Prof. Koch's Method to Cure Tuberculosis Popularly Treated Part 5

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.

Frequently the process is extended to the mucous lining of the hard palate and to the gums. Lupus generally appears on the lips in the same manner as in the nose. The upper lip especially appears very much swollen and covered with ulcers after a prolonged existence of the affection. Sometimes even the aperture of the mouth itself is reduced in size by the development of ulcers and scars on the surrounding parts.

If the process extends to the lower eyelid, the connective tissue as a rule becomes much swollen and reddened. The malady especially attacks the inner angle of the eye, destroys the entrance of the lachrymal duct, and from there the lupous tubercles appear on the connective tissue.

Gradually tubercular formations develop on the cornea and sight becomes impaired.

On other parts of the face lupus generally appears in the form of small knots, about the size of millet seeds, which remain for a time then multiply and spread. The epidermis swells between these knots and irregular ulcers develop on a hard swollen and glossy ground, and are covered by dark brown rinds.

Tubercles appear anew on the margins of the ulcers and in the s.p.a.ces between them, isolated whitish spots of sunken or raised scab tissue are observed on which very frequently lupous tubercles again develop.

Lupus appears on the throat, neck, back, breast, and the extremities, most frequently in serpentine form i. e. swellings of the skin develop, being arranged in curves, they progress in the same manner, these are transformed into just so many ulcers. Between these whitish scarred spots are noticeable on which small red lupous tubercles again appear.

Lupus is more frequently found on the extremities than on the trunk. The surface of the skin is found to be tense and glossy on a firm base which is affected by lupus.

Deep ulcerous formations of lupus are sometimes observed on the fingers and toes, particularly on the finger-joints, these may at times penetrate into the inner parts of the joints, secreting whitish pus and covered with a thick rind.

As regards the difference between lupus and syphilitic diseases it has been found that lupus commonly developes before p.u.b.erty while syphilis appears in the mature age.

The ulcers of lupus are often round like those of syphilis with sharply defined margins, but at the same time they are flat accompanied by little or no pain; rim and base of the same are loose, red, rank, and bleed easily. On the other hand syphilitic ulcers are very painful and rim and base are covered with greasy matter.

Lupus appears only in the form of knots, which are deeply inbedded, from size of a pinhead to that of a lentil, but never as large knots in the beginning. Syphilis produces large and palpable knots from the start.

Loss of the bony part of the nose or destruction of the hard palate are observed, but rarely and after protracted existence of lupus, and often in the case of syphilis.

The indicated peculiarities however refer only to typical cases of lupus and of syphilis. In other cases it was almost impossible to show a difference.

As regards the course of lupus, the same begins, as has been stated before, in earliest childhood, sometimes only in the form of scaly spots and knots. Less often lupus developes after complete development of manhood. It is more frequent with women than with men. Sometimes some of the knots remain isolated and disappear again after a time; in other cases additions appear in the course of time, which may affect larger portions of the body and lead to more or less dangerous ulcers. As a rule the course of lupus, even of great extent, is not malignant and at the most the alliance with _traumatic erysipelas_ and possibly the appearance of _pulmonary consumption_ may succeed the affliction. In cases of not too rare occurrence it has been observed that lupus has developed into _cancer_, which has always resulted fatally.

The _treatment_ of lupus has princ.i.p.ally 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 sc.r.a.ped 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. But with the superficial spreading peculiar to many cases of lupus this method can only be applied within certain limits. Then again the secondary growths after an operation may be of serious consequences.

Unfortunately it has not been possible before this to remove all diseased portions, no matter what method was applied, because often tiny lupous tubercles spring up which are almost invisible to the naked eye.

These tubercles will again be the starting point for another spreading of lupus.

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 t.e.s.t.i.c.l.es_ is not so very rare, it is found in about 2-1/2 per cent. of all men afflicted with pulmonary consumption.

It is more rarely met with in children than in men.

The conditions under which tuberculosis of the t.e.s.t.i.c.l.es and epididymis developes are various inflammatory processes with existing disposition.

It is mostly gonorrhea or some other inflammation of the urethra, or injured t.e.s.t.i.c.l.e. It occurs less frequently without any apparent cause.

According to the starting point of tuberculosis the symptoms are varied.

If it starts in the t.e.s.t.i.c.l.e, this appears normal or larger in size, but never reaches extraordinary dimensions. The surface of the t.e.s.t.i.c.l.e is at first smooth in the case of increased tension, later only does it become irregular, b.u.mpy and of unequal consistency.

If the starting point is in the epididymis, hard, rounded lumps are formed generally in the head or tail of the epididymis, rarely in the body. These increase in size and cause a swelling often of extraordinary dimensions, the surface of which appears hard, irregular, b.u.mpy and in certain parts yielding and elastic. If the process is extended to the t.e.s.t.i.c.l.e, this also increases in size. Then both together form an oval swollen ma.s.s and can not be distinguished from each other.

Striking changes appear only later and consist in the softening of the lumps and in the development of abscesses.

Very soon the lobuli are affected. The same are then thickened in the septa, are hard and form an irregular, b.u.mpy swelling surrounded by more or less thickened tissue.

Very soon tuberculous changes are caused in the prostate gland, an organ situated near the intestine and the functions of which are to dilute the s.e.m.e.n. A hardening is often the first sign, this is followed by increase in size and then softening.

With the affection of the prostate gland, that of the urethra also begins, which pa.s.ses through the middle of the prostate gland. This disease often appears in the form of a yellowish secretion, which is more and more increased and becomes ichorous with the decay of the urethra and the prostate gland. This secretion must be distinguished from that which as a venereal affection caused the whole process. The tubercular derangements do not only extend forward but also upward. The bladder, the ureters and the kidneys are affected and show extreme derangements with altered urinal secretions and excretions.

Of other symptoms of tuberculosis of the t.e.s.t.i.c.l.es pain deserves especial mention. The same is slight in the beginning, but often becomes insufferable.

The symptoms here related often increase very slowly. Essential changes are caused during the chronic course of tuberculosis of the t.e.s.t.i.c.l.es if suppuration sets in. The skin is perforated and fistulae are formed. If there is no halt in the process, general tuberculosis results and this has until now always caused death.

According to the time in which the general derangements come about, a chronic and acute tuberculosis of the t.e.s.t.i.c.l.es has been distinguished.

The former is the more frequent, the latter of rare occurrence.

The s.e.xual functions may remain unchanged if only one t.e.s.t.i.c.l.e is diseased, but are generally ruined if both epididymes are affected, because the secretion of the s.e.m.e.n is then interrupted by the stopping up of the vas deferens. In some cases the s.e.xual function may be interrupted for a time only and may then be resumed.

The treatment before this has been surgical, in which the diseased parts were carefully removed, and where this was impossible, even castration (removal of the t.e.s.t.i.c.l.e) was performed. Without doubt Koch's method will cause great changes in the method of treatment here also.

Finally we must include in our reflection the well-known disease of children, _scrofula_. Although the same is not a form of tuberculosis in the sense of the diseases just considered, still tuberculosis and scrofula have the most intimate relations. Scrofula is only too often a precursory stage of tuberculosis.

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 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.

Furthermore it is more frequent in a cold and damp climate than in a dry one. Elevation has no influence on the development of this disease.

Scrofulous individuals are found in the mountains as well as in the plains.

Scrofula princ.i.p.ally attacks children; it occurs most frequently in the time from the second to the fifteenth year. Rarely earlier developed scrofula drags beyond the age of p.u.b.erty or more advanced manhood. s.e.x has no particular influence on the development of scrofula.

In many cases this particular disease is _inherited_. The following causes are considered in the inheritance of scrofula: great age, close relationship and infirmity of the parents; but the germ of scrofula is planted in the child by parents that are themselves afflicted with tuberculosis or scrofula. This is most frequently observed in children that have descended from parents, who were scrofulous in their youth and remained so, or that became tuberculous later on and at the time of generation were afflicted by advanced scrofula or tuberculosis, or that were suffering from oft-treated but never entirely cured syphilis. Some scientists claim to have observed the inheritance of scrofula by children, whose parents at the time of generation were afflicted with tuberculosis or were suffering from general debility resulting from hunger and want.

In the majority of cases scrofula is acquired, as a rule the development of this disease is favored by indigence and poor hygienic conditions according to the coinciding experience of all scientists; _nutrition_, especially in the first year of life, has the greatest influence on the origin of scrofula.

In _infancy_ the most frequent cause of scrofula is the premature giving of _farinaceous_ food besides the mother's milk, or the feeding of children with so-called pap, especially when this is done in the _first month of their life_.

In later months the excessive eating of bread, potatoes or vegetables instead of milk has an injurious effect.

Furthermore the development of scrofula is favored by the breathing of _foul damp air_ such as is frequently found in newly built or damp houses and also by _deficient care of the skin_.

Scrofula thrives in the narrow tenement dwellings in which is found a close, overheated, foul air pregnant with smoke, kitchen fumes and mustiness from the damp walls.

Frequently the development of scrofula has been observed to succeed measles, diphtheria, scarlatina or whooping-cough.

The opponents of vaccination also designate vaccination as a frequent cause of scrofula. It is supposed that a poison is transferred into the system with the lymph which is enabled to generate the phenomena of scrofula. However the supposition has not as yet been proven.

Of course the fact cannot be denied, that cases of developing scrofula have been at times observed as succeeding vaccination. But the circ.u.mstances are the same as in the case of the contagious diseases mentioned above. No one will probably maintain that in those cases in which the development of scrofula had been succeeding those diseases, that this has resulted from a poison generated by the preceding disease.

The attempt to designate symptoms by which to recognize a scrofulous const.i.tution has at all times been made. Many physicians have for a long time distinguished a _torpid_ and an _erethistic_ scrofulous const.i.tution.