6 
100.8 
100 
80 
90 
2 
U 
23 
4 
100 
103 
99 
96 
112 
3 
U 
25 
2 
99 
102.2 
99 
70 
106 
4 
u 
26 
6 
99 
105.8 
99 
84 
144 
5 
“ 
28 
5 
99 
105 
100.4 
100 
144 
6 
Feb. 
3 
6 
98 
105 
99 
82 
140 
7 
“ 
5 
2% 
99 
100.4 
99.2 
96 
100 
8 
a 
7 
3 
99 
99.8 
99 
76 
86 
9 
u 
10 
6 
98.2 
103 
98 
76 
108 
10 
u 
14 
6 
98 
99 
98 
74 
84 
11 
a 
19 
5 
98 
99.4 
98.4 
72 
90 
12 
“ 
21 
6 
98.4 
99.4 
98.4 
76 
80 
13 
a 
24 
6 
98.4 
99.6 
98 
72 
96 
The local and general reactions in this case were pronounced, 
but both subsided gradually during the treatment. While in the 
beginning of the treatment the temperature rose to nearly 106° 
F., the last injection of six milligrammes was followed by only a 
little more than one degree of rise in the temperature. During 
the time the patient received this treatment, she lost much in 
flesh and became very anaemic. She left the hospital February 
26th, and at that time the joint was not much swollen and I confi- 
dently expected a permanent improvement. She returned in two 
weeks, when the effusion had returned to about the same extent 
as when the treatment was commenced. As I had lost faith in 
the Koch remedy in the treatment of this class of tuberculosis, I 
returned to the treatment by intra-articular injections of iodo- 
form. 
Case 6. Tuberculosis of left knee-joint. 
William Gabl, thirty years of age, laborer, became an inmate 
of the Milwaukee Hospital, March 9th, 1891. No history of 
tuberculosis in his family. Had been in good health until nearly 
a year ago, when, without injury or any other apparent cause, he 
was taken with a pain in the left knee-joint, and in less than 
twelve hours it became enormously swollen and exceedingly pain- 
ful. He was forced to abandon his work and seek rest, which in 
a few days brought about a marked improvement; the swelling 15 
disappeared almost completely, and the slight pain and soreness 
in the joint, which then existed, did not prevent him from follow- 
ing his occupation. From this time on, however, the knee was 
never entirely well, a mimber of slight attacks similar to the first, 
occurring during the summer months. Since November, he has 
been unable to work, the swelling remained permanently, being 
most marked at the upper recess of the synovial sac and on each 
side of the patella, The pain has never been severe when the 
limb is at rest, and until recently, the patient has been able to 
walk without the aid of crutches. 
On admission the patient was anaemic and had lost about 
twenty-five pounds in weight during his illness. A physical 
examination of the chest yielded a negative result. The left limb 
is atrophic. The swelling of the knee-joint, which is consider- 
able, appears to be due entirely to thickening of the synovial 
membrane, there evidently being no effusion in the joint. 
Patient can flex and extend the leg nearly as well as the opposite 
one. The temperature was normal before the first injection was 
given, but within six hours the thermometer registered 104.7° F. 
in the axilla. 
Number 
of 
Injections. 
Date. 
Dose in 
Milli- 
grammes. 
Temperatnre 
before 
Injection. 
Temperature 
during 
Keaction. 
Temperature 
after 
Reaction. 
Pulse before 
and during 
Reaction. 
1 
Mar. 9 
2 
98.4 
104.7 
98.2 
81 
108 
2 
“ 12 
2 
98.2 
101.8 
98.4 
78 
96 
3 
“ 16 
2 
99 
102.3 
98 
66 
84 
4 
“ 21 
2 
97.8 
99.6 
97.8 
72 
90 
5 
“ 25 
2 
99 
99.9 
99 
76 
80 
The local reaction was prompt after every injection, consisting 
of increased swelling, pain, and tenderness. After the fourth 
injection the physical signs pointed to the existence of a moder- 
ate effusion in the joint. During the febrile reaction, the patient 
suffered always more or less from headache, backache, and pain 
in the region of the spleen. As the general reaction appeared to 
have nearly ceased after the fifth injection, the Koch treatment 
was suspended to ascertain its ultimate effect upon the local 
lesion. As, a week later, no perceptible improvement had taken 
place, the joint was aspirated and about three ounces of a synov- 
ial fluid, in which minute fibrinous flocculi were suspended, 
removed, and an ounce of a ten per cent, iodoform emulsion 16 
injected. The Bruns’ treatment is being continued with a fair 
prospect of an ultimate recovery. 
Case 7. Tuberculosis of hip-joint. 
Maggie McDermott, aged fifteen,was admitted to the Milwaukee 
Hospital, February 28th, 1891, to be treated for an affection of the 
left hip-joint. Her father died of pulmonary tuberculosis five 
years ago. With the exception of the usual diseases incident to 
childhood, the patient considered herself in good health until a 
year ago, when she was taken with pain in the region of the left 
hip joint. From that time on she has walked with a decided 
limp, but continued her work as a servant girl until a few months 
ago. The pain was always worse at night and after undergoing 
unusual exertion. The greatest pain is referred to the region in 
front of the hip-joint, but at times she complains also of a pain 
about the inner aspect of the knee-joint on the same side. Her 
general health is not much impaired. An examination of the hip- 
joint reveals all the characteristic signs and symptoms of tuber- 
cular synovitis following a primary focus in the neck of the 
femur. Extension was made by weight and pulley; at the same 
time she was subjected to Koch’s treatment with results shown in 
the accompanying table. 
Number 
of 
Injections. 
Date. 
Dose in 
Milli- 
grammes. 
Temperature 
before 
Injection. 
Temperature 
during 
Reaction. 
Temperature 
after 
Reaction. 
Pulse before 
and during 
Reaction. 
1 
Mar. 2 
2 
99 
100.1 
98 
78 
92 
2 
“ 5 
4 
98 
103.3 
99.6 
80 
102 
3 
“ 12 
4 
99 
103.5 
100.4 
90 
112 
4 
“ 16 
4 
98.4 
100.6 
99 
84 
100 
5 
“ 21 
4 
99 
101 
98.4 
84 
92 
6 
“ 23 
4 
97.4 
99.4 
99.6 
80 
108 
7 
Apr. 3 
4 
98.2 
100 
99.4 
92 
104 
8 
“ 6 
4 
98 
100 
98.2 
94 
100 
The injections until towards the last always w7ere followed by 
an aggravation of the local symptoms which usually lasted until 
the end of twenty-four to thirty-six hours. Rest in bed and 
extension had a prompt effect in diminishing the pain and ten- 
derness, but the tuberculin injections appeared to have no 
influence in arresting the progress of the disease and had to be 
abandoned, as the patient’s general condition had undergone a 
decided change for the worse since their use had been com- 
menced. 17 
Case 8. Pulmonary and laryngeal tuberculosis; tuberculosis 
of middle ear on both sides, and of the mastoid process on the 
right side. 
Charles W. Mueller, aged thirty-five, German, farmer by 
occupation, came under my care at the Milwaukee Hospital, 
December 10th, 1890. Tuberculosis is hereditary in his family, 
and he gives a history of pulmonary tuberculosis dating back 
for a year and a half. About six months ago he became hoarse, 
a symptom which gradually increased in severity until he came 
to the hospital, when his voice was a mere whisper. Two months 
later his ears became affected, the first indication of this trouble 
being a roaring, buzzing noise attended by slight pain and fol- 
lowed by increasing deafness. The patient is considerably 
emaciated, but his appetite and digestion have been good. 
Examination of the chest reveals extensive infiltration of the right 
apex of the lung with a number of small cavities. The laryngo- 
scope shows numerous nodules at the base of the epiglottis and 
upon the vocal cords, oedematous infiltration, and at some points 
minute foci of caseation and ulceration; drum of the ear on 
both sides perforated and covered with fungous granulations; on 
the right side, over the mastoid process and a considerable dis- 
tance above and behind it, the skin is reddened and undermined 
by an extensive tubercular abscess. 
The abscess was incised and its interior, which was lined with 
a thick layer of granulation tissue, was scraped out with a sharp 
spoon, and after thorough irrigation was tamponed with iodoform 
gauze. Almost the entire external surface of the mastoid process 
was denuded of periosteum. Granulations taken from the interior 
of the abscess and from the external ear examined under the 
microscope contained numerous tubercle bacilli. The external 
ear on both sides was disinfected, iodoformized and loosely 
packed with absorbent cotton. Under this treatment some 
improvement was noticeable until the tuberculin treatment was 
initiated. This patient received the first dose of Koch’s lymph 
administered in the Milwaukee Hospital. Gradually increasing 
doses were given until the maximum dose, twenty-five milli- 
grammes, was reached, as both the local and general reactions 
were not well marked. As soon as the dose exceeded ten milli- 
Otitis Media Tuberculosa. 18 
grammes a diarrhoea set in which it was found difficult to control* 
and which greatly reduced the strength of the patient. 
Number 
of 
Injections. 
Date. 
Dose in 
Milli- 
grammes. 
Temperature 
before 
Reaction. 
Temperature 
during 
Reaction. 
Temperature 
after 
Reaction. 
Pulse before 
and during 
Reaction. 
1 
Jan.21 
2 
99 
102.2 
98.6 
84 
96 
2 
" 23 
4 
98 
101 
99 
80 
100 
3 
“ 25 
6 
98 
100.8 
98.4 
94 
100 
4 
“ 27 
10 
98 
102 
99.2 
86 
106 
5 
“ 29 
15 
97.2 
102.6 
98 
82 
98 
6 
Feb. 2 
18 
98.7 
101 .4 
98.2 
86 
90 
7 
“ 5 
20 
98.4 
102.8 
98.8 
82 
94 
8 
“ 7 
20 
99.3 
100.6 
99.2 
88 
104 
9 
“ 9 
25 
98.6 
102.2 
98.4 
84 
102 
During this treatment the patient lost his appetite, which in 
addition to the exhausting diarrhoea contributed largely to the 
rapid loss of flesh and strength. He left the hospital March 12th 
and died a few weeks later. I have no doubt that the lymph 
treatment shortened his life a number of weeks and perhaps 
months. 
Tuberculosis of Lymphatic Glands. 
Case 9. Tuberculosis of glands of neck; previous operation 
followed by relapse; tuberculin treatment; second operation. 
Clara Struebig, aged twenty, member of a highly tuberculous 
family, has been ailing since childhood with what was then 
denominated scrofula. Both corneae are opaque and at nine 
different times iridectomy has been performed. She has been 
the subject of glandular enlargement on the right side of the 
neck for several years, and November last she came to the hos- 
pital, and I removed a whole chain of glands extending from the 
external ear to the clavicle. The upper glands were in an 
advanced state of caseation; in some of them the caseous material 
had undergone liquefaction, transforming the interior of the 
glands into tubercular abscesses. The wound healed kindly and 
the patient left the hospital much improved in her general con- 
dition. 
Within a few weeks the glands on the opposite side of the 
neck commenced to enlarge, and when she again entered the 
hospital, February 14th, 1891, I found the deep glands under- 
neath the sterno-cleido-mastoid muscle enlarged as far as the 
middle of the neck and the superficial glands in the supra- 19 
clavicular space. On the right side the disease had returned in 
the lower portion of the neck where an uninterrupted chain of 
glands could be traced as far as the clavicle. As the Koch treat- 
ment was at that time being applied in all forms of tuberculosis, 
I was anxious to observe its effects on glandular tuberculosis, and 
as the patient was equally willing to submit to it, she received the 
first injection the day she entered the hospital. 
The patient not being strong and somewhat anaemic, only one 
milligramme was injected, but even this small dose produced 
violent constitutional symptoms. The temperature rapidly rose 
from 99.4° to 102°, the enlarged glands became more swollen 
and tender, and pulse rate increased from 80 to 120. The patient 
spent a sleepless night and complained of a violent headache. 
Number 
of 
Injections. 
Date. 
Dose in 
Milli- 
grammes. 
Temperature 
before 
Injection. 
Temperature 
during 
Reaction. 
Temperature 
after 
Reaction. 
Pulse before 
and during 
Reaction. 
1 
Feb.14 
1 
99.6 
102 
98 
80 
120 
2 
“ 
19 
1 
98.2 
99 
98.4 
84 
100 
3 
“ 
21 
2 
99 
103 
98.2 
98 
144 
4 
Mar. 
2 
A 
98.4 
99.4 
97.6 
74 
88 
5 
(( 
5 
A 
98.4 
100 
99.2 
81 
90 
6 
U 
9 
i 
98.4 
101.5 
98 
90 
116 
7 
U 
12 
l 
98 
100 
98.5 
81 
104 
8 
a 
16 
i A 
98.4 
99.4 
98 
76 
88 
9 
u 
18 
2 
98.4 
99.2 
98.2 
80 
88 
10 
a 
21 
2^ 
98 
100.6 
97.8 
72 
110 
11 
a 
24 
3 
98 
100.2 
98.2 
88 
100 
During this treatment the patient’s appetite diminished, 
frequent attacks of diarrhoea set in, which, with the periodical 
febrile disturbance following the injections, greatly reduced her 
strength. The third injection was followed during the febrile 
reaction by aching pains all over the body, but more particularly 
in the lumbar region. Glands that could not be felt before the 
tuberculin treatment was commenced, appeared as small, hard 
nodules under the skin, their number increasing almost with 
every injection. She remained in the hospital for a week after 
suspension of the treatment, when the glandular swellings 
decreased in size and her general condition commenced to 
improve. She left the hospital and returned after four weeks to 
submit herself to a second operation. The glands on both sides 
of the neck were removed, an operation attended by great difficul- 
ties, as the internal jugular had to be isolated to the extent of 
four to six inches. The wounds healed by primary intention, and 20 
the patient returned to her home at the end of two weeks. 
Examination of the glands after extirpation showed that begin- 
ning caseation had taken place in glands not larger than a hemp 
seed. This early caseation was evidently caused by the action of 
the tuberculin. 
Case 10. Tuberculosis of cervical glands on both sides; 
incipient tuberculosis of right apex of lung. 
Lena Messman, aged twenty-two, entered the Milwaukee 
Hospital January 27th, 1891. Tuberculosis hereditary in the 
family. She has had a cough for several months which she 
attributes to a catarrhal affection of the pharynx. Six months 
ago she noticed a number of enlarged glands on both sides of the 
neck just below the angles of the lower jaw. The glands slowly 
increased in size and new ones appeared lower down and along 
the posterior border of the sterno-cleido-mastoid muscles. Her 
general health is materially impaired. Both tonsils enlarged and 
mucous membrane of pharynx the seat of a hypertrophic catarrhal 
inflammation. A chain of enlarged lymphatic glands on both 
sides of the neck extending from the angles of the jaw to the 
clavicles, the largest of the glands being about the size of a hazel 
nut, their size diminishing from above downward. On the right 
side most of the glands can be felt underneath the sterno-cleido- 
mastoid muscle along the course of the large vessels of the neck, 
while on the left side the superficial glands are affected. The 
patient came to the hospital with the expectation of having an 
operation performed, but as a physical examination of the chest 
left no doubt that the right apex of the lung was the seat of an 
incipient tubercular infiltration it -was deemed advisable to give 
the tuberculin treatment a trial, to be followed, should it prove 
successful, by an operation later. 
Number 
of 
Injections. 
Date. 
Dose in 
Milli- 
grammes. 
Temperature 
before 
Injection. 
Temperature 
during 
Reaction. 
Temperature 
after 
Reaction. 
Pulse before 
and during 
Reaction. 
1 
Jan.27 
1 
99.4 
99.8 
98.4 
84 
96 
2 
“ 31 
2 
99 
104 
98.2 
88 
120 
3 
Feb. 3 
6 
98.2 
102.6 
98 
84 
98 
4 
“ 5 
5 
98 
103.8 
98 
92 
124 
5 
“ 9 
6 
98 
103.8 
98.2 
88 
124 
6 
“ 12 
5 
98.2 
101.7 
98.2 
72 
114 
7 
“ 14 
4 
98.2 
99.8 
98.2 
100 
120 
8 
“ 13 
4 
98 
100.4 
98 
96 
112 
9 
“ 19 
4 
98 
100 
98.2 
98 
106 
10 
“ 21 
5 
98.2 
99.6 
98.4 
100 
106 21 
During the febrile reaction which was always most marked 
about six hours after injection the cough was aggravated; at the 
same time the patient complained of soreness of the throat, pain 
in the chest and back; but after the first few injections the 
enlarged glands became more swollen, painful and tender. 
During this treatment the patient lost so much flesh and strength 
that operative interference was out of question. She remained in 
the hospital a week after the treatment had been suspended, but 
only partly regained her former strength, while the glands that 
could be felt were more numerous than when she entered the 
hospital, while those that had been previously enlarged presented 
more marked evidences of caseation and liquefaction of the 
tubercular product. 
Tuberculosis of Lung anb Larynx. 
Case 11. Otto Anderson, aged twenty-eight, was admitted to 
the Milwaukee Hospital January 26th, 1891. A brother died of 
pulmonary tuberculosis. He has had a dry hacking cough and 
occasional attacks of haemoptysis for a year and a half. Six 
months ago he became hoarse, and this symptom has gradually 
increased until now he is not able to speak above a whisper. 
Physical examination of the chest reveals a small cavity in the 
right apex, and tine and coarse rales as far down as the lower 
border of the third rib. The sputum contained an abundance of 
tubercle bacilli. The laryngoscope showed that the surface of the 
vocal cords was freely studded with miliary tubercles, which at 
some points had broken down, resulting in small excavated ulcers 
lined with pale, flabby granulations; epiglottis nearly same 
condition and oedematous. 
As the patient was treated at the same time by iodine inhala- 
tion it is somewhat difficult to estimate the value of the local 
action of the tuberculin on the laryngeal affection. During the 
commencement of the treatment, the laryngeal difficulty was 
aggravated, the tendency to cough increased, and the secretions 
from the larynx and pharynx more abundant and viscid. After 
the third injection, the ulcerations presented a more healthy 
appearance, the granulations were smaller and more vascular. 
The number of tubercle bacilli in the sputum was greatly 
increased. 22 
Number 
of 
Injections. 
Date. 
Dose in 
Milli- 
grammes. 
Temperature 
before 
Injection. 
Temperature 
during 
Reaction. 
Temperature 
after 
Reaction. 
Pulse before 
and during 
Reaction. 
1 
Jan. 
26 
2 
98.4 
101 
98.4 
72 
98 
2 
U 
28 
6 
98.6 
99.4 
98.4 
72 
80 
3 
U 
30 
9 
98.4 
99.6 
98.3 
72 
74 
4 
Feb. 
2 
9 
99 
101 
99 
66 
92 
5 
“ 
5 
10 
99.8 
100 
98.4 
76 
80 
6 
U 
7 
15 
98.4 
101.4 
98.8 
74 
100 
7 
u 
10 
10 
98.4 
100.6 
98.6 
72 
82 
8 
u 
18 
8 
96.6 
99.8 
98.2 
71 
80 
9 
a 
24 
10 
99 
100.6 
98.2 
82 
92 
10 
u 
28 
10 
98.4 
100 
99.2 
84 
90 
11 
Mar 
3 
10 
98.4 
100.2 
97.8 
86 
99 
12 
(£ 
5 
15 
98 
101.2 
98 
88 
90 
13 
U 
9 
15 
97.6 
99.6 
98.2 
72 
82 
14 
U 
12 
20 
98 
100 
98.2 
72 
98 
15 
U 
17 
15 
98.2 
100 
98 
82 
94 
16 
u 
20 
15 
98.4 
100.2 
98.4 
74 
84 
17 
u 
25 
20 
98 
99.5 
98.2 
76 
90 
This patient received more tuberculin than any of the cases 
previously reported, but notwithstanding the large doses 
employed the general reaction never was well marked and the 
patient did not lose in weight during the treatment, although at 
times the injections increased the tendency to diarrhoea. The 
improvement of the laryngeal lesion, which was apparent during 
the beginning of the treatment, now came to a standstill; no 
attempt at healing of the ulcers was observed, and when the 
patient left the hospital a week after the last injection was made 
the subjective and objective symptoms were about the same as 
when he entered. 
PuLMONARY TUBERCULOSIS. 
During the time the above cases of surgical tuberculosis were 
under my own care at the Milwaukee Hospital, forty-three cases 
of pulmonary tuberculosis were treated in the same institution by 
the same method by my colleague, Dr. E. Kovats. I desire on this 
occasion to thank him for the permission to use his material in 
the preparation of this paper. I had frequent opportunities to 
examine these cases before, during, and after treatment. The 
length of time the treatment was continued varied from one week 
to three months, on an average probably about four weeks. The 
doses ranged from one-half to eighty milligrammes; as a rule, 
they seldom exceeded five milligrammes. The injections were 
made every second or third day. An eruption of the skin resem- 23 
bling scarlatina was observed in several cases; in others herpes 
labialis appeared soon after injection. A general feeling of 
malaise, nausea, vomiting and diarrhoea were among the more 
common severe symptoms following the use of the remedy. 
Case 1. Joseph Stark, thirty years old, admitted to the 
hospital January 1st, 1891. Has for several years been suffer- 
ing from a chronic affection of the nose, which, upon careful 
examination, is found to be of a tubercular character. Has been 
ill for six months, and has had two attacks of haemoptysis, one 
two months ago, the other two weeks before admission. Physical 
examination of the chest reveals infiltration of both apices. 
During the treatment he had an attack of hemorrhage from the 
lungs, and on another occasion a profuse diarrhoea followed the 
tuberculin injection. On left side the disease extended, but the 
general condition appeared to be somewhat improved when the 
patient left the hospital at his own request. 
Case 2. Joseph Minz, aged thirty-five, entered the hospital 
February 5th, 1891. The history of pulmonary disease dates 
back four months. Dullness on percussion over left apex 
anteriorly, and fine crepitation on deep inspiration; same 
physical signs over posterior portion of right apex. During the 
treatment dullness and diminished respiratory sounds over the 
lower lobe of left lung appeared, showing that dissemination 
of the disease was hastened by the action of the tuberculin. 
When he entered the hospital the temperature was 102° F., 
which was always followed by a decided increase four or five 
hours after each injection. The dose was gradually decreased 
from five to one milligramme. The dullness over the affected 
areas increased and respiration became more difficult. He left 
the hospital decidedly weaker, and local conditions were more 
extensive than when the treatment was commenced. 
Case 8. Franz Kakuska, laborer, aged thirty-five years, was 
admitted March 8d, 1891. Dates his sickness back to an attack 
of pulmonary hemorrhage two years ago. Left apex extensively 
infiltrated. As he experienced no improvement after the injec- 
tions he left the hospital at the end of two weeks. 
Case 4. Ernest Stahlke, twenty-five years of age, admitted 
March 11th, 1891. Frequent pulmonary hemorrhages, begin- 
ning tuberculosis of larynx. Extensive disease of left lung with 24 
formation of cavities. Small doses produced decided reaction, 
both local and general, but the treatment was followed by speedy 
aggravation of all symptoms, which induced the patient to leave 
the hospital after a brief trial. 
Case 5. M. Fergusson, aged twenty-two years, farmer, came 
under treatment March 3d, 1891. He claims to have been in 
good health until three weeks ago. Diffuse infiltration on both 
sides and over a large surface, with high temperature. The 
patient insisted on being treated with Koch’s lymph, and received 
one milligramme every second day for a week. The temperature 
was increased by the injection, and remained continuously high, 
and the patient left the hospital much weaker than when he 
entered; at the same time the cough was much more troublesome, 
and breathing more difficult. 
Case 6. Adam Meinhard, aged twenty-four, farmer, was 
admitted to the hospital February 15th, 1891. His father died 
of pulmonary tuberculosis a few years ago. Has been suffering 
from a dry, hacking cough and slight pulmonary hemorrhage 
since last fall. Beginning infiltration of left apex indicated by 
slight dullness, fine, dry, crepitant rales, and prolonged expira- 
tory sounds. Small doses of tuberculin during the early part of 
the treatment produced intense local and general reaction. 
Sputum contained no bacilli. The dose was gradually increased 
to twenty milligrammes. At first the patient lost two pounds in 
weight, but later gained eight pounds. The patient was dis- 
charged as cured, and reported himself as being in good health 
several weeks after he had left the hospital. 
Case 7. N. A. Nelson, thirty-two years of age, was admitted 
to the hospital February 19tli, 1891. Has been ailing for a year 
and a half with symptoms of pulmonary tuberculosis, with 
occasional attacks of haemoptysis. Has been hoarse for several 
months owing to a well-marked laryngeal tuberculosis. Left 
apex extensively infiltrated. The treatment was continued for 
four weeks with no improvement of local or general symptoms. 
Case 8. George Pemkert, aged thirty-seven years, came to the 
hospital January 26th, 1891. Apex and base of lung on right 
side seat of disease; over the base posteriorly the physical signs 
point to the existence of small cavities. Sputum contained num- 
erous bacilli. Pulse 80, temperature towards evening 103° F. 25 
Breathing difficult and cough distressing. Injection of one to 
three milligrammes every other day appeared to improve the 
general and local conditions, as the temperature became less and 
the pulse diminished in frequency and increased in force. The 
dose was gradually increased from three to ten milligrammes, 
with the result that all the symptoms became aggravated. A 
pneumothorax developed suddenly in the right pleural cavity, 
followed by an effusion. Later two pints of a serous fluid were 
removed by aspiration. After this only small doses of tuberculin 
were used until March 20th, when the patient was discharged as 
incurable. He died at his home the latter part of April. 
Case 9. Robert Lewis, twenty-eight years of age, farmer, was 
admitted to the hospital January 1st, 1891. Has been sick for 
eleven months. During the month of August he had an attack 
of haemoptysis. Distinct dullness over right apex anteriorly, and 
diminished respiratory sounds, while posteriorly over the same 
area could be heard fine crepitation towards the end of forced 
inspiration. Beginning infiltration in apex of left lung. During 
the beginning of the treatment the injections produced typical 
local and general reactions, but later they were followed by 
nausea, vomiting, diarrhoea, and loss of appetite; at the same time 
the local extension increased from day to day and the general 
condition became so alarming that the patient was advised to 
leave the hospital. 
Case 10. Ben Walter, aged twenty-eight, came to the hospital 
to be treated by Koch’s method, January 22d, 1891. The disease 
commenced two and a half years ago with pulmonary hemorrhage. 
Has had a cough ever since. A fistulous opening leads to the 
lower jaw which is the seat of a tubercular affection. Small cavi- 
ties in left apex. Treatment was commenced with one-fourth of a 
milligramme of tuberculin, but the dose was gradually increased 
to ten milligrammes. The treatment was continued for several 
weeks, and when the patient left the hospital a decided improve- 
ment had taken place. 
Case 11. Henry Hayden, aged twenty-six, entered the hospital 
January 26th, 1891. Has not been well since he had la grippe 
a year ago. Both apices the seat of symptoms indicative of a 
catarrhal affection. Hoarseness from the beginning of the disease. 
No expectoration. The dose of tuberculin gradually increased 26 
from one to twenty milligrammes. Reaction slight. At times 
the injection followed by nausea and diarrhoea. Treatment con- 
tinued for more than two months. At the time the patient left 
the hospital an examination of the chest showed a decided 
improvement in the local conditions, dullness having disappeared 
entirely and crepitation could be heard only over isolated circum- 
scribed points. 
Case 12. Albert Studenraus, aged twenty-seven years, drug- 
gist, came under observation January 1st, 1891. Five years ago 
he had an attack of pneumonia on left side from which he never 
recovered completely. The physical signs point to tuberculosis 
of left apex and posteriorly on same side dullness and crepitation 
over base of lung. Had a slight hemorrhage from the lung day 
after admission. The injection of tuberculin never produced 
general reaction, although the dose during the ten weeks he was 
under treatment was increased to eighty milligrammes. His 
weight increased from one hundred and twenty-six and a half to 
one hundred and thirty-three and three-fourths pounds. The 
dullness over base of lung disappeared completely and the physi- 
cal signs over apex indicated great improvement. 
Case 13. Edward Williams, twenty-nine years old, engineer, 
came under treatment January 15th, 1891. Had an attack of 
pneumonia ten years ago from which he did not recover for four 
months. Examination reveals diminished respiratory sounds 
and slight dullness over right apex; gained three and one-half 
pounds in weight. Dullness diminished, but bronchial rales 
over apex remained at time of discharge. 
Case 14. Dennis Flynn, forty-four years old, farmer, was 
placed under Koch’s treatment February 24th, 1891. Had a 
hemorrhage from the lungs five months ago, and has not been 
well since. Physical signs indicate recent infiltration of right 
apex. Temperature before treatment always above 101° F. As 
soon as the injection was increased to five milligrammes the 
febrile reaction became so intense that the dose had to be dimin- 
ished to two milligrammes. Repeated attacks of haemoptysis. 
The pulmonary affection and general condition of the patient 
were so much aggravated by the treatment that he was advised to 
leave the hospital at the end of two weeks, having lost during 
this time six pounds in weight. 27 
Case 15. Fred Hadfield, twenty-four years old, suffering from 
advanced tuberculosis, was brought to the hospital February 2d, 
1891. Tuberculosis hereditary in the family. Disease com- 
menced six years ago with a tuberculosis of the ankle-joint which 
necessitated an amputation. Return of disease in the stump. 
Since January, 1888, has had five attacks of pulmonary hemor- 
rhage. Almost the entire left lung affected, the lower portion of 
which was solidified and the seat of multiple cavities. Injections 
of tuberculin in doses of one milligramme were made at his 
urgent request every other day. The temperature, which was 
never less than 101° F., was always increased by the injection. 
Treatment continued for about three weeks. During this time 
the local conditions remained about the same, but the subjective 
symptoms were improved and the patient gained two pounds in 
weight. At the time he left the hospital, the temperature curves 
were about the same as before the treatment was commenced. 
Case 16. Oscar Kurze, thirty-seven years old, machinist, was 
admitted to the hospital February 3d, 1891. The pulmonary 
affection commenced two years ago, but patient was able to follow 
his occupation until five weeks before he entered the hospital. 
Hoarseness for one year. Extensive infiltration of lung on right 
side with small cavities in apex. Laryngosc ne reveals tubercu- 
losis of larynx. During the four weeks he was under treatment, 
he gained six pounds in weight, but the local conditions remained 
about the same. 
Case 17. John Wahlen, thirty-four years of age, shoemaker, 
was placed under the lymph treatment February 7th, 1891. Had 
two hemorrhages from the lungs, the first, five, and the second, 
three years ago. Pulmonary affection located in right apex. 
Incipient tuberculosis of larynx. Treatment continued several 
weeks, during which time he lost four pounds in weight; at the 
same time the local affection and all of the subjective symptoms 
were greatly aggravated. 
Case 18. Albert Sprenger, forty years old, machinist, entered 
the hospital March 4th, 1891. He dates his pulmonary affection 
back to an attack of la grippe fourteen months ago. Physical 
examination reveals tuberculosis in apex of left lung with a focus 
at base of right lung. Temperature before treatment ranges 
between 99 and 100° F., and never rose afterwards above 101 F., 28 
although the dose of tuberculin was gradually increased to twenty 
milligrammes. He gained four pounds in weight and the local 
and general conditions appeared to be improved by the treatment. 
Case 19. Eugen Bentzler, twenty-five years old, painter, 
came under treatment March 7th, 1891. Has not been well since 
he suffered from an attack of la grippe a year ago. 
Infiltration of right apex and base of left lung. Patient 
gained seven pounds in weight and improved otherwise under 
treatment. 
Case 20. Ferdinand Rossow, aged nineteen, clerk, entered 
the hospital March 16th, 1891. Disease commenced with an 
attack of pulmonary hemorrhage November last; since that time 
he has had a hacking cough. 
Dullness and cavernous breathing over left apex; dullness 
and bronchial rales over base of left lung. Has high evening 
temperature. The dose of tuberculin never exceeded one milli- 
gramme. The patient lost four pounds in weight in the course 
of two weeks, and during the same time the extension of the 
pulmonary affection was rapid and the cavities increased in size. 
Case 21. Theodor Freese, thirty-four years old, bricklayer, 
came under treatment March 19th, 1891. Pulmonary affection 
commenced November last, and two months ago he had an attack 
of pulmonary hemorrhage. The laryngoscope reveals a com- 
mencing tuberculosis of the larynx. Dullness and bronchial 
breathing over right apex. Pneumothorax on left side. Great 
dyspnoea; temperature 104° F. As the patient insisted on being 
treated with Koch’s lymph, half-milligramme doses of tuberculin 
were injected every other day. This treatment had no effect on 
the temperature. The patient died April 2d, 1891. 
Case 22. William Heath, twenty-three years old, traveling 
agent, came to the hospital to undergo treatment for an affection 
of the larynx March 23d, 1891. The laryngeal trouble com- 
menced in May, 1890. Laryngoscopic picture presents the char- 
acteristic appearances of advanced tuberculosis of nearly all the 
structures at the entrance into the larynx. Infiltration of both 
apices. Evening temperature before treatment 103.4° F. One- 
half milligramme doses of tuberculin were employed, but they 
had no influence on the temperature, or in arresting the rapid 
progress of the laryngeal and pulmonary lesions. Case 23. John Banner, aged twenty-three, wagon-maker, 
placed himself under Koch’s method of treatment at the hospital 
March 25th, 1891, for tuberculosis of the larynx and right apex. 
He received three doses of tuberculin of one milligramme each 
during the course of one week, and then left the hospital 
without any signs of improvement. 
Case 24. John Giegerich, aged twenty-four, bookkeeper, 
entered the hospital January 24th, 1891. Disease commenced 
with haemoptysis six years ago. Spent one year in Colorado 
without much benefit. 
Large cavity in upper lobe of left lung and beginning infiltra- 
tion of right apex. The dose of tuberculin increased gradually 
from one to ten milligrammes. Large doses produced nausea, 
bloody sputa, but the temperature during reaction never rose 
above 101° F. Treatment was continued with small doses for 
over two months with the result that the subjective symptoms 
improved somewhat, but the local lesions remained unaffected. 
Case 25. Mary Brockmayer, aged twenty-three, came to 
the hospital January 22d, 1891. Disease commenced September, 
1890. Large cavity in upper portion of left lung; beginning 
infiltration of right apex. The evening temperature was high 
before treatment was commenced, and the patient left the hospital 
at the end of two weeks decidedly worse in every respect than 
when she entered. 
Case 26. Mrs. Wendland, aged thirty-three, housewife, became 
an inmate of the Milwaukee Hospital for the purpose of being 
treated with Koch’s lymph for advanced pulmonary tuberculosis. 
Only small doses were employed to satisfy the patient, who insisted 
on being treated by this method. The treatment had no effect 
in arresting the rapid progress of the disease, and the patient 
died during the second week. 
Case 27. Mrs. Krcehnke, aged forty-three, was admitted to 
the hospital January 24th, 1891. Pulmonary affection commenced 
two and a half years ago with haemoptysis. Cavity in right apex. 
Under the tuberculin treatment the objective and subjective 
symptoms were greatly aggravated, and the patient left the hos- 
pital in a critical condition at the end of three weeks. 
Case 28. Ella Berg, aged sixteen, was admitted to the hospital 
January 29th, 1891. Pulmonary disease had existed for two 
29 30 
years. Dullness over left apex as far as the fourth rib, cavernous 
breathing over this space. Over base of lung on same side moist 
bronchial rales. Injections never exceeded three milligrammes. 
Rapid emaciation, increase of fever, and aggravation of subjective 
symptoms necessitated suspension of treatment. The patient left 
the hospital at the expiration of two weeks and died a few days 
later. 
Case 29. Carrie Mathieson, aged twenty-four, milliner, came 
to the hospital January 31st, 1891. 
Has not been well since she suffered from la grippe a year 
ago. Since then has had two attacks of pulmonary hemorrhage, 
the first in July, the second in December, 1890. Extensive 
infiltration of left upper portion of lung with cavities in apex. 
Under the tuberculin treatment she failed rapidly. She left the 
hospital at the end of three weeks, and died at her home a few 
weeks later. 
Case 30. Minna Bartel, twenty-five years old, housewife, 
sought hospital treatment February 3d, 1891. Duration of disease 
seven months. Advanced pulmonary tuberculosis with secondary 
tuberculosis of larynx. Tuberculin treatment was tried faithfully 
for a number of weeks with decidedly unfavorable results. 
Case 31. Augusta Avery, twenty-four years of age, house- 
wife, was admitted to the hospital January 27tli, 1891. Disease 
commenced with a pulmonary hemorrhage July 4th of the pre- 
ceding year. Copious haemoptysis four weeks before she entered 
the hospital. Slight dullness and diminished respiratory sounds 
over right apex anteriorly. Small doses of tuberculin produced 
no rise in temperature, but when ten milligrammes were injected 
the temperature during reaction reached 101.4° F. 
About this time patient complained of soreness in the pharynx, 
and on inspection a number of nodules varying in size from a 
hazel-nut to that of a walnut could be seen, the mucous membrane 
covering them in a state of intense inflammation. As no improve- 
ment was perceptible in the conditions of the lung, and at the 
same time both wrist-joints became swollen and painful, the 
treatment was suspended. 
Case 32. Minna Feldt, aged twenty-two, housemaid, was 
admitted to the hospital January 24th, 1891. Claims that dura- 
tion of disease does not extend over four weeks. Three weeks 31 
ago haemoptysis. Examination reveals incipient tuberculosis of 
right apex. Tuberculin injections in increasing doses continued 
for several weeks had no effect in arresting the progress of the 
disease. 
Case 33. Christine Stromberg, aged twenty-six, housewife, 
entered the hospital January 24tli, 1891. She fixes December 
8th, 1890, as the day when her pulmonary disease commenced. 
Incipient tuberculosis of right apex. Tuberculin injections 
caused but slight reaction. Local condition somewhat improved 
when she left the hospital four weeks after admission. 
Case 34. Maria Niebuhr, twenty years old, milliner, came 
under treatment February 2d, 1891. Had an attack of whooping- 
cough a year and a half ago, and has had a cough ever since. 
Dullness and fine bronchial rales over left apex and coarse 
bronchial rales over base on same side. Evening temperature 
high. Local and general condition aggravated by the tuberculin 
injections. 
Case 35. Amanda Sundermann, aged twenty, housemaid, 
entered the hospital March 12th, 1891. Has been ill since 
October, 1890. Beginning tuberculosis in upper portion of right 
lung. Largest dose of tuberculin used eight milligrammes. 
Some improvement until she came down with an attack of 
la grippe while in the hospital. 
Case 36. Max Seibel, twenty years old, was admitted to the hos- 
pital January 26th, 1891. Advanced pulmonary tuberculosis with 
high evening temperature. The injections of tuberculin increased 
the temperature curves and hastened the fatal termination. 
Case 37. Herman Zuehlke, aged thirty, admitted to hospital 
January 31st, 1891. Tuberculosis of larynx and infiltration of 
both apices and base of left lung. The tuberculin injections were 
followed on three different occasions by haemoptysis, and on that 
account treatment was suspended and patient advised to leave the 
hospital. 
Case 38. Joseph List, twenty-three years old, came to the 
hospital January 31st, 1891, to be treated by injections of Koch’s 
lymph for advanced pulmonary and laryngeal tuberculosis. The 
suffering and debility were greatly increased by the injections, 
and the patient was advised to return to his home. He died a 
few weeks after he left the hospital. 32 
Case 39. J. Biedermann, thirty years old, entered the hospital 
February 3d, 1891. Duration of pulmonary disease one year. 
Part affected, right apex. Tuberculosis of larynx commenced 
several months ago. Tuberculin treatment proved very danger- 
ous in this case, as the local lesions extended rapidly, and the 
debility increased after every injection. Patient discharged at 
the end of two weeks. 
Case 40. D. Haget, forty-three years old, presented himself at 
the hospital for the Koch treatment January 26th, 1891. Cavity 
in upper portion of right lung with commencing infiltration of 
left apex. Treatment continued for three weeks when the patient 
left the hospital in a critical condition at his own request. Death 
three weeks subsequently. 
Case 41. Charles Wagner, aged twenty-eight, brass finisher, 
entered the hospital February 2d, 1891. Has had a cough for 
ten years and haemoptysis in 1887. Limited infiltration of right 
apex. Tuberculin injections were well borne, and the patient 
left the hospital after four weeks’ treatment, materially improved. 
Case 42. Henry Pritchard, thirty years old, came under treat- 
ment February 3d, 1891. Extensive infiltration of right apex. 
The tuberculin injections hastened the local extension of the 
disease and produced such great prostration that treatment was 
suspended at the request of the patient. Death a few weeks after 
he left the hospital. 
Case 43. Herman Rehm, nineteen years old, farmer, came to 
the hospital February 7th, 1891, for the purpose of undergoing 
treatment by Koch’s lymph. Extensive infiltration of left apex; 
over base of left lung, dullness, fine and coarse bronchial rales. 
Noticeable improvement had taken place in the general condition 
of the patient when he left the hospital at the end of six weeks; 
at the same time the physical symptoms indicated that the local 
condition had undergone a favorable change. 
The injections were made as a rule every other day in order 
to ascertain the full extent of the local and general reaction fol- 
lowing each dose of tuberculin. The first dose never exceeded 
one milligramme, and in grave cases the treatment was com- 
menced with one-half of this quantity. The dose was never 
increased, if the temperature during the reaction following it rose 
above 101° F., and if this result was reached in many cases the 33 
dose was diminished, or the interval between the injections 
increased. It is therefore probable that in the grave cases the 
unfavorable symptoms following the injections were not so much 
due to the action of the tuberculin as to the intrinsic tendencies 
of the disease to aggravation. It is, however, an entirely different 
matter in the mild cases in which in spite of a careful increase of 
the dose the local and general symptoms underwent a rapid 
change for the worse, as in such cases the unfavorable results 
must be attributed to the action of the tuberculin and not to the 
intrinsic tendencies of the disease. The whole number of cases 
treated by tuberculin injections at the Milwaukee Hospital during 
the months of January, February, March and April is forty-three 
—thirty-two males, and eleven females. For the sake of con- 
venience these can be divided into mild, medium, and grave cases. 
Mild cases, 8 males and 4 females 12 
Medium cases, 10 males and 2 females 12 
Advanced cases, 14 males and 5 females 19 
43 
Died in the hospital, one male and one female 2 
Aggravation of all the symptoms during treatment: 
14 males and 8 females 22 
No improvement, 5 males and 1 female 6 
Improved, 10 males and 1 female 11 
Apparently cured, 2 males 2 
Died, 2 
43 
Died soon after leaving the hospital: 
4 males and 2 females, 6 
Of the mild cases unfavorably affected by the treatment: 
1 male and 3 females, 4 
Of the mild cases improved, 4 males and 1 female 5 
Of the mild cases apparently cured, 2 males, 2 
11 
The two cases that were apparently cured belonged to the 
mild type of the disease; no such result was obtained in any of 34 
the thirty-one cases belonging to the medium or advanced form 
of the disease. In one of the cases that was apparently cured, 
the sputum contained no bacilli, and in the other there was no 
expectoration, consequently some doubt must remain as to the 
tubercular nature of the pulmonary affection. 
In the cases of medium gravity the result of the treatment 
was as follows: 
Aggravated 5 
Not improved 2 
Improved 5 
. 12 
In the grave cases the treatment was followed by serious 
results in 12 
By no improvement in 3 
By temporary improvement in 2 
By death 2 
19 
General Remarks. 
Diagnostic Value of Tuberculin. Great diversity of opinion 
prevails at the present time as to the diagnostic value of tuber- 
culin. The first reports of the use of this substance were unani- 
mous in attributing to it positive diagnostic value. It was claimed 
that reaction only occurred in tubercular patients by the specific 
action of the lymph on tubercular tissue, and that the absence of 
increase of temperature after injection of the lymph decided the 
non-tubercular nature of the affection. 
Leyden, Quincke, Ebstein, Weber and Biermer maintain that 
the absence or presence of reaction after the use of tuberculin 
must not be regarded as absolute proof of the existence or non- 
existence of tubercular disease in all cases. 
Schultze, Finkler, Guttmann, Schreiber, Lichtheim and 
Rumpf have great faith in the diagnostic value of the use of 
tuberculin in tuberculosis of the internal organs. The same 
discrepancy of opinion exists among surgeons as to the value of 
tuberculin injections in the differential diagnosis of surgical 
tubercular and non-tubercular lesions. 35 
Bergmann relies on the reaction following the use of tuber- 
culin in differentiating between tuberculosis on the one hand and 
syphilis and carcinoma on the other. Bardeleben and Kohler are 
reserved in their verdict as to the diagnostic value of the method. 
Trendelenberg regards the febrile reaction following an injec- 
tion of tuberculin as an evidence of the tubercular nature of the 
lesion, except in tuberculosis of the testicle. Esmarch is of the 
opinion that in doubtful cases the reaction following the use of 
the remedy is of great diagnostic value. Bramann and Mikulicz 
place great confidence in the presence or absence of reaction. 
Konig and Hildebrand have observed reactions in lesions resem- 
bling in appearance tubercular affections, but which by other 
diagnostic aids were shown not to be of a tubercular nature. 
Clinical experience has demonstrated that general reaction is 
produced by tuberculin in cases of actinomycosis and in certain 
forms of sarcomatous tumors, and that consequently this method 
of diagnosis cannot be relied upon in differentiating between 
tubercular lesions and these affections. 
A number of the cases reported in this paper furnish con- 
clusive proof that the susceptibility to general reaction varies 
greatly in different tubercular individuals. In some, intense 
reaction followed the use of small doses when the tubercular 
lesion was limited; in others suffering from extensive tubercu- 
losis, large doses produced no rise in temperature. That in the 
latter class of cases the affection was of a tubercular nature there 
could be no doubt from the history of the cases, the appearance 
and location of the lesions, the subsequent behavior of the affec- 
tion; and in some of the cases the presence of tubercle bacilli in 
the affected tissues was demonstrated. 
I look upon the local reaction in affections of the lymphatic 
glands as a valuable diagnostic aid in differentiating by the use 
of Koch’s lymph between tubercular and non-tubercular affections 
of these organs. If the enlargement of the lymphatic glands is 
due to a tubercular affection, the existing swellings not only 
become larger, more painful and tender a few hours after the 
injection of a dose of the lymph, but other glands that could not 
be felt before the injection become enlarged, and can be felt in 
the vicinity of those that were recognized before the use of the 
remedy. But even in such cases I regard inoculation-experiments 36 
of greater diagnostic value than injections of tuberculin, yielding 
more positive results without exposing the patient to the risks of 
local and metastatic dissemination of the disease incident to the 
latter procedure. 
If patients suffering from non-tubercular affections will 
occasionally, only, respond to the tuberculin test on the one hand, 
and on the other, in exceptional cases, individuals suffering from 
well-marked typical tubercular affections have proved themselves 
refractory to the action of tuberculin, it must appear evident that 
the use of this substance cannot be relied upon in making a 
positive differential diagnosis between tubercular and non- 
tubercular affections. If it can be shown at the same time that 
a single injection of tuberculin is not devoid of danger, and that 
implantation of the product of this disease in guinea pigs in the 
course of three or four weeks will yield results which will enable 
us to make a reliable diagnosis between tubercular and non- 
tubercular affections, it is apparent that the use of Koch’s lymph 
as a diagnostic resource should be discarded or at least limited to 
exceptional cases. 
Therapeutic Value of Tuberculin. It is now generally con- 
ceded that many cases of tuberculosis reported as cured have 
since relapsed; some of these have died, and others have been 
subjected to different treatment. In many instances, of course, 
the original report has not been supplemented by subsequent 
communication; as an absolute diagnosis, even by the use of 
Koch’s lymph, is not always possible. It may be some of the 
alleged cures rest on a faulty diagnosis. This applies with special 
force to the two cases of pulmonary disease reported as cured in 
this paper. 
Again, it must not be forgotten that tubercular affections not 
infrequently, under favorable local or general conditions or 
improved dietetic, hygienic or climatic changes, undergo a spon- 
taneous cure, so that for nearly all methods of treatment so far 
suggested similiar exceptional results can be claimed. In not a 
single instance of the eleven cases of surgical tuberculosis that 
came under my own observation did the treatment result in any- 
thing more than a temporary improvement, and in several of them 
it was followed by local extension of the disease and serious 
impairment of the general health. The effect of tuberculin 37 
proved more serious in the treatment of the forty-three cases of 
pulmonary tuberculosis. There can be but little doubt that in a 
number of the fatal cases, death was hastened by the treatment, 
and that in a number of the mild cases it contributed largely 
towards the rapid local extension of the lesion; while the tubercu- 
lin treatment of pulmonary tuberculosis can show no better 
results, it is difficult to ignore the fact that it has been productive 
of more harm than almost any other plan of treatment heretofore 
suggested, and on this score alone the verdict “Away With Koch’s 
Lymph! ” is timely and imperative. 
Dangers Attending the Use of Tuberculin. Tuberculin when 
brought in contact with tubercular tissue produces coagulation- 
necrosis, and during this process a toxic chemical substance is 
produced, which, when it reaches the general circulation, causes 
the febrile reaction. The time necessary to reach this stage of its 
action is usually from three to six hours. The intensity of the 
reaction depends on the quantity of the toxic substance that is 
produced and finds its way into the general circulation. The 
general reaction is a septic condition of the organism produced 
by the toxic substance resulting from the action of the tuberculin 
on the tubercular tissue. The temperature and the other general 
symptoms continue until this toxic substance is eliminated 
through one or more of the excretory organs. The immediate 
danger attending the tuberculin treatment consists in the produc- 
tion and introduction into the circulation of a fatal dose of this 
toxic substance. That the fear of a fatal sepsis resulting from 
the action of Koch’s lymph is not unfounded is shown by a 
number of such cases that have been reported. If the whole 
truth were known, this number would be greatly increased by 
unpublished cases. 
The more remote dangers attending the tuberculin treatment 
have been pointed out by Virchow. The destructive effect of the 
tuberculin on the granulation tissue breaks down the wall sur- 
rounding the infected area and liberates the bacilli and their 
spores, an occurrence which can hardly fail in giving rise to local 
and general dissemination. The granulation tissue, the specific 
primary product of tubercular inflammation, is the wall of defense 
built up by the tissues to protect the adjacent parts and the 
organism against invasion. Any method of treatment which 38 
interferes with this manner of defense clears the way for the 
enemy and secures victory for the invading army. If future 
research should lead to the discovery of a specific remedy for the 
cure of tuberculosis, it will be an antagonistic microbe to the 
bacillus of tuberculosis or a substance which, when brought in 
contact with a tubercular focus, will have an opposite effect on 
the tissues from that of Koch’s lymph. 
I have given Koch’s lymph a fair trial and have carefully 
observed its effects, and have become firmly convinced both of 
the danger which attends its use and its utter inutility in curing 
any form of tuberculosis. 
This paper has been written for the special purpose of placing 
myself on record as one who protests earnestly against further 
experimentation with this mysterious and dangerous fluid. A 
careful study of the voluminous literature on the use of Koch’s 
lymph, and my own experience with it, have induced me to head 
this paper with the title it bears, “Away With Koch’s Lymph !”