302 TUBERCULOSIS 



abandon the attempt to assign to different elements in a tuber- 

 culin the reactive effects on the one hand and the immunising 

 effects on the other ; thus the bacillary emulsion tuberculin is prob- 

 ably as much used as the tuberculin-B,, and the object is now to 

 practise such a dosage as shall give the maximum of good effect. 

 For ordinary cases with little or no evidence of constitutional 

 disturbance, an amount of tuberculin corresponding to from a six- 

 hundredth to a one-thousandth of a milligramme of tubercle 

 powder is a sufficient dose ; for more marked cases with little or no 

 fever, from a two-thousandth to a four-thousandth of a milligramme 

 is given. In febrile cases the greatest care must be exercised, and a 

 twenty-thousandth to a fifty- thousandth of a milligramme probably 

 represents the limits of safe dosage. The injections are also now 

 given less frequently, usually at ten-day intervals. The best results 

 are obtained where the tuberculous infection is localised, e.g., in 

 lupus, tubercular joints and glands, genito-urinary tuberculosis, 

 and, generally speaking, the dosage must be regulated by a study 

 of the clinical effects. Under certain circumstances information 

 as to the effect of the treatment is easily available. Thus, if in a 

 quiescent lung affection a tuberculin injection causes increased 

 cough, increase of expectoration, or slight rise of temperature, the 

 dose given has been too large, and the same is true if in a 

 tuberculosis about the bladder symptoms of urinary irritation 

 supervene. While undoubtedly in many cases good results have 

 been obtained, every administration must be looked upon as of 

 the nature of an experiment, and the treatment should only be 

 in the hands of those who have had great experience of the 

 subject. 



The fact that in so many cases tubercular infections tend to 

 disappear under ordinary treatment makes it at present extremely 

 difficult to estimate truly the therapeutic effects of vaccine 

 therapy. 



Tuberculin Therapy associated with Opsonic Observations. - 

 Wright holds that the opsonic qualities of the serum constitute 

 the means by which the body frees itself of the invading bacilli, 

 these being actually destroyed by the phagocytic cells. A 

 natural cure results when the absorption into the circulation of 

 the products of the local disintegration of the tubercle bacilli so 

 stimulates some reactive mechanism in the body that sufficient 

 opsonin is produced to cause a phagocytosis of all the tubercle 

 bacilli present. The occurrence of a low opsonic index in chronic 

 local tuberculosis is due to the using up of the opsonins in the 

 focus of infection, and in such a case the general mechanism has 

 not been stimulated to produce a conquering amount of opsonin. 



