VACCINE TREATMENT OF TUBERCULOSIS 215 



As it was out of the question to use killed-off cultures as such, 

 owing to the production of abscesses when used hypodermically, or 

 the formation of nodules in the lungs when injected intravenously, 

 Koch resorted to the following procedure: Young cultures which had 

 been dried in the vacuum w r ere ground to pieces in a specially con- 

 structed apparatus, and the resultant powder shaken with distilled 

 water, and then centrifugalized. The residue constitutes Koch's 

 so-called T. R. preparation, while the supernatant fluid was termed 

 T. O. Subsequently he brought out his New (neu) Tuberculin, 

 which is practically an aqueous emulsion of the entire organisms, 

 pulverized to mere fragments, and preserved by the addition of 50 

 per cent, of glycerin. 



Although the use of the old tuberculin is still continued, this new 7 

 product is rapidly gaining in favor and virtually corresponds to the 

 bacterial vaccines which we have considered heretofore. Its anti- 

 genie power is proved by the fact that on treatment with this material 

 the agglutinin titer of the patient's serum is frequently raised as 

 high as 1 : 500. This, to be sure, does not constitute an index to the 

 degree of immunity which is produced, but it proves that the sub- 

 stance in question has the power to bring about that general allergic 

 state of which agglutinin production is one of the possible mani- 

 festations. 



Dosage and Injection. Old Tuberculin. The old tuberculin is put 

 up in 1 c.c. and 5 c.c. ampoules. Unless a very large number of 

 people are to be injected at one time it is better to use the smaller 

 size. From this four dilutions are prepared by starting with a 

 1 in 10 (A) of the original strength, by then making a 1 in 10 from 

 this (B); a 1 in 10 from that (C), and a 1 in 10 from the last (D), 

 using sterile water as diluent, and working with sterile glassware. 

 As 1 c.c. of he original product represents 1000 milligrams of the pure 

 tuberculin, 1 c.c. of dilution A will contain 100 milligrams, 1 c.c. of 

 B 10 milligrams, 1 c.c. of C 1 milligram, and 1 c.c. of D 0.1 milligram; 

 from which latter further dilutions can be prepared according to the 

 same plan, as desired. 



As an initial dose, that amount is suggested w r hich a preliminary 

 diagnostic examination has shown to produce a systemic reaction 

 (see Tuberculin Test). If this is for any reason omitted, it is best to 

 start the patient with 0.1 milligram, and to increase the dose progres- 

 sively at intervals which are determined according to the activity 



