VACCINE TREATMENT OF TUBERCULOSIS 211 



following: The existence of a cutaneous susceptibility to the action 

 of tuberculin is first established by intracutaneous injection of 

 tuberculin in different concentration (TTOO" milligram, or, if this 

 give a negative result, of T^O or more). One-third of a c.c. of a 

 solution containing TTOT or TTTO milligram to the c.c., as the case 

 may be, is then injected intracutaneously at each one of two or 

 three different points, a platinum-indium needle being conveniently 

 used for the purpose. These injections are repeated at intervals 

 of from four to eight days, the same dose being used as long as this 

 is followed by a local reaction. The maximal dose is rarely more 

 than one-tenth of a milligram. 



Indications and Centra-indications. Anyone who has seen some of 

 the disastrous results which followed the use of tuberculin in the 

 early days of its history, will realize that not all cases of tubercu- 

 losis are suitable for the tuberculin treatment. Now we know that 

 it is best to exclude those cases in which there is any febrile move- 

 ment of note, and particularly those in which low morning tem- 

 peratures alternate with correspondingly high evening temperatures; 

 then also those in whom there is evidence of active involvement 

 of the pleura ; further, all cases of pregnancy, diabetes, and epilepsy, 

 heart and kidney lesions, occurring in tubercular subjects, while a 

 tendency to hemorrhage does not in itself constitute a contra-indica- 

 tion. If, moreover, every injection is followed by a marked reaction, 

 and it is impossible to obviate this, either by a suitable diminution 

 of the dose, or by using one that is larger, after giving the organism 

 time to recover from the last reaction, it is evidently not advisable 

 to continue the treatment. Generally speaking, Wright's method, 

 or that of Wolff-Eisner, should be employed in those cases in which 

 we are in doubt whether or not to use tuberculin at all. In fine, 

 I would add that in surgical tuberculosis the physician should never 

 withhold recognized surgical treatment, hoping that immunization 

 treatment alone will suffice. 



Reactions. The reactions which follow the use of tuberculin for 

 curative purposes are essentially the same as those which are noted 

 when the material is injected for diagnostic reasons (which see). 

 There are, however, certain points of difference. Generally speaking 

 the reactions develop after a shorter time, which varies with the 

 size of the dose. Following the injection of 3 to 20 milligrams there 

 is frequently a response as early as eight hours, and after doses 



