As the interest in Dr. Friedrich Franz Friedmann and his tuberculin
increases and a large part of the world is anxiously waiting to have its
hopes confirmed that at last a real cure for tuberculosis has been
discovered, it will be interesting to state what is positively known
about this treatment, to what extent it is a new discovery and why the
medical profession has shown such hostility to its originator.
In the first place Friedmann’s remedy is not a “serum.” Anti-toxins,
such as those used against diphtheria and lock-jaw are sera. An
antitoxin is the serum of an animal which has been treated with
toxin-forming germs till his blood serum is full of defensive substances
against that toxin. An antitoxin, as its name indicates, is an antidote
to a poison.
Friedmann’s tuberculin belongs to the class which we have of late begun
to call vaccines, a term formerly applied only to the virus of cowpox
but now made to cover all forms of virus which are used to stimulate the
production of defensive substances. The real difference between an
antitoxin and a vaccine is that the first contains an antidote and is an
emergency remedy for an acute disease, while the second is a weak form
of virus which causes the body of the patient to manufacture its own
antidote.
What Friedmann claims as novel in his tuberculin is that it consists of
living tubercle bacilli, while those in general use consist of dead
bacilli or their extractives. It has long been known that living bacilli
would call forth a more rapid production of defensive substances than
dead. Dr. Trudeau of Saranac Lake demonstrated this twenty years ago,
experimenting on rabbits with bacilli of bird tuberculosis. Later
several Americans confirmed his results, using non-virulent strains of
human tubercle bacilli. Von Behring’s famous experiments on immunizing
calves were made with living bacilli. So far therefore as is yet known,
there is nothing new in the principle Friedmann is following. As to the
details of his cure, we are in ignorance.
It will be long before any dependable word can be given out as to the
results of Friedmann’s work in New York city. Every physician knows that
optimism, eagerness to grasp at every hopeful sign, are characteristics
of a fair majority of consumptives. We shall need a much longer period
of observation before we can be sure that this tuberculin has any
superiority to the many previously tested, almost all of which have had
initial success followed by more or less disillusionment.
Still greater caution must be used in estimating the immunizing
properties of Friedmann’s tuberculin. Friedmann treated over 300
children eighteen months ago and states that during this interval none
of them have developed tuberculosis. It will be at least fifteen years
before positive statements can be made concerning these children and
then only by comparing them with a similar group of non-treated children
living in conditions as nearly as possible identical with those of the
treated children.
As to the attitude of American physicians to Dr. Friedmann one can
hardly accuse them of unfairness and of narrow-minded professional
jealousy if one realizes that he has violated three of the fundamental
laws of medical ethics and, however impatient the non-medical world may
be of much that comes under this head, no one can think that secrecy,
exclusiveness or self-advertisement are in accordance with the best
traditions of medicine.
A significant contrast could be drawn between the methods pursued by Dr.
Friedmann and those pursued by Paul Ehrlich when he announced his new
cure for syphilis. No charge of charlatanism or commercialism could ever
be brought against Ehrlich. From the first, the medical world knew all
about salvarsan, and knew that it would be put into everyone’s hands as
soon as Ehrlich thought it safe to give it out for general use. He
insisted that it first must be carefully tested, not by himself alone
but by approved clinicians, who would agree to use it only on patients
that could be kept under constant supervision in hospitals, and who also
would agree to make detailed reports of these cases. After this thorough
trying out of the new cure, it was given unreservedly to the medical
profession the world over. Undoubtedly Ehrlich could have come to
America and reaped golden profits by keeping the cure in his own hands,
for thousands of cases were eager to have it administered.
The Friedmann tuberculin may be what its discoverer claims it is, but
the confidence felt in its promoter can never be the same as that which
Ehrlich has won.