TUBERCULIN TREATMENT. 607 



culous process only the tissues directly involved 

 are stimulated to antibody production. Koch pub- 

 lished favorable results from the use of tuberculin 

 but reports from other sources were less satisfac- 

 tory. Koch's Neutuberculin (Bazillenemulsion) 

 is used in a similar manner. Koch proposes to use Treatment 

 the agglutinating power of the patient's serum as and "New 

 an index of the immunity caused by the injection. 

 The formation of agglutinins perhaps indicates in 

 a general way the ability of the patient to form 

 antibodies, but from the well-known fact that the 

 agglutinating power does not go hand in hand with 

 the protective power of serum in relation to many 

 infections, this method of estimating the degree 

 of immunity does not rest on a good basis. The 

 agglutination reaction is carried on with the emul- 

 sion which is used for immunization. Treatment 

 in man is begun by the injection of 0.0025 mg. of 

 solid substance and the amount is increased rap- 

 idly every day or two until a reaction occurs with 

 a temperature of from 1.5 to 2 C. After a pause 

 of a week the injections are begun again and event- 

 ually a dose of 20 mg. may be given. During 

 treatment the agglutinating power of the patient's 

 serum is tested frequently, and if it is not suffi- 

 ciently high intravenous injection of the fluid por- 

 tion of the emulsion may be practiced. The agglu- 

 tinating power may go as high as from 1 to 25 to 

 1 to 150, rarely 1 to 200 or 300. 



Following the work of Wright and Douglas, the 

 opsonic index has been used as a guide to the 

 injection of preparations of tubercle bacilli. By 

 the concentration of opsonins the state of immu- 

 nity can be gaged and the dosage thus regulated 

 as to time and amount. By means of this proce- 



