Against the practical application of such dilutions of dead tubercle bacilli there presented itself the fact that the tubercle bacilli are not absorbed at the inoculation points, nor do they disappear in another way, but for a long time remain unchanged, and engender greater or smaller suppurative foci. Anything, therefore, intended to exercise a healing effect on the tuberculous process must be a soluble substance which would be liberated to a certain extent by the fluids of the body floating around the tubercle bacilli, and be transferred in a fairly rapid manner to the juices of the body; while the substance producing suppuration apparently remains behind in the tubercular bacilli, or dissolves but very slowly. The only important point was, therefore, to induce outside the body the process going on inside, if possible, and to extract from the tubercular bacilli alone the curative substance. This demanded time and toil, until I finally succeeded, with the aid of a forty to fifty per cent. solution of glycerine, in obtaining an effective substance from the tubercular bacilli. With the fluid so obtained I made further experiments on animals, and finally on human beings.

These fluids were given to other physicians to enable them to repeat the experiments.

The remedy which is used in the new treatment consists of a glycerine extract, derived from the pure cultivation of tubercle bacilli. Into the simple extract there naturally passes from the tubercular bacilli, besides the effective substance, all the other matter soluble in fifty per cent. glycerine.

Consequently, it contains a certain quantity of mineral salts, coloring substances, and other unknown extractive matters. Some of these substances can be removed from it tolerably easily. The effective substance is insoluble in absolute alcohol. It can be precipitated by it, though not, indeed, in a pure condition, but still combined with the other extractive matter. It is likewise insoluble in alcohol. The coloring matter may also be removed, rendering it possible to obtain from the extract a colorless, dry substance containing the effective principle in a much more concentrated form than the original glycerine solution. For application in practice this purification of the glycerine extract offers no advantage, because the substances so eliminated are unessential for the human organism. The process of purification would make the cost of the remedy unnecessarily high.

Regarding the constitution of the more effective substances, only surmises may for the present be expressed. It appears to me to be derivative from albuminous bodies, having a close affinity to them. It does not belong to the group of so-called toxalbumins, because it bears high temperatures, and in the dialyzer goes easily and quickly through the membrane. The proportion of the substance in the extract to all appearance is very small. It is estimated at fractions of one per cent., which, if correct, we should have to do with a matter whose effects upon organisms attacked with tuberculosis go far beyond what is known to us of the strongest drugs.

Regarding the manner in which the specific action of the remedy on tuberculous tissue is to be represented, various hypotheses may naturally be put forward. Without wishing to affirm that my view affords the best explanation, I represent the process myself in the following manner:

The tubercle bacilli produced when growing in living tissues, the same as in artificial cultivations, contain substances which variously and notably unfavorably influence living elements in their vicinity. Among these is a substance which in a certain degree of concentration kills or so alters living protoplasm that it passes into a condition that Weigert describes as coagulation necrosis. In tissue thus become necrotic the bacillus finds such unfavorable conditions of nourishment that it can grow no more and sometimes dies.

This explains the remarkable phenomenon that in organs newly attacked with tuberculosis, for instance in guinea pigs' spleen and liver, which then are covered with gray nodules, numbers of bacilli are found, whereas they are rare or wholly absent when the enormously enlarged spleen consists almost entirely of whitish substance in a condition of coagulation necrosis, such as is often found in cases of natural death in tuberculous guinea pigs. The single bacillus cannot, therefore, induce necrosis at a great distance, for as soon as necrosis attains a certain extension the growth of the bacillus subsides, and therewith the production of the necrotizing substance. A kind of reciprocal compensation thus occurs, causing the vegetation of isolated bacilli to remain so extraordinarily restricted, as, for instance, in lupus and scrofulous glands.

In such cases the necrosis generally extends only to a part of the cells, which then, with further growth, assume the peculiar form of riesen zelle, or giant cells. Thus, in this interpretation, follow first the explanation Weigert gives of the production of giant cells.

If now one increased artificially in the vicinity of the bacillus the amount of necrotizing substance in the tissue, the necrosis would spread a greater distance. The conditions of nourishment for the bacillus would thereby become more unfavorable than usual.

In the first place the tissue which had become necrotic over a large extent would decay and detach itself, and where such were possible would carry off the inclosed bacilli and eject them outwardly, so far disturbing their vegetation that they would much more speedily be killed than under ordinary circumstances.

It is just in looking at such changes that the effect of the remedy appears to consist. It contains a certain quantity of necrotizing substance, a correspondingly large dose of which injures certain tissue elements even in a healthy person, and perhaps the white blood corpuscles or adjacent cells, thereby producing fever and a complication of symptoms, whereas with tuberculous patients a much smaller quantity suffices to induce at certain places, namely, where tubercle bacilli are vegetating and have already impregnated the adjacent region with the same necrotizing matter, more or less extensive necrosis of the cells, with the phenomena in the whole organism which result from and are connected with it.

For the present, at least, it is impossible to explain the specific influence which the remedy, in accurately defined doses, exercises upon tuberculous tissue, and the possibility of increasing the doses with such remarkable rapidity, and the remedial effects which have unquestionably been produced under not too favorable circumstances.

Of the consumptive patients whom he described as temporarily cured, two have been returned to the Moabit Hospital for further observation.

No bacilli have appeared in their sputum for the past three months, and their phthisical symptoms have gradually and completely disappeared.