Tuberculosis 



the perfectly clear TO takes up at least 50 per cent, of 

 the solid substance, as otherwise the quantity of TO in 

 the final preparation is so great as to produce undesirable 

 reactions. 



The fluid is best preserved by the addition of 20 per cent, 

 of glycerin, which does not injure the TR and prevents 

 its decomposition. 



The finished fluid contains 10 mg. of solid constituents 

 to the cubic centimeter, and before administration should 

 be diluted with physiologic salt solution (not solutions of 

 carbolic acid). When administering the remedy to man, 

 the injections are made with a hypodermic syringe into the 

 tissues of the back. The beginning dose is -g-J-g- mg., rapidly 

 increased to 20 mg., the injections being made daily. 



Experiment showed that TR had decided immunizing 

 powers. Injected into tuberculous animals in too large a dose 

 it produces a reaction, but its immunizing effects were entirely 

 independent of the reaction. Koch's aim in using this 

 preparation in the therapeutic treatment of tuberculosis was 

 to produce immunity against the tubercle bacillus without 

 reactions, by gradual but rapid increase of the dose. In so 

 large a number of cases did Koch produce immunity to 

 tuberculosis by the administration of TR, that he believes 

 it proved beyond a doubt that his observations are correct. 



By proper administration of the TR he was able to render 

 guinea-pigs so completely immune that they were able 

 to withstand inoculation with virulent bacilli. The point 

 of inoculation presents no change when the remedy is ad- 

 ministered; and the neighboring lymph-glands are generally 

 normal, or when slightly swollen contain no bacilli. 



In speaking of his experiments upon guinea-pigs, Koch 

 says: 



"I have, in general, got the impression in these experi- 

 ments that full immunization sets in two or three weeks 

 after the use of large doses. A cure in tuberculous guinea- 

 pigs, animals in which the disease runs, as is well known, 

 a very rapid course, may, therefore, take place only when 

 the treatment is introduced early as early as one or two 

 weeks after the infection with tuberculosis. 



"This rule avails also for tuberculous human beings, 

 whose treatment must not be begun too late. ... A 

 patient who has but a few months to live cannot expect 

 any value from the use of the remedy, and it will be of 



