SCIENCE IN MEDICINE 253 



Pulmonary Tuberculosis. — The above line of treatment 

 associated with the all-important fresh air has formed the basis of 

 the successful sanatorium treatment of pulmonary tuberculosis. 

 It is not, however, uncommon in these institutions to find, after 

 a patient has undergone a long course of rest and forced feeding 

 which has resulted in the temperature remaining normal and in 

 a considerable gain in body weight, that when he is allowed to 

 get up the temperature chart again shows an evening rise, 

 indicating that the disease is still active. In these cases, again, 

 if the blood be examined as regards its opsonic power, it will 

 be found that the succession of negative and positive phases is 

 re-established. Koch's old Tuberculin, first available in 1890, 

 was extensively tried, but had, at all events in this country, 

 fallen into disrepute. The chief cause of its failure was that the 

 method of administration was wrong. Anything between a 

 milligram and ten milligrams was given at intervals of two or 

 three days, and it has been found that such doses reduced the 

 resistance of the body, as evidenced by severe constitutional 

 disturbances. The effect of administering it in that manner 

 was, in the light of modern knowledge, to produce a cumulative 

 action in the direction of the negative phase. The resistance 

 of the patient was driven lower and lower, and when it is 

 remembered that at the same time in many cases the patient 

 was inoculating himself with living bacilli, it is not surprising 

 to find that this method of treatment did not meet with success, 

 but often, unfortunately, with disastrous results. It has now 

 been established that rijwffth to ^th of a mgm. is the dose of 

 tuberculin which offers the best chance of success. Even the 

 administration of this dose is followed by a slight negative 

 phase, but not of a sufficient degree or duration to do any 

 harm. The effect of a single inoculation would seem to last 

 for about ten days when dealing with a patient who is not 

 inoculating himseli. It is still a question as to how far 

 inoculation should be undertaken during active tuberculosis. 

 If possible it would seem to be wisest, by fresh air, rest, and 

 forced feeding, to localise the infection as far as possible, before 

 beginning treatment with tuberculin. This method has been 

 carried out by Turban in Davos for a considerable number of 

 years, though he has been giving large but infrequent doses, 

 with great success as regards the small number of recurrences. 

 But the bacteriology of acute pulmonary tuberculosis, associated 



