6o 



THE TUBERCULIN THERAPY. 



selected cases is of decided benefit. Nevertheless, even at the present day, 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 T.) 



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

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

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

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

 attention to this. 



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, i, 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 



February 



March 



April 



CHART 2. Example of Hypersusceptibility brought about by going back to a smaller dose. 



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. 



If at any time a distinct or even doubtful reaction occurs, it is absolutely 

 necessary to await the complete subsidence of the latter, and then the same 

 dose is to be repeated. In such a case, an interval of at least eight to ten 

 days should elapse. The dosage should under no condition be diminished, 

 as thereby instead of immunity, hyper-susceptibility is the result. There- 

 fore, patients who at a short time previously had a diagnostic tuberculin 

 test performed upon them, should receive the highest dose employed in this 

 connection as the initial prescription for their tuberculin therapy. The 

 following chart illustrates the condition of hyper-susceptibility occasioned 

 by a diminution in dosage. (Chart 2.) 



