212 ACTIVE IMMUNIZATION 



of 50 milligrams this may even develop within four or five hours. 

 The duration, moreover, is shorter, so that all the symptoms may 

 have disappeared within eight hours, counting from the time of 

 their development. The response, both local and systemic, more- 

 over, is more intense, the former preceding the latter. As in con- 

 nection with the diagnostic test, local redness develops at the point 

 of injection after one or two hours; this is followed by pain and 

 infiltration, reaching its maximum after about twelve hours and 

 disappearing only after a number of days. The systemic response 

 manifests itself in an initial chill or chilly sensations, headache, 

 muscle pain, and fever. The reaction reaches its height after from 

 four to twelve or fourteen hours (according to the size of the dose), 

 and then subsides so that normal relations are restored within 

 twenty-four or thirty-six hours, the patient merely experiencing a 

 certain degree of lassitude and tendency to increased expectoration, 

 which may continue for several days. The height of the temperature 

 differs considerably, and while usually not exceeding 102 F., it may 

 reach 103 and 104. 



In especially susceptible people, or when the higher doses are 

 reached, the systemic symptoms may be much more severe and 

 extend over many days, and during such a period it w^ould, of course, 

 be a mistake to repeat the injection. When these febrile periods 

 are very lengthy and accompanied by lasting loss of weight and 

 cardiac disturbance of notable degree, the treatment should be 

 suspended or eliminated. 



Results. So far as the results of the tuberculin treatment go, so 

 much depends upon the individual case, the duration of the disease, 

 the character and seat of the lesion, the possibility of supplementing 

 vaccination with adequate hygienic treatment, etc., that from a 

 prognostic standpoint every case must be judged upon its own merits. 

 Suffice it to say that the average case, cceteris paribus, does better 

 under immunization treatment than without it, and that every 

 physician should recognize the rationale and value of the method. 

 But I feel very strongly that in order to obtain the best results the 

 treatment should be carried out either in special institutions or by 

 men who are thoroughly familiar with the intricacies of immunization 

 methods. As a matter of fact the best results have been reported 

 from just such sources. 



Bandelier thus found that of 202 cases of pulmonary tuberculosis 



