VACCINE TREATMENT OF TUBERCULOSIS 201 



was as yet known of anaphylaxis, and the symptoms following its 

 injection were generally attributed to associated toxic substances. 

 Koch hence directed his efforts to the preparation of a less toxic 

 product, especially as he had not succeeded in producing an actual 

 immunity in his experimental animals with the old tuberculin. 



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 were ground to pieces in a specially 

 constructed apparatus, and the resultant powder shaken with 

 distilled water, and then centrifugalized. The residue constitutes 

 Koch's so-called T 11 preparation, while the supernatant fluid was 

 termed T O. Subsequently he brought out his New (neu) Tuber- 

 culin, which is practically an aqueous emulsion of the entire organ- 

 isms, 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 

 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. ampules. Unless a very large number of 

 people is 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 

 the original product represents 1000 milligrams of the pure tuber- 

 culin, 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. 



