The Consumption Cure
The Consumption Cure is a letter written by Arthur Conan Doyle first published in The Evening News (Portsmouth) and The Daily Telegraph on 20 november 1890.
- in The Daily Telegraph (20 November 1890 [UK])
- in The Evening News (Portsmouth) (20 November 1890 [UK])
The Consumption Cure
Sir, — It may, perhaps, be not entirely out of place for an English physician who has had good opportunities of seeing the recent development of the treatment for tuberculosis in Berlin to say something as to its present position and probable results. Great as is Koch's discovery, there can be no question that our knowledge of it is still very incomplete, and that it leaves large issues open to question. The sooner that this is recognised the less chance will there be of serious disappointment among those who are looking to Berlin for a panacea for their own or their friends' ill-health. I have seen the cases under Professor Bergmann's treatment, those under Professor Bardeleben at the Charite Hospitul, and those of Dr. Levy at his Clinical Cluss, in the Prentzlauer Strasse. This series of cases, taken together with the observations of the assistant physicians and students who have seen most of the treatment, enables one to form some opinion, however imperfect, as to the weaker and stronger points of the system.
In the first place, as to the obtaining of the all-important lymph. I called upon Dr. A. Libbertz, to whom its distribution had been entrusted, and I learned that the present supply is insufficient to meet the demands of the German hospitals, and that it will be at least six weeks before any other demands could be supplied. A pile of letters upon the floor 4ft across and as high as a man's knee gave some indication of what the future demand would be. These, I was informed, represented a single post.
Now as to what may fairly be expected from the lymph when this initial difficulty has been got over. 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 the tubercular tissue is all cleared out from the system, but there is no means by which you can tell how far the bacilli have also been gt 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 smallpox. The one is (for a time at least) conclusive, while in the other your remedy does not touch the real seat of the evil. To use a homely illustration, it is as if a man whose house was infested with rats were to remove the marks of the creatures every morning and expect in that way to get rid of them. Professor Koch himself admits that the bacillus is untouched, and there has not been time yet to see how far its presence will re-establish the old state of things. There is, however, grave reason to fear that it may at least possibly have the effect which I indicate.
Another objection — though a much slighter one — is that the process stirs into activity all those tubercular processes 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 cornea, which had been healed for twenty years, to suddenly break out again, thus demonstrating that the original ulcer came from a tubercular cause. No doubt the ultimate effect of the injection would be beneficial to the corneal ulcer, as well as to the joint, but it is none the less somewhat trying to the patient to have all his varied ailments brought to a head simultaneously. It may also be remarked that the fever and reaction after the injection is in some cases so very high (41° Centigrade, or over 108° 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 lupus, scrofula, phthisis, or any of the manifold forms, of tubercle. This alone is a very important addition to the art of medicine.
Lupus and joint affections (scrofulous) undoubtedly get great benefit, but Koch himself cannot tell how far this is temporary and how far permanent. In the early stages of phthisis, again, it causes a rapid change for the better. When cavities are formed, however, Koch himself says that the aid of the surgeon should be employed, which means an extensive and serious operation.
Whatever may be thought of 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. Leaving other own to expound his views, he immures himself once more in his laboratory, and I can say from experience that it is impossible for the stranger in Berlin to see the man whom, of all others, he would most wish to meet.
I hope that perhaps these remarks may be of some practical value to those of your readers who may have some personal reason for desiring to know exactly what is thought in Berlin of the recent discovery. — I am, Sir, your obedient servant,
A. CONAN DOYLE, M.D.
Central Hotel, Berlin, Nov. 17