Part 6 (1/2)
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 diminis.h.i.+ng 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.