274 CLINICAL BACTERIOLOGY. 



tuberculin and to TO that is, to all of the bodily con- 

 stituents of the tubercle-bacilli. 



The new preparations are put upon the market by the 

 Hochst Works. For purposes of preservation 20 per cent, 

 of glycerin is added. One cubic centimeter of the new 

 tuberculin TR contains 10 mg. of solid substance. After 

 appropriate dilution with sterile, physiologic solution of 

 sodium chlorid (if the daughter-solution is to be preserved 

 for some time, 20 per cent, of glycerin is added), the treat- 

 ment is begun by injecting -g-J-g- mg. The next higher 

 dose is to be administered on the second day, and it should 

 be of such an amount that temperature-elevations of more 

 than y 2 do not take place. Should these occur, the next 

 injection must be deferred until the temperature has again 

 become normal. As a rule, the treatment is suspended 

 when the dose reaches 20 mg., and, if no reaction follows, 

 the same amount is repeated at considerable intervals. 



If it is desired to immunize healthy animals, as large a 

 quantity is injected at first as is well borne by them for 

 instance, in the case of guinea-pigs, 2 or 3 mg. In this 

 way Koch was able to immunize a considerable number of 

 guinea-pigs to highly virulent tubercle- bacilli. The height 

 of the immunity is attained two or three weeks after ad- 

 ministration of the large dose. From this it appears that 

 in therapeutic experiments on artificially infected guinea- 

 pigs, which rapidly succumb to the disease, the treatment 

 must be instituted quite early not later than two weeks 

 after the introduction of the virus. 



Koch recommends that this new remedy be employed 

 only in recent, pure cases of tuberculosis, uncomplicated 

 by mixed infection. Patients who exhibit a temperature 

 above 38 C. (100.4 F.) are not adapted to the new 

 method of treatment. In cases of lupus Koch obtained 

 considerable improvement without noteworthy local re- 

 action. At the conclusion of his communication Koch 

 emphasizes the fact that perhaps combinations of TO and 

 TR with serum-preparations made from TO and TR may 

 more quickly lead to the desired results. The clinical 

 reports that have thus far been made with regard to the 

 treatment of tuberculosis with TR show the freedom from 

 danger that attends the use of the remedy, but little as to 

 its therapeutic utility. Personally, no noteworthy results 

 have been obtained in fifteen cases of pulmonary tubercu- 



