TREATMENT WITH OLD TUBERCULIN 65 



Following such procedure, decidedly unfavorable results were obtained in the latter 

 class of patients and consequently a marked waning in the enthusiasm which first 

 greeted the tuberculin therapy was the inevitable outcome. Thus the once highly 

 praised remedy was entirely rejected. 



During the second period only very few former followers of Koch continued their 

 studies. They, however, made it their business to investigate the causes which 

 accounted for the failure of tuberculin therapy, Their researches led to new prin- 

 ciples in the treatment, and to more exact knowledge of its indications as well as 

 contraindications. 



The success obtained by the untiring efforts of these investigators brought about 

 after many years a revival of the interest in this therapy. It was again taken up (third 

 tuberculin era) and there is no doubt that when properly handled, tuberculin in well 

 selected cases is of decided benefit. Nevertheless, even at the present day, a conclusive 

 opinion as to many of its details cannot be formed. Attempts are being made to set 

 the individual treatment upon a biological instead of upon the more or less schematic 

 basis thus far employed. 



Old Tuberculin (Tuberculin Koch 2Y). 



While it was the aim in the early era of tuberculin treatment to produce 

 very strong general reactions, it is the general consensus of opinion at pres- 

 ent that it is best so to arrange the tuberculin therapy as to avoid a general 

 reaction and especially the fever. Gcetsch was the man who first called 

 attention to this. 



February 



March 



April 



CHART 2. Example of hyper-susceptibility brought about by going back to a smaller dose. 



With such object in view, one must begin with small doses. Some men 

 start with i/ioo mg., others with i/io mg. T. If no reaction is incited, 

 the dose is increased in five to seven days to 5/100 mg. and then to i/io, 

 2/10, 4/10, 8/10, 1,2,4, 6, 8, 10, 20, 40, 80, 100, 150, 200, 300, 400, 600, 800, 

 and 1000 mg. This last amount represents the maximum dose. If the 

 patient still gives a focal reaction with such a dose, it is best to repeat it at 

 intervals of two to four weeks, until finally no reaction is apparent. 

 Occasionally one will advance with the doses at a more rapid rate, but in 

 general, inoculations should not be repeated more than twice a week. 

 5 



