620 THE POPULAR SCIENCE MONTHLY. 



all practical purposes. In a healthy man, 0'25 c. c. produces an 

 intense effect. Koch thus describes the symptoms produced 

 by that dose on himself, after it had been injected into his upper 

 arm : " Three to four hours after the injection there came on pain 

 in the limbs, fatigue, inclination to cough, difficulty in breathing, 

 which speedily increased. In the fifth hour an unusually violent 

 attack of shivering followed, which lasted almost an hour. At 

 the same time there were sickness, vomiting, and rise of body 

 temperature up to 39"6 C. (103'3 Fahr.). After twelve hours all 

 these symptoms abated ; the temperature fell until next day it 

 was normal, and a feeling of fatigue and pain in the limbs con- 

 tinued for a few days, and for exactly the same period of time 

 the site of injection remained slightly painful and red." 



One c. c. of a one-per-cent solution that is to say, a dose of 

 O'Ol c. c. of the remedy is the smallest dose which affects healthy 

 adults, and the symptoms, more or less marked, following its ad- 

 ministration are, in the majority of cases, slight pain in the limbs 

 and a sense of transient fatigue. Only a few persons after this 

 dose show a rise of temperature up to not more than about 100 

 Fahr. The word "reaction" is used to indicate the symptoms, 

 mild or severe, which follow upon the use of the remedy. In 

 non-tuberculous adults there is no real reaction consequent upon 

 the administration of any dose of the remedy less in amount than 

 0*01 c. c. ; therefore, the presence of reaction in the adult after a 

 dose of less than - 01 c. c. of the remedy shows the presence of 

 tubercle in the patient. If in the adult no reaction were ob- 

 tained by any dose short of 0"01 c. c, then it would be certain 

 that the case in question was not one of tuberculosis. This is a 

 law to which no exception has hitherto been found, and it gives 

 the remedy great diagnostic value, which, it seems likely, will 

 be one of its most useful clinical applications. The law applies 

 to both man and beast, and to all tubercular conditions. Already 

 cases have occurred in which the presence of tuberculosis was 

 not even suspected until the remedy was injected and reaction 

 followed. 



The dose of the remedy is regulated in tubercular cases by the 

 age and strength of the patient, and by the conditions of his dis- 

 ease. In children and weak people, and in cases of very extensive 

 disease of the lungs, the treatment should begin with the smallest 

 effective dose, which should be very gradually increased. In 

 fairly strong adults with lupus, joint or gland disease, and also 

 in cases of lung tubercle, where the disease is slight in extent, or 

 where the case is doubtful, a full dose of O'Ol c. c. may be adminis- 

 tered with safety. But in lung disease, however slight or other- 

 wise favorable the case may be, it is well to begin with a much 

 lower dose. The difference in the conduct of the treatment of 



