Dr. Koch and his Cure
BACILLI OF TUBERCULAR PHTHISIS, SEEN THROUGH MICROSCOPE.
THE SAME BACILLI AFTER FOURTEEN DAYS' DEVELOPMENT.
MICROSCOPIC VIEW OF CULTIVATED BACILLI.
Dr. Koch and his Cure
By A. Conan Doyle.
To the Englishman in Berlin, and indeed to the German also, it is at present very much easier to see the bacillus of Koch, than to catch even the most fleeting glimpse of its illustrious discoverer. His name is on every lip, his utterances are the constant subject of conversation, but, like the Veiled Prophet, he still remains unseen to any eyes save those of his own immediate co-workers and assistants. The stranger must content himself by looking up at the long grey walls of the Hygiene Museum in Kloster Strasse, and knowing that somewhere within them the great master mind is working, which is rapidly bringing under subjection those unruly tribes of deadly micro-organisms which are the last creatures in the organic world to submit to the sway of man.
THE RECLUSE OF KLOSTER STRASSE.
The great bacteriologist is a man so devoted to his own particular line of work that all descriptions of him from other points of view must, in the main, be negative. Some five feet and a half in height, sturdily built, with brown hair fringing off to grey at the edges, he is a man whose 'appearance might be commonplace were it not for the vivacity of his expression and the quick decision of his manner. Of a thoroughly German type, with his earnest face, his high thoughtful forehead, and his slightly retroussé nose, he looks what he is, a student, a worker, and a philosopher. His eyes are small, grey, aid search-ii g, but so sorely tried by long years of microscopic work that they require the aid of the strongest glasses. A married man, and of a domestic turn of mind, his life is spent either in the complete privacy of his family, or in the absorbing labour of his laboratory. He smokes little, drinks less, and leads so regular a life that he preserves his whole energy for the all-important 'mission to which he has devoted himself. One hobby he has, and only one, derived very probably from the hereditary influence of a long series of mountain-dwelling ancestors. He is a keen mountaineer, and never more happy than when, alpinestock in hand, lie is breathing in the invigorating air of the higher Alps. Visitors at Pontresina last year may have observed there a quiet little sturdy gentleman, tweed-suited and be-spectacled, who vanished early from the hotel to reappear jaded and travel-stained in the evening ; but few would have surmised that the energetic climber was none other than the renowned Professor of Berlin. It might perhaps be possible to trace some analogy between the clear and calm atmosphere of scientific thought and those still and rarefied regions in which Tyndall loves to dwell and Koch to wander.
THE KOCH LABORATORY.
To his own private sanctum few, as has already, been remarked, can gain access, but in the Kloster Strasse there is his public laboratory, in which some fifty. young men, including several Americans and Englishmen. are pursuing their studies in bacteriology. It is a large square chamber, well lit and lofty, with rows of microscopes bristling along the deal tables which line it upon every side. Bunsen burners, reservoirs of distilled water, freezing machines for the cutting of microscopic sections, and every other conceivable aid to the bacteriological student, lie ready to his hand. Under glass protectors may be seen innumerable sections of potatoes with bright red, or blue, or black, smears upon their white surfaces where colonies of rare bacilli have been planted, whose growth is watched and recorded from day to clay. All manner of fruits with the mould and fungi which live upon them, infusions of meat or of sugar peopled with unseen millions, squares of gelatine which are the matrix in which innumerable forms of life are sprouting, all these indicate to the visitor the style of work upon which the students are engaged, and the methods by which they carry them out. Here, too, under the microscope may be seen the prepared slides which contain specimens of those bacilli of disease which have already been isolated. This one, stained with logwood, where little purple dots, like grains of pepper, are sprinkled thickly over the field, is a demonstration of that deadly tubercle-bacillus which has harassed mankind from the dawn of time, and yet has become visible to him only during the last eight years. Here, under the next object-glass, are little pink curved creatures, so minute as to be hardly visible under the power of 700 diameters which we are using. Yet these pretty and infinitely fragile things are the accursed comma-bacilli of cholera, the most terrible scourge which has ever devastated the microbe-ridden earth. Here, too, is the little rod-shaped filament of the Bacillus anthracis, the curving tendrils of the Obermeyer spirillus, the great spores of Bacillus prodigiosus, and the jointed branches of Aspergillus. It is a strange thing to look upon these utterly insignificant creatures, and to realize that in one year they would claim more victims from the human race than all the tigers who have ever trod a jungle. A satire, indeed, it is upon the majesty of man when we look at these infinitesimal and contemptible creatures which have it in their power t o over throw the strongest intellect and to shatter the most robust frame.
A special section exists in connection with the laboratory for experiments upon the effects which the bacteria have upon animal mid here the action of all infusions and injections is checked by their use upon guinea-pigs before being used upon human subjects.
THE EARLY DAYS OF DR. KOCH.
Professor Koch is forty-seven years of age. In 1843 he saw the light at Clausthal, where his father was an official in the employ of a mining company. From the age of nineteen to twenty-three lie studied at Göttingen, where he was brought under the influence of the famous Jacob Henle. Henle was an all-round man of science, who had gained his laurels as an anatomist, but who held enlightened and advanced views on many medical points. Among other things, he hold very strongly that the influence of plant life in its lower forms would be found to underlie many of the diseases to which the human frame is liable. It is more than probable that to Henle's suggestions may be traced that line of thought which in the case of Koch has led to such great results.
After taking his degree, Koch Became assistant physician at the hospital of Hamburg, and shortly afterwards he started in private practice in the little town of Langenhagen, in Hanover. Thence he migrated to Wollstein, where, in a little village, he settled down to the humdrum life of a country doctor. He was then twenty-nine years of age, strong and vigorous, with all his great powers striving for an outlet., even m the unpropitious surroundings in which he found himself. To him it must seem but yesterday that he drove his little cob and ramshackle provincial trap along the rough Posen roads to attend the rude peasants and rough farmers who centre round the village. Never, surely, could a man have found himself in a position less favourable for scientific research — poor, humble, unknown, isolated from sympathy and from the scientific appliances which are the necessary tools of the investigator. Yet he was a man of too strong a character to allow himself to be warped by the position in which he found himself, or to be reverted from the line of work which was most congenial to his nature. Looking round, he saw that in one respect, at least, he might claim an advantage over his scientific brethren. If they had chemicals, laboratories, instruments, microscopes, he, at least, had cattle — nothing but cattle. To cattle, therefore, he turned himself, and soon proved that work of first-class importance might be achieved among these humblest of patients.
THE DISCOVERY OF THE BACILLUS ANTHRACIS.
Splenic fever, which has been surmised to have been one of the plagues of Egypt, has long been a bugbear of Continental farmers. The extreme virulence and infectiousness of this disease had often invited speculation, but it was not until about the year 1850 that Dr. Devaine discovered a very minute rod-like creature in the blood of the afflicted animals, which he conjectured to be the true cause of the disease, though he did not see his way to demonstrating the fact.
This was the broken enquiry which Koch now took in hand with the most successful results. Starting upon the supposition that these little creatures were not necessarily Confined to the blood, but would live and multiply in any medium which was nutritious and warm, he made a suitable animal infusion, and introduced a small quantity of infected blood. In a few days the fluid, which had been clear, became turbid, and he found it to be swarming with countless millions of bacillus anthracis, as the organism is named, all derived apparently from the few which chanced to be in the original drop of blood. By taking a little of this fluid, and introducing it into a second bowl of the cultivating medium, he produced a second generation, and from that a third, each as virulent as the first. A drop injected into an animal brought on all the characteristic and deadly symptoms of splenic fever. In the course of these researches Koch found that the organism appeared in three forms—as rods, as round spores, and as long branching filaments ; and he made the extremely important discovery that while in the two former cases they were extremely poisonous, in the form of filaments they became absolutely innocuous, A great step was won when Koch found himself able to cultivate the infection, as he might grow monkshood or any vegetable poison in the soil of his back garden. It is a matter of history how Pasteur enlarged upon Koch's results, how he found that a weaker infusion might be made, which would render the animal innocuous to the more virulent type of the disease, and how France has been millions of pounds the richer for the vast number of animals who have been inoculated against the plague. Here was indeed a worthy rivalry between France and Germany — a contest as to which should confer the greatest benefits upon mankind. Koch's paper upon anthrax appeared in Colin's "Communications on the Biology of Plants," and instantly drew widespread attention to the writer, as did a second paper shortly afterwards upon the preserving and photographing of bacteria.
AT THE UNIVERSITY OF BONN.
In the year 1880 Koch finally abandoned his country practice, and came to the University of Bonn, as assistant to Professor Finkelnburg. Before leaving Wollstein he had published a research over those micro-organisms which infest wounds. Lister's antiseptic system of surgery had been founded upon the presumption that such creatures exist, but Koch was the first to absolutely demonstrate it. His research was of importance not only for its results, but also on account of the additions which it made to our knowledge of the technical management of the microscope. Koch was the first to show the extreme importance of using certain staining agents, which enabled the bacteria to be more easily distinguished by the fact that they took a deeper tint than the tissues in which they lay. He was also the first to use the oil immersion method, by which the object glass is screwed down upon a drop of oil which condenses the light upon the object which is being examined.
HE FINDS THE BACILLUS OF TUBERCLE.
In the scientific atmosphere of Bonn, Koch found himself at last in a thoroughly congenial situation, and was soon at work again with his microscopes and his solutions. In 1882 he announced and demonstrated the bacillus of tubercle. Important as this discovery has proved, by being the one end of the chain which led to the idea or inoculation, it was also of great service to physicians as, putting into their hands an exact means of testing as to whether any given illness be tubercular or not. The presence of the little rod-like body is conclusive as a sign of true phthisis as distinguished from fibroid pneumonia, or any other wasting disease. In his recent report he complains, with some truth, that physicians have not sufficiently used this weapon which he has placed in their hands. He also was able to prove beyond all doubt that the condition known as scrofula and the skin disease known as lupus were both distinguished by the presence of the bacillus, and were therefore all different manifestations of the same disease. It is an affair of yesterday how brilliantly he has proved by the bedside what he had deduced in the laboratory.
AND THE CHOLERA BACILLUS.
In 1883 cholera, after a rest of ten years, hovered once more over the eastern portion of Europe. It appeared first in Damietta, whence it spread rapidly over Egypt. The German Government sent out a commission, with Koch at its head, to investigate the disease upon the spot. Before they had come to any definite conclusions, however, the cholera abated. With the thoroughness and patience which characterizes all Koch's work, he obtained leave to follow the cholera to India, where it is endemic, and to study it at its source. Here he succeeded in isolating and demonstrating the comma bacillus. Whether in this case also the finding of the cause of mischief may be the first step towards the discovery of its antidote time alone can show. It is at least well within the limits of reasonable hope.
Honours now crowded thick and fast upon the discoverer, but even as poverty had failed to drive him from his life's work, so the greater trial of success was unable to relax his diligence. Appointed Professor of Hygiene and of Bacteriology in the University of Berlin, he quietly settled down to the investigation upon tubercle, which had been interrupted by his journey to India. For four years he pursued his silent studies, until he was able, at the recent medical congress at Berlin, to announce that they were almost complete, and that he would shortly give them to the world. The announcement was perhaps unfortunate, for it aroused such immense interest, and gave rise to so many circumstantial but fictitious rumours as to the efficacy of his treatment, that he was compelled, in order to prevent widespread disappointment, to give his discovery to the public rather earlier than ho would, otherwise have done.
And now as to the real value of that treatment — a question of the most vital importance to so many thousands of sufferers and so many hundreds of thousands of anxious relatives. Before entering into so grave s question, I may perhaps explain what grounds I have upon which to form an opinion. I had the good fortune to be the first English physician to arrive in Berlin after the announcement of Koch's discovery, and I had opportunities of seeing all the cases which are under treatment in Von Bergmann's wards, the clinical wards of Dr. Levy in the Prantzlauer Strasse, and under Dr. Bardeleben at the Charité Hospital. From these combined sources, I may fairly say that I had some material from which to draw a deduction.
THE COURTESY OF VON BERGMANN.
The stranger in Berlin is somewhat lost among the number of hospitals and clinical classes which make the city a great centre of teaching. My letters of introduction were to gentlemen who showed me the greatest kindness, but who were not medical men, and knew little, therefore, as to the means by which I might attain my end. Hearing, however, that Professor Von Bergmann intended to give a lecture upon the Sunday night on the cases under his treatment, I adopted the course which seemed to me to be the most direct and the most likely to be successful. Putting myself in the position of a German medical man who was seeking information in London, I thought it best to go straight to the Professor and explain to him my difficulty. No doubt it would have succeeded in ninety — nine cases out of a hundred, but Von Bergmann unfortunately was the hundredth man. Never at any time remarkable for the suavity of his manners, lie is notoriously gruff to our fellow — countrymen, and sees a Morell Mackenzie in every travelling Briton. No one can come in contact with him without at once seeing the difficulty which any colleague would have in working with him, and understanding where the blame lay in the painful controversy which followed the late Emperor's decease.
"There's no place," he shouted, in answer to my modest request that after travelling 700 miles I might be admitted to his lecture. " Perhaps you would like to take my place. That is the only one vacant." Then, as I bowed and turned away, he roared after me, a The first two rows of my clinik are entirely taken up by Englishmen." As I happened to know that the only Englishmen at his lectures were Mr. Malcolm Morris, of St. Mary's, and Dr. Pringle, of the Middlesex Hospital, I was as little impressed by his accuracy as by his courtesy.
PATIENTS UNDER TREATMENT.
As it happened, however, there was among the knot of students who overheard the incident an American gentleman, Dr. Hartz, of Michigan, who, on the good old principle that blood is thicker than water, at once lent me his powerful aid. Through his kind assistance I was enabled next morning to turn the Professor's flank by seeing in his wards the same cases which he had lectured upon the night before. A long and grim array they were of twisted joints, rotting bones, and foul ulcers of the akin, all more or less under the benign influence of the inoculation. Some of the ulcers were nearly healed, and I was assured by the assistant surgeons, and by Dr. Hartz, that where I now saw a white cicatrix drawing over the gap, there had formerly been nothing but disease and putrescence. Here and there I saw a patient, bright-eyed, flushed, and breathing heavily, who was in the stage of reaction after the administration of the injection ; for it cannot be too clearly understood that the first effect of the virus is to intensify the symptoms, to raise the temperature to an almost dangerous degree, and in every way to make the patient worse instead of better.
DR. LEVY'S CLASS ROOMS.
From Von Bergmann's wards we made our way to Dr. Levy's Clinik, where again a similar series of cases were presented to us. The rooms were small, and, what with the press of the doctors, the crowd of patients seeking admission, and the number of sufferers who already occupied the beds, it was a somewhat trying atmosphere. The same scene was to be witnessed at the Charité Hospital, save that it was to the students rather than to the doctors that the teaching was addressed.
WHAT THE REMEDY DOES.
As to the efficacy of the treatment, the scepticism with which it has been encountered in sonic quarters is as undeserved as the absolute confidence with which others have hailed it. It must never be lost sight of that Koch has never claimed that his fluid kills the tubercle bacillus. On the contrary, it has no effect upon it, but destroys the low form of tissue in the meshes of which the bacilli lie. Should this tissue slough in the case of lupus, or be expelled in the sputum in the case of phthisis, and should it contain in its meshes all the bacilli, then it would be possible to hope for a complete cure. When one considers, however, the number and the minute size of these deadly organisms, and the evidence that the lymphatics as well as the organs are affected by them, it is evident that it will only be in very exceptional cases that the bacilli are all expelled. By the cessation of the reaction after injection you can tell when tho tubercular tissue is all cleared out of the system, but there are no means by which you can tell how far the bacilli themselves have been got rid of. If any remain they will, of course, cause by their irritation fresh tubercular tissue to form, which in turn may be destroyed by a new series of injections. But, unfortunately, it is evident that the system soon establishes a tolerance to the injected fluid, so that the time must apparently come when the continually renewed tubercle tissue will refuse to respond to the remedy, in whatever strength it may be applied. Here lies the vast difference between Koch's treatment of consumption, and the action of vaccine in the case of small-pox. The one is for a time at least conclusive, while in the other your remedy does not treat the real seat of the evil. It continually removes the traces of the enemy, but it still leaves him deep in the invaded country.
ONE OF ITS DANGERS.
Another objection, though a much lighter one, is that the process stirs into activity all those tubercular centres which have become dormant. In one case which I have seen, the injection, given for the cure of a tubercular joint, caused an ulcer of the eye, which had been healed for twenty years, to suddenly break out again, thus demonstrating that the original ulcer came from a tubercular cause. It may also be remarked that the fever and reaction after the injection is in some cases so very high (41 deg. Cent. or nearly 104 deg. Fahr.) that it is hardly safe to use it in the case of a debilitated patient.
So much as to the more obviously weak points of the system. Others may develop themselves as more experience is gained. On the other hand, its virtues are many, and it represents an entirely new departure in medicine.
There can be no question that it forms an admirable aid to diagnosis. Tubercle, and tubercle alone, responds to its action, so that in all cases where the exact nature of a complaint is doubtful, a single injection is enough to determine whether it is scrofulous, lupous, phthisical, or in any way tuberculous. This alone is a very important addition to the art of medicine.
Of its curative action in lupus there can be no question, though I have heard Dr. Koeler, the Berlin specialist upon skin affections, express a doubt as to the permanency of the cicatrix. This point, however, will be very shortly settled in England by the outcome of the case which Mr. Malcolm Morris, the well-known specialist, took over to Berlin. As far as this case has progressed there can be no doubt that the result has been astonishingly successful.
In the case of true phthisis of the lungs, which is of more immediate importance in these islands, the evidence is so slight that we can only regard it as an indication and a hope, rather than a proof. It is obvious that the difficulty of getting rid of the tubercular matter is enormously increased when the diseased products are buried deeply in a vital organ. It may prove that even here the specific action of the remedy may triumph over the degenerative process, but it would be an encouraging of false hopes to pretend that this result is in any way assured.
THE DEMAND FOR THE LYMPH.
Lastly, as to the obtaining of the all-important lymph. I called upon Dr. A. Libbertz, to whom its distribution has been entrusted, and I learned that the present supply is insufficient to meet the demands, even of the Berlin hospitals, and that it will be months before any other applicants can be supplied. A pile of letters upon the floor, four feet across, and as high as a man's knee, gave some indication as to what the future demand would be. These, I was informed, represented a single post.
Whatever may be the ultimate decision as to the system, there can be but one opinion as to the man himself. With the noble modesty which is his characteristic, he has retired from every public demonstration ; and with the candour of a true man of science his utterances are mostly directed to the pointing out of the weak points and flaws in his own system. If anyone is deceived upon the point it is assuredly not the fault of the discoverer. Associates say that he has aged years in the last six months, and that his lined face and dry yellow skin are the direct results of the germ-laden atmosphere in which he has so fearlessly lived. It may well be that the eyes of posterity, passing over the ninety-year-old warrior in Silesia, and the giant statesman in Pomerania, may fix their gaze upon the silent worker in the Kloster Strasse, as being the noblest German of them all.