VACCINE TREATMENT OF TUBERCULOSIS 217 



In this connection, Bandelier advises that when the change from the 

 old to the new is made, to begin with the two-hundredth part of that 

 dose of the old tuberculin which produced no reaction. 



While Koch emphasizes the importance of steadily increasing the 

 dose, Wright does so only in the beginning; later on he continues 

 with a constant dose. His initial quantity is much smaller than 

 that recommended by Koch, viz., 1 c.c. of a dilution of the new 

 tuberculin of 1 : 200,000. Each dose is repeated a week or ten days 

 apart, and then increased by one-fifth to one-sixth, until 1 c.c. of 

 a dilution of 1 : 50,000 to 1 : 10,000 is reached, after which the final 

 dose is continued (without further increase) for a number of months. 



Time of Injection. As soon as reactions begin to appear, it is 

 advisable to give the injections in the morning, so that the patient 

 is not disturbed by the febrile movement during the night. If this 

 is at all marked, Koch recommends that the injections be stopped, 

 and resumed two or three days after the temperature returns to 

 normal, the same dose being given as the one preceding. 



Still another procedure has been recommended by Wolff-Eisner, 

 which was planned with the idea of developing receptors for the 

 tubercular poison in the cutaneous connective tissue, i. e., in vitally 

 unimportant structures, in which the poisons in question that are 

 formed in the diseased organs can be anchored. The method is the 

 following: The existence of a cutaneous susceptibility to the action 

 of tuberculin is first established by intracutaneous injection of 

 tuberculin in different concentration (yoVff milligram, or, if this 

 give a negative result, of -j-^ or more). One-third of a c.c. of a 

 solution containing 10 1 00 or y^ milligram to the c.c., as the case 

 may be, is then injected intracutaneously at each one of two or 

 three different points, a platinum-iridium needle being conveniently 

 used for the purpose. These injections are repeated at intervals 

 of from four to eight days, the same dose being used as long as this 

 is followed by a local reaction. The maximal dose is rarely more 

 than one-tenth of a milligram. 



Indications and Centra-indications. Anyone who has seen some of 

 the disastrous results which followed the use of tuberculin in the 

 early days of its history, will realize that not all cases of tuberculosis 

 are suitable for the tuberculin treatment. Now we know that it 

 is best to exclude those cases in which there is any febrile movement 

 of note, and particularly those in which low morning temperatures 



