TUBERCULOSIS TUBERCULIN THERAPY 671 



families who are below par physically and show tuberculin hypersen- 

 sitiveness, with indefinite physical signs, are proper subjects for re- 

 ceiving tuberculin treatment. 



5. The question arises as to whether tuberculin may be administered 

 to ambulant patients. Tuberculin should be regarded as but one factor 

 in the treatment of tuberculosis, and, as such, should be combined with 

 the best therapeutic measures available. Therefore the tuberculin 

 treatment is supplementary to rest, hygiene, and fresh air, and the 

 benefit of the sanatorium should not be denied to patients, especially 

 to the poorer ones. The treatment of a mildly progressive ambulant 

 case should be undertaken only when prolonged rest in bed has had no 

 visible effect, and when no measures can be devised for administering 

 the tuberculin while the patient is in bed, as, e. g., -patients who have 

 been at the sanatorium and have returned to work, or those who cannot 

 be persuaded to enter a sanatorium or for whom no place can be found. 

 The tuberculin treatment of more chronic or localized tuberculosis may 

 be successfully undertaken in the clinic or office. 



Contraindications to Tuberculin Therapy. Owing to the increased 

 focal hyperemia that follows the injection of tuberculin, hemoptysis has 

 been considered a contraindication to its use. In such cases it is well 

 to wait for some time at least and begin the injections with very small 

 doses, as the ultimate effect, namely, the production of fibrous tissue, 

 may be of great aid in prolonging life. 



Various authorities have expressed different views regarding other 

 contraindications, such as marked general weakness, fever, cardiac 

 disease, nephritis, epilepsy, syphilis, hysteria, etc. As was stated by 

 Hamman and Wolman, these are not contraindications, but unfortunate 

 complications that would embarrass any form of treatment. Tuberculin 

 may be given to any patient whose resisting powers have not been too 

 much depressed as the result of complications. For the beginner in 

 this form of therapy, however, it is advisable that he acquire experience 

 by undertaking the treatment of uncomplicated cases before assuming 

 the responsibility of treating the more difficult ones. 



The fact that the ophthalmic test has been made is no contraindica- 

 tion to treatment by tuberculin if the reaction has subsided, since a 

 flare-up rarely occurs except after large diagnostic doses (Hamman and 

 Wolman). 



ADMINISTRATION OF TUBERCULIN 



1. Subcutaneous Injection. Of most importance in this connection 

 is the attitude of the therapeutist toward the question of reactions 



