DR. KOCH'S METHOD OF TREATING CONSUMPTION. 621 



lung tubercle and of lupus is that the former is treated with 

 small doses daily, and the latter with large doses at intervals of 

 one or two weeks. Tuberculosis of joints, bones, and glands is 

 treated in the same way as lupus. 



A first dose in early cases of lung tubercle in an adult should 

 be either O'OOl c. c. or 0*002 c. c. If reaction follows this dose, then 

 it should be repeated after the temperature has returned to the 

 normal point. The same dose should be continued in this way 

 until no reaction follows its use. The dose should then be in- 

 creased by one, or at most two, milligrammes at a time ; each dose 

 being repeated until it is found that no reaction follows its ad- 

 ministration, and so on until the dose of O'Ol c. c. is reached. The 

 dose of the remedy should never exceed O'Ol c. c, except as a test 

 to ascertain whether the utmost limit of benefit to the patient 

 has been secured, and this test should be applied to every case. 

 The duration of the treatment in early cases of lung tubercle 

 Koch states to be, as I have already said, from four to six weeks. 

 If after the administration of test doses of the remedy no evidence 

 of the presence of disease is noticed, then the case, Koch says, 

 may " be pronounced cured." I repeat, this statement refers to 

 early lung tubercle only. 



As regards the immunity from tuberculosis which may be 

 enjoyed by the human patient after such a course of treatment, 

 no evidence, so far as I know, has yet been brought forward con- 

 cerning it in clinical records from hospitals, though the protect- 

 ive power of the remedy has been established as a fact by Koch's 

 experiments as regards beasts. The doses of the remedy are pre- 

 pared as follows : Two dilutions of the fluid are in general use, a 

 one-per-cent dilution and a ten-per-cent dilution. The one-per-cent 

 dilution is prepared by putting 0'5 c. c. of the remedy into a glass 

 vessel graduated up to 50 c. c. The vessel is then filled up to 50 c. c. 

 with distilled water containing a half per cent of carbolic acid. 

 One c. c. of this solution contains a dose of O'Ol c. c. of the remedy. 

 Koch's syringe is graduated in milligrammes up to a capacity of 

 1 c. c. ; therefore, if 1 c. c. of this one-per-cent dilution be placed in 

 that syringe, each marked milligramme of it will contain a dose 

 of the remedy equal to 0*001 c. c. The ten-per-cent dilution is used 

 exactly in the same way as the one-per-cent dilution. Every milli- 

 gramme of it contains 0*01 of the remedy, and by means of this 

 stronger dilution the larger doses may be given, or, by dilution, 

 any less dose that may be needed. The subcutaneous injection of 

 the remedy is made in the skin of the back, between the shoulder- 

 blades and the spine, or near the lumbar part of the spine. These 

 parts are selected for this purpose because they are less sensitive 

 than most parts of the skin, and because absorption takes place 

 very quickly from their neighborhood. Before giving an injec- 



