TECHNIQUE OF TUBERCULIN-THERAPY. 59 



but not as regularly or of such characteristic appearance. The small intestine is often 

 deeply and evenly congested. In all this symptom-complex, in short, 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 furthermore interpreted the disappearance of the 

 reaction after 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 those tuberculous patients as cured who after gradually diminishing 

 reactions to tuberculin had become entirely refractory to it. Truth to say, 

 these individuals had merely become immunized against old tuberculin, and 

 had another preparation such as new tuberculin been injected, 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 immunization, 

 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 encapsules 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 tuberculin. 

 At this time, the aim of tuberculin treatment was to cause very marked reactions 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. 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 in this field. These, however, made it their business to investigate the 

 causes which led to the failure of tuberculin therapy. Their researches led to new 

 principles 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 



