VACCINE THERAPY 303 



knowledge of the proper precautions in treatment has been built up and 

 satisfactory results are now reported. Applied to pulmonary tubercu- 

 losis it has been followed by improvement in many cases, particularly 

 in those under sanitarium treatment. It also is claimed to be an im- 

 portant aid in the treatment of tuberculosis of the bones and joints 

 and of the eye. Improvement has been reported also in cases of tuber- 

 culous enteritis and mesenteric lymphadenitis. Kleinberg, however, 

 maintains that only a small proportion of bone and joint cases improve, 

 that the majority show no improvement and that in some cases relapses 

 occurred and new abscesses appeared. 



Apparently the most suitable patients for tuberculin therapy are 

 those with incipient tuberculosis or old cases of fibroid phthisis with 

 fair or good nutrition. Advanced or moderately advanced cases may 

 be so treated if the general condition is good. Hamman and Wolman 

 do not consider marked general weakness, fever, cardiac disease, 

 nephritis, epilepsy, syphilis of themselves contraindications but rather 

 unfortunate complications which may prevent specific treatment. 



The injections are given subcutaneously at the lower angle of the 

 scapula. In order to observe whether or not reaction occurs the in- 

 jections are given in the afternoon after the patient's temperature has 

 been taken. This avoids mistaking an accidental afternoon rise of tem- 

 perature for a rise due to the tuberculin. Hamman and Wolman recom- 

 mend the following range of doses: 



Tuberculin Initial dose Maximal dose 



Old tuberculin 0.000,000,1 to 0.000,001 c.c. I. c.c. 



New tuberculin 0.000,001 to 0.000,1 c.c. 2. c.c. 



Bacillus emulsion 0.000,001 to 0.000,1 c.c. 2. c.c. 



Three classes of patients are recognized: (i) children, (2) patients 

 who exhibit a slight fever or are not in good condition, (3) patients in 

 good general condition. The smaller initial doses are for patients of 

 the first two groups, the larger for patients in the third group. Other 

 forms of tuberculin are employed, but the types noted above have been 

 given the most extensive trial. Provided reactions are absent or very 

 slight, the injections may be repeated every three or four days. Tuber- 

 culin has been given by mouth, but is absorbed irregularly and may pro- 

 duce unexpected reactions. It has also been administered intrafocally 

 in tuberculous pleurisy, tuberculous peritonitis, lupus and tuberculosis 

 of the joints and of the tunica vaginalis. Results have in some instances 

 been encouraging. The local reactions include pain, tenderness and 

 swelling. General reactions are exhibited by rise in temperature, 

 malaise, headache, insomnia, rapid pulse, loss of weight. 



Shiga has recently reported upon the use of a " serovaccine." This 

 is designed especially for prophylactic injection in those who by virtue 

 of family relations, constitution or other conditions are predisposed to 

 the disease and for early incipient cases. He claims to have obtained ex- 

 cellent results by weekly vaccination with increasing amounts of the sero- 

 vaccine followed after fifteen injections by two graded doses of living 

 avirulent tubercle bacilli. The method is prophylactic rather than curative. 



