Part 11

Dr. Mersch published a pathogenesy, based to a large extent upon that of Dr. de Keghel; it is an excellent work.

"On Tuberculin," an extract from the Journal Belge d' homeopathie, 1895.

Dr. d'Abzen, of Lisbon, sent to the Tuberculosis Congress of 1895, at Coimbra, a study of the works of Koch and Pasteur, and an enumeration of the treatises published by homoeopathists.

Pathogenese, sua importancia.

We must notice also an English translation of Dr. Mersch's pathogenesy, by Dr. Arnulphy, of Chicago, in which special attention is paid to the symptoms observed in healthy and non-tuberculous persons, with some original remarks about Tuberculin. It is published in the Clinique for this year (February, 1896).

Nor must we overlook a series of writers who have published isolated observations of the cases of persons cured with Tuberculin. Such are Drs. Lambreghts, Joussett, Zoppritz, Horace Holmes, Richardson, Young, Clarke, Pinart, Youman, U. H. Merson, Snow, Lamb, Clarke, Ebersole, W. James, Kunkel, A. Zoppritz, Steinhauf, Van den Berghe, &c.

Finally, for my own part, in my articles in L'Art Medical, published three years ago, and in the Hahnemannian Monthly (July, 1894), I have insisted on homoeopathic action of the viruses of tuberculosis.

In certain of the pathogenesies of Tuberculin we find thrown pell-mell together symptoms appertaining to Koch's lymph, as well as others which belong to the product baptized by several names, such as Bacillinum and Tuberculin, in the recommendation of which Hering and Swan, and Dr. J. Compton Burnett, in England, have made themselves conspicuous.

Bacillinum--since it must be distinguished from Koch's Tuberculin--is a maceration of a typical tuberculous lung. Koch's lymph is an extract in glycerine of dead tuberculous bacilli. The former is compound natural infection; the latter is a product of laboratory experiment. In the one, various bacteriological species are associated which give, clinically, an appearance of cachexia and of hectic fever; from the other we may sometimes observe vascular, cardiac, renal changes having no connection with the clinical "syndrome" of pulmonary tuberculosis. To place these products together in the same pathogenesy gives an absolutely wrong sense, and the fact that both contain Koch's bacillus gives no excuse for confounding them. In my opinion there are, from a homoeopathic point of view, distinct differences between Bacillinum and the Koch's lymph.

Dr. J. Compton Burnett, in his book, "New Cure for Consumption," p. 129, makes this remark: "The best way to get some really good Bacillinum is to take a portion of the lung of an individual who has died of genuine bacillary tuberculosis pulmonum, choosing a good-sized portion from the parietes of the cavity and its circumjacent tissue, as herein will be found everything pertaining to the tuberculous process--bacilla, debris, ptomaines and tubercles in all its stages (such was practically the origin of the matrix of my Bacillinum) and preparing by trituration in spirit. In this way nothing is lost."

Experimentally Koch's bacillus, like many other microbes, does not reproduce a clinical symptom-group; and we homoeopaths must have an assemblage of clearly-defined symptoms before prescribing a poison on homoeopathic principles. Such is unfortunately the case with many other microbes in pure culture. The experimental diphtheria does not resemble clinical diphtheria. The pneumococcus, pathogenetic of pneumonia, is met with in many other diseases, such as pleurisy, salpingitis, meningitis, etc. Koch's bacillus, too, sometimes remarkably mild in its effects, and seeming to meet with no reaction in the system, evolves aside as in the verrucous tuberculosis; while at other times nothing is able to arrest the action of this terrible microbe, and the world still waits in vain for the man who shall find the means of combatting it. The toxins of tuberculosis are far from reproducing clinical tuberculosis; yet even here we find a curious aspect sometimes assumed by certain poisons drawn from the pure cultivation of microbes. We cannot produce with Tuberculin symptoms analogous to those of real tuberculosis--as it is possible, for instance, to produce tetanus with the toxine alone, Tetanin.

As a general rule, in the case of a healthy man, Koch's lymph would not develop any reaction, its effects manifesting themselves in a febrile congestion, which betrays the presence of tubercles. In our pathogeneses (those of Mersch-Arnulphy), we note the following symptoms--"catarrhal pneumonia with soft hepatisation, and tendency to abscess formation; at post-mortems it is not a gelatinous or fibrinous exudation which oozes out from the alveoli, but an opaque and watery fluid; 'never,' so says Virchow, 'is there found the characteristic lesion of croupous pneumonia.'" A pneumonia from which issues an aqueous and opaque liquid! I confess I do not understand it.

Experimentally this same lymph of Koch gives symptoms of inflammation of the arteries which are not found in clinical tuberculosis.

Animals inoculated with progressive doses of Avian tuberculin, or with serum of tuberculous animals, undergo wasting and loss of appetite, and other general symptoms. They may die of cachexia, or may develop an isolated abscess; but they do not present characteristic symptoms as they would under the action of Cantharis, of Phosphorus, or of Lead.

Finally, inoculation with dead bacilli may produce real tuberculosis.

In the pathogenesy put forth by homoeopathists, pulmonary symptoms do not occupy a prominent place. Dr. Burnett, who has experimented on himself with Bacillinum, notes at the end of his symptoms, after the headache, a slight and almost insignificant cough.

In explaining the clinical forms of infectious complaints, we are frequently forced to admit the increasingly preponderant part played by association of microbes--as it is the frequent case in diphtheria--and especially the modifications which depend directly on the disposition of the organ attacked, and not upon the action of the microbe itself.

An examination of the above considerations leads me to the following conclusions:

1. That the importance of the materia medica of the tubercular virtues ought not to be exaggerated. There are few characteristic symptoms to take off; it is more wise to guide oneself in the homoeopathic application of the therapeutics by the clinical symptoms of the evolution of the various tuberculosis, rather than by the intoxication produced by their active products, the Tuberculins.

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 homoeopathic remedies.

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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 homoeopathicity of Koch's lymph in nephritis. Dr. Jousset has experimented in it with encouraging results, using homoeopathic dilutions, in Bright's disease; and at the meeting of the Societe Homoeopathique Francaise on April 18, 1895, Drs. Tessier, Silva and Jousset, father and son, mentioned the diminution of albumen 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 homoeopathic dilutions in cases of tuberculosis. Personally I have not used it, and I am loth to pass 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 homoeopathic 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 homoeopathists have not used this remedy in all the infinitesimal dilutions. Homoeopaths 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 homoeopathic 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 assumed 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.