Max Birnbaum

“ We need but consider, that pulmonary consumption, the most frequent form of tuberculosis, annually demands over 30,000 victims in the cities of the German Empire over 15,000 inhabitants, and out of every 100 deceased 12–13 have fallen prey to this sickness.
The number of sufferers from pulmonary consumption can not nearly be determined, it certainly exceeds all other diseases by far. In the case of many people we can only infer from their appearance and hereditary tendencies, before visible signs can be discovered, that they will succumb to this terrible disease. ”

“ We will see that Koch's new method to cure has the advantage both to make visible all tubercles, even those that have escaped our notice and also to effect a cure in the shortest time even in old chronic cases that have before this been considered incurable. It is especially possible in this form of tuberculosis to follow the specific action of the new remedy, as we will learn later on.
Tuberculosis of the testicles is not so very rare, it is found in about 21⁄2 per cent. of all men afflicted with pulmonary consumption. It is more rarely met with in children than in men. ”

“ Very important for the recognition of the disease is the manner of vomiting. For a child suffering from a spoiled stomach will be troubled with nausea, belching, choking and cold sweat long before it is forced to vomit, while children with acute hydrocephalus will throw up without any previous symptoms of that kind, just as though they filled the mouth with water and spit it out again. Vomiting is facilitated when children are raised or placed on their side. ”

“ Any physician who fails to search for tubercle bacilli in the sputum, to establish phthisis in as early a stage as possible, commits gross negligence toward his patient, because his life may depend on this diagnosis and the specific treatment which has hurriedly been introduced on this basis. In doubtful cases the physician should gain certainty as to the existence or absence of tuberculosis through a trial injection. ”

“ It has not been definitely decided at the present time whether the drinking of milk from tuberculous cows brings with it the danger of tuberculosis for mankind. It will certainly be best to avoid such milk, especially when the cow's udder is found to be tuberculously diseased or when tubercle-bacilli can be traced in the milk.
The use of meat as food may also become dangerous to man, but this is a rare occurrence. It is particularly dangerous to eat the liver, kidneys and lymphatic glands of tuberculous animals. ”

“ Inflammation of the hip-joint developes very slowly in children, it generally takes months before the slightest beginning symptoms reach a threatening appearance. The first sign is lameness; among laymen tuberculous inflammation of the hip-joints is known as "voluntary limping."
By limping we understand that mode of walking in which one leg is spared and by this the trunk is supported only a short time by one extremity and all the longer by the other. In every painful affection of the lower extremity limping results as the weight of the body increases the pain. ”

“ The treatment of lupus has principally been a local one. Caustics were applied to destroy lupous tubercles by direct action, and furthermore recourse has been taken to the so-called mechanical treatment, in which the ringworm was scraped out.
Our experiences relating to the mechanical treatment of lupus have taught us the following.
Lupus can not be cured without destroying and removing the diseased and affected tissue. That method which effects the most radical destruction, protects most from relapses. Therefore the best method of treating lupus is to cut out the diseased skin. ”

“ Pulmonary consumption is only one form of tuberculosis, by far the most frequent. This is the reason why pulmonary consumption, pulmonary tuberculosis, consumption and tuberculosis are used as synonymous terms.
Tuberculosis is the general expression. By that we understand a disease which is generated by a certain kind of organism belonging to the class of bacteria. These organisms are the tubercle bacilli, which were discovered by Koch in the year 1882.
Now these tubercle bacilli settle most frequently in the lungs and here cause serious derangements of the lung tissue. ”

“ The manifold scrofulous affections, such as inflamed eyes, diseased ears, skin diseases, catarrh of the nose, pharynx or bronchials, inflammation of the joints and suppuration are not caused through the cooperation of tubercle-bacilli. But here the [68] same find an excellent soil for growth and propagation, and they use the same to the full extent and so give the impetus for the development of tuberculosis.
Scrofula is one of the most frequent diseases, it is spread over the whole world. It occurs more seldom in the tropics than in the north. ”

“ Pulmonary consumption is not hereditary in the strict sense of the word. Only an inclination to this [12] disease is transmitted. As the danger of contagion of those having such disposition is very great, so as a rule the disease makes its appearance sooner or later.
On the other hand it must be considered that the penetration only of the tubercle-bacilli into the body is not sufficient to generate tuberculosis. If they do not find the ground adapted to their nourishment and propagation they perish. ”

“ Then a so-called immunity results which we know of in other similar diseases. We know that anyone who has had the measles or scarlet fever rarely is again attacked by the same, as a rule he is permanently proof against them.
In the same way as vaccination protects from small pox, an injection of Koch's remedy acts against pulmonary consumption. Koch makes a cautious statement:
"On the other hand it is possible, from analogy with other infectious diseases that those who are once cured become permanently exempt." ”

“ But this much should be remembered by everyone that this remedy also acts best and surest during the beginning of a disease. We hope that no one will allow valuable time to slip unimproved; it may easily happen that it is too late for successful treatment. Everyone will be able to recognize the symptoms of diseases, which Koch has taught to cure, from the foregoing complete description, and it is better to apply the remedy once too often than miss the proper time for application. ”

“ In the beginning stages of the disease breathing is normal except in such case where tuberculosis has made great progress in the lungs and in the case of high fever. Then of course breathing becomes more rapid. Acute hydrocephalus influences respiration in such a way that it slackens and becomes irregular. In one minute children may breath fifteen times, in another thirty, then again 20 times; at one time breathing may be very slight with almost invisible expansion of the chest and without any noise whatever, then again it may consist of deep sighs ”

“ Sometimes the whole process on the nose is so rapid, that very often the physician is not called to the patient, before a large part of the wing of the nose or of the nasal epidermis is destroyed and deep ulcers have developed under the rind. New tubercles of lupus are commonly noticed to spring up on the margins of these ulcers; the cartilage as a rule resists the progress of the disease for a longer period and may be unhurt, while the skin on the wing of the nose may be completely destroyed. ”

“ Pneumonia may culminate in pulmonary consumption: but on the whole this rarely happens. Much oftener it is the case with Pleurisy. But it is assumed and rightly, that most people who are attacked by pleurisy, are already consumptive.
A hemorrhage of the lungs may nearly always be considered a sure sign that consumption has taken hold of the respective individual; but such a hemorrhage certainly forms considerable danger to falling a victim to tuberculosis, if the individual is as yet free from the same. ”

“ All patients treated in the first stages of phthisis were freed from all symptoms of disease in the course of 4–6 weeks so that they could be considered as cured. Even patients with cavities not too large were considerably improved and nearly healed. But in the case of such consumptives, whose lungs contained many and large cavities no objective improvement could be marked, although the expectoration diminished and they appeared to feel much better. I am inclined to assume on the basis of these experiences, that the earliest stages of phthisis can with certainty be cured by this remedy. ”

“ Of all diseases based on tuberculosis only ringworm or lupus is perceivable by the eye, as it is a disease of the skin, all other tuberculous diseases take their course in the internal parts of the body, and therefore are not perceptible to the eye. The symptoms that follow an injection of Koch's liquid can be best observed in the case of lupus. ”

“ Justly has a vast excitement taken hold of all classes of the people, an excitement that has caused all other contemporary events to fall back. The search for an actual remedy for that exceedingly ravaging disease, tuberculosis, has at last been crowned with success, and even the most uneducated will be able to estimate the significance of this event. ”

“ An examination of all organs indicates no change. The children are easily afflicted with eruptions of the skin, with inflammation of the eyes and ears, and catarrh of the mucous membranes, which are characterized by great obstinacy. The derangements in nutrition here described are caused by the lymphatic glands though a swelling of the same can not be found.
In the case of erethistic scrofula the children are found to be of slight and lean structure, with fine hair and long eyelashes; they are active, easily excited, gifted and extremely sensitive to physical pain. ”

“ At the same time we know of exceptional cases where cough was entirely absent in the first stages of the disease, or was at least so slight that it was overlooked, and under such conditions the pale and poor appearance and reduced strength is mistaken for chlorosis or some other anaemic affection, also the existing febrile excitements are wrongly judged, or on account of lack of appetite or light derangements of the stomach a stomachic affection is surmised, until suddenly a hemorrhage of the lungs clearly defines the true nature of the ailment. ”

“ Now tuberculous inflammation of the knee-joint will be treated by Koch's method and in extreme cases only will operation be necessary. At all rates, an absolute cure will be easily effected.
Aside from the hip- and knee-joint the spinal column is most frequently attacked by tuberculosis. Here also it is the youthful age, from the third year upward, that has to suffer most from this serious disease. Adults are rarely attacked by it and with them it generally appears in connection with general tuberculosis. ”

“ It seems that no experiments have as yet been made with other animals.
Koch has tried the remedy on himself and has passed through all the symptoms of a poisoning. He certainly injected into his arm a considerable quantity of the liquid; twenty-five times as much as he injected in his patients.
But here also there is a difference. In sick people much smaller quantities act than in the healthy. One cubic centimeter of the liquid has hardly any effect on a healthy person, but quite a marked one on those afflicted with tuberculosis. ”

“ Every child that has once been attacked with this disease has heretofore died. Until now Koch has not been able to make any experiments with acute hydrocephalus, so that it remains an open question whether it is now possible to cure this disease.
Besides tuberculosis of the cerebral membranes with which children are afflicted, tuberculosis of the brain may occur, although this disease is very rare. Tuberculosis of the brain appears in the shape of small tumors in all parts of the brain. After longer duration of tuberculosis of the brain, tubercular meningitis appears. ”

“ Pulmonary consumption is relatively more frequent among the poorer than the well to do people, this is partly due to the meagre and scanty food of the poorer, and that they are obliged to subsist almost exclusively on vegetable diet. The higher the meat prices rise and the less the majority of the people can afford to procure meat, the larger will be the number of consumptives. The poorly nourished offer a good soil for the tubercle bacilli in consequence of their weakness. ”

“ For every one will prefer to remain exempt from consumption although it may now be possible to cure those afflicted. The lately published and popularly treated precautionary measures, especially with reference to the expectoration of consumptives retain their full value.
Henceforth the sputum is also to be thrown in a spittoon which is either entirely empty or on account of easier cleansing has the bottom covered with a thin layer of water. It should not be permitted to fill the spittoons with sand or sawdust as the tubercle bacilli can be easily thrown up with the dust. ”

“ Even now a spontaneous change for the better is possible, though this happens very rarely; more [53] frequently the disease progresses and leads to death from exhaustion resulting from severe suppuration and continual attacks of fever.
Restoration to health is indicated by decreased suppurative discharges; the openings of the fistulae contract, the general condition is improved, the appetite is restored, etc. Finally the fistulae heal, the joint becomes fixed at an angle or bent or otherwise crippled, but painfulness disappears and the patient escapes with his life and a stiff leg. ”

“ For this reason the chronic diseases contribute so much toward the multiplication of the number of consumptives, because they stipulate a continuous weakening of the organism and an emaciation of the system. To these belong Bright's disease, which very often turns into pulmonary consumption, greensickness or chlorosis, anaemia, continued febrile diseases, severe chronic suppuration, chronic catarrh of the stomach, frequent pregnancies, childbed diseases. ”

“ The tubercle bacilli destroy the lung tissue and change it into pus, which is coughed out. In this way larger and smaller cavities are formed in the lungs; finally the cavities may even take more space than the remaining lung tissue. When cavities have already been formed, coughing comes easy and with abundant expectoration. Toward the end of life the coughing and spitting stops as a result of the extreme feebleness and weakness.
The violence and frequency of the cough depends mainly whether the larger bronchial tubes and the trachea are affected ”