64 TUBERCULIN THERAPY 



site in question. The neighboring lymph glands are similarly reddened. Besides the 

 tuberculous changes present within the liver and spleen, these organs show on their 

 surface many blackish- red spots varying in size from that of a pin-point to a hemp seed, 

 and resembling very closely the ecchymosis found in some infectious diseases. On 

 microscopical examination are found no blood extravasations, but very widely dis- 

 tended capillaries directly surrounding the tuberculous foci. The capillaries are so 

 densely plugged with red blood cells that it seems almost impossible for the circulation to 

 h ave continued in these places. In exceptional cases only, are the blood vessels ruptured 

 and the escaped blood found within the tuberculous foci. The lungs present similar 

 changes, but not as regularly or of such characteristic appearance. The small intestine 

 is often deeply and evenly congested. In all this symptom-complex, the never failing 

 and almost pathognomonic feature is the hemorrhagic-like spots on the liver surface. 



Koch considered that the tuberculin brought about the death of the 

 tuberculous tissue. He interpreted the disappearance of the reaction after 

 repeated inoculations with tuberculin, as evidence that the entire tuber- 

 culous structure had been destroyed; in other words that healing had set in. 



Accordingly, in the first tuberculin era, the erroneous tendency arose 

 to consider fhose tuberculous patients as cured who after gradually dimin- 

 ishing reactions to tuberculin had become entirely refractory to it. 

 Actually, these individuals had merely become immunized against old 

 tuberculin, and if another preparation such as new tuberculin had been in- 

 jected, a reaction would have recurred. 



Basing their conclusions on experimental work, Wassermann, Bruck 

 and also the author have shown that besides the factor of partial immuni- 

 zation, it is the focal action of the tuberculin which is the beneficial agent 

 in its therapy. 



The inflammatory hyperemia produced leads to a destruction of the 

 tuberculous tissue, while at the same time the inflammatory process 

 recedes. In addition there is a formation of connective tissue which en- 

 capsules the focus and with it also is associated the local stimulation of 

 antibodies. 



The Technique of Tuberculin-therapy. 



Three distinct periods can be noted in the history of this therapy. The first began 

 in the memorable year, 1890, when Robert Koch made known his discovery of tuber- 

 culin. At this time, the aim of tuberculin treatment was to cause very marked reac- 

 tions and to continue with the injections until no further reaction was obtained. In 

 lupus, glandular or bone tuberculosis 10 mg. was the initial dose. In tuberculosis of 

 the lungs i mg. was the beginning. If the patient reacted to this amount, he received 

 daily inoculations of this dose until no reaction appeared. Then 2 mg. T. were given 

 and the same procedure repeated. Quite frequently, depending upon the strength of 

 the individual concerned, 10 mg. was given as the primary inoculation in phthisis, and 

 then rapidly increased. While Koch himself very soon recognized that this rather 

 severe treatment was suitable only for incipient or moderately advanced cases, very 

 sick and far advanced phthisis patients were similarly treated by many physicians. 



