the 



KOCH'S OLD TUBERCULIN 325 







the treatment of tuberculosis than tuberculin or anti-tuberculous serum given alone. 

 It [is said to] assist the production of the disease experimentally (Arloing and 

 Descos). 



2. In persons infected with tuberculosis and in tuberculous animals, the 

 inoculation of small doses of tuberculin gives rise to a marked reaction and 

 ere symptoms which may terminate fatally. 



A dose of O5 c.c. of tuberculin rapidly kills a guinea-pig infected with 

 tuberculosis 5 or 6 weeks before ; there is a sudden rise of temperature followed 

 by a gradual fall and the animal dies in a state of coma. Post mortem there 

 is intense congestion around the tuberculous foci and the internal organs are 

 red, congested and ecchymosed. 



In tuberculous cattle the inoculation of quantities of 0* 30-0' 40 c.c. causes 

 a rise of temperature about 6 hours afterwards from 38-39 C. (the normal 

 bovine temperature) to 40-41 C. The animal recovers its normal condition 

 in a few days. Large doses of tuberculin are liable to kill the animal. 



Persons suffering from tuberculosis react very sharply indeed to the 

 inoculation of tuberculin : O25 c.c. invariably leads to a fatal result. 



The so-called curative doses employed by Koch were G'003-0'004 c.c. Following 

 the injection the patient had rigors, and a rise of temperature to 41 C. The inocu- 

 lation was frequently followed by coughing, nausea, vomiting, jaundice, etc. Around 

 cutaneous tuberculous lesions there was an intense inflammatory reaction. Accord- 

 ing to Koch these symptoms ought to last 1215 hours and then give way to a pro- 

 gressive improvement of the pre-existing lesions. Nothing would be gained here 

 by recalling the disasters which followed the use of tuberculin. The treatment of 

 tuberculosis with tuberculin has recently been revived especially in Germany as 

 the result of the work of Denys, Sahli, and Beraneck. The doses used are much 

 smaller than those used by Koch. The results obtained by this method of treat- 

 ment have not shown it to be of any great value. 



Intra-cerebral inoculation. A guinea-pig weighing 500 grams which will 

 stand the inoculation of 1 c.c. sub-cutaneously dies when inoculated in the 

 brain with 3-4 mg. of the same tuberculin (von Lingelsheim, Borrel). 



A guinea-pig inoculated 12 days previously with tuberculous material 

 succumbs to the intra-cerebral inoculation of O'l mg. of tuberculin. The 

 inoculation of 0*001 mg. of tuberculin into the brain of a guinea-pig which 

 has been infected with tuberculosis 6 weeks previously produces symptoms 

 of hiccough, convulsions, muscular twitchings, etc. and the animal very soon 

 dies. These facts afford an explanation of the symptoms of tuberculous 

 meningitis the only form of tuberculosis in which the action of the poison on 

 the nerve cells can be demonstrated (Borrel). 



The toxins of tetanus, plague, etc., are no more toxic in the brain of tuberculous 

 guinea-pigs than in the brain of healthy animals. Mallein alone acts like tuberculin : 

 unconcentrated mallein which is harmless to tuberculous guinea-pigs when inoculated 

 sub-cutaneously in doses of 3-4 c.c. leads to a fatal result when inoculated intra- 

 cerebrally in doses of O'Ol or O'OOl c.c. (Borrel). 



2. Koch's old tuberculin in the diagnosis of tuberculosis. 



A. In Cattle. Nocard showed that tuberculin is a valuable reagent in the 

 diagnosis of tuberculosis in cattle. In bovine animals the early diagnosis 

 of tuberculosis is clinically impossible in the majority of cases, but it is very 

 important from the point of view of prophylaxis that the disease should be 

 recognized in these animals in its very earliest stages. 



Tuberculous cattle, however small the lesions may be, react to the inocula- 

 tion of 0-30-0-40 c.c. of crude tuberculin. The temperature rises l'5-3 C. 

 Animals free from tuberculosis do not react under similar conditions. 



The method of diagnosis is as follows. 



