730 ACTIVE IMMUNIZATION 



though, of course, a damaged lung remained. In a case of hydrocele the 

 injection of old tuberculin was followed by a sharp local and a moderate 

 general reaction, followed by absorption, and without the slightest 

 evidence of recurrence to date, now about a year since the injection was 

 made. 



Results of Tuberculin Therapy. The early and disastrous results 

 obtained with tuberculin in various types of tuberculosis cannot be used 

 at the present day as a measure for determining the therapeutic value of 

 tuberculin. 



So much depends upon the individual case, the duration and activity 

 of the disease, the possibility of supplementing the active immunization 

 with sanatorium treatment, the skill and patience of the physician, etc., 

 that, from a prognostic standpoint, every case must be judged upon its 

 own merits. The results of the modern use of tuberculin show quite 

 clearly that it is not a "cure" for tuberculosis, but, rather, a rational and 

 useful therapeutic aid, the best results being secured when the treat- 

 ment is carried out in special institutions or by specially trained physi- 

 cians who have a practical knowledge of the difficulties, dangers, and 

 possibilities of tuberculin therapy. 



The value of this or of any therapy can be judged according to various 

 standards: (1) Working ability; (2) duration of life; (3) the presence 

 of tubercle bacilli in the sputum; (4) physical signs, and (5) the symp- 

 toms. 



The first three are especially valuable; duration of life is, after all, 

 the most important criterion, as anything that prolongs life is, of course, 

 welcomed. 



Kremser chose 110 patients expectorating tubercle bacilli and treated 

 55 unselected cases with tuberculin; of these, 22, or 40 per cent., lost 

 the bacilli from their sputum; of those treated without tuberculin only 

 16, or 29 per cent., lost their bacilli. Phillippi found that 58 per cent, of 

 his second stage cases were rid of bacilli in the sputum under tuberculin 

 treatment, as against 19 per cent, without. Brown reports from Saranac 

 Lake that, in the incipient class, 67 per cent, of the tuberculin patients 

 were rid of bacilli; of the others, 64 per cent. In the moderately 

 advanced the figures are respectively 44 per cent, and 24 per cent. 

 Bandelier gives the reports of 500 cases, of whom 202 had tubercle ba- 

 cilli in the sputum. In the following table he compares the working 

 capacity and sputum examinations of these patients under tuberculin 

 treatment : 



