68 TUBERCULIN THERAPY 



of bacilli still remained the same, and the physical signs of the lungs unaltered. Sub- 

 sequently the patient received treatment with B. E.; the temperature finally sub- 

 sided, the cough and sputum likewise, and the bacilli became few and at times en- 

 tirely absent for several days in succession. In fact, the general condition became 

 excellent. Objectively, there was no demonstration of catarrhal affection. 



It might be noted that such a remarkable increase in weight in so short 

 a time is by no means the rule, although good effects are observed in many 

 cases. 



Naturally the medical treatment should not be limited to the tuberculin 

 therapy. Even in the immunization of healthy animals, attention is paid 

 to their housing and feeding; so much more imperative is this consideration 

 when applied to sick human individuals. 



Bearing in mind that in any treatment, success is only achieved by 

 creating a favorable medium, the same good influences should not be 

 neglected in tuberculin therapy. Rest and forced feeding are curative 

 factors which one cannot omit, and the best places for obtaining these, at 

 the beginning at least, are hospitals, sanatoriums or convalescent homes. 

 When in such a way, the general status of the patient is improved, ambu- 

 lant therapy may be instituted. 



As for the contraindications to tuberculin treatment, it is very 

 Contraindi- difficult to set general rules. Here the opinions of various 

 cations to authorities differ greatly. While for example, M oiler and 

 Tuberculin others consider hemoptysis as a distinct contraindication, 

 Therapy. Aufrecht and Kramer claim that under tuberculin therapy 

 hemoptysis is decidedly improved. It is easy to understand 

 this difference in attitude, if the changes in the focal reaction are considered. 

 There is no doubt that hemoptysis may be excited by increased supply of 

 blood and the inflammatory process associated with the inoculation of tu- 

 berculin. The more severe the focal reaction, the greater is this possibility. 

 On the other hand, the new formation of connective tissue and the absorp- 

 tion of the tuberculous tissue will diminish the frequency of hemorrhage. 

 With a general tendency toward hemoptysis, it is therefore best to wait a 

 long time after the cessation of the latter, and then begin with small doses. 

 The patient should be under careful observation and by constant physical 

 examination any possible focal reaction should be controlled. If, in spite 

 of this, hemoptysis does set in, one should not at once be discouraged. An 

 interval of about fourteen days is to be allowed, and then the treat- 

 ment again undertaken. Frequently, the hemoptysis will cease. If not, 

 or if the patient loses in weight and becomes weaker, the tuberculin therapy 

 should be discontinued. 



As further contraindications, Moller mentions marked general weak- 

 ness, fever, heart affections, epilepsy, and hysteria. In full agreement with 

 Bandelier and Rcepke, the author does not consider any of the above as 



