NEW TUBERCULIN. 



Bearing in mind that just as in any other treatment, success is only 

 achieved by creating a favorable medium, the same focussing of good 

 influences should be employed in tuberculin therapy. Rest and forced 

 feeding are curative factors which one cannot neglect, and the best places 

 for the obtention of these, at the beginning at least, are hospitals, sanatoriums 

 or convalescent homes. When in such a way, the general status of the pa- 

 tient is improved, ambulant therapy can be continued. 



As for the contraindications to tuberculin treatment, it is very 

 Contraindica- difficult to set general rules. The opinions of various authori- 



tions to ties differ greatly on the subject. While for example, Moller 

 Tuberculin and others consider hemoptosis as a distinct contraindication, 



Therapy. Aufrecht and Kramer claim that under tuberculin therapy 

 hemoptosis 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 hemoptosis may be excited by increased supply of 

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

 culin. 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 hemoptosis, 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, hemoptosis does set in, one should not at once be discouraged. An 

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

 ment again undertaken. Frequently, the hemoptosis 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 Roepke, the author does not consider any of the above as 

 cause for the non-employment of tuberculin. Only where absolute cachexia, 

 without any possibility for improvement exists, is this therapy to be omitted. 

 In all other conditions, an attempt is by all means justified. Experience, 

 as a matter of course, plays an important role in the selection of suitable 

 cases. For a beginner, it is advisable to gain practice by the treatment of 

 uncomplicated cases before undertaking those of greater difficulty. 

 2. New Tuberculin, Bacilli -Emulsion (B. E.) and New Tuberculin T. R. 



Treatment with new tuberculin follows along the very same lines set 

 down for old tuberculin. 



New tuberculin T. R. is the mildest of all preparations. It is very 

 suitable for the beginning treatment of susceptible patients. When the in- 

 dividual does not react to large doses, it is well to start in with B. E. The 



