TUBERCULOSIS TUBERCULIN THERAPY 729 



Soils Cohen has used a modification of Latham's method, and reports, 

 favorable results: "Tuberculin residue (T. R.) triturated with milk 

 sugar is given with skim milk, whey, or beef -juice. The initial dose is 

 0.000001 mg. Both subjective and objective symptoms of reaction are 

 watched for. The dose is repeated once or twice weekly, according to 

 results. It is gradually increased by increments of 0.000001 mg. to the 

 reaction point, and then dropped one point lower, and so continued for 

 some weeks. Later, a further increase is attempted, and if reaction is 

 not shown, is proceeded with in a similar gradual way. The arbitrary 

 increment of 0.000001 mg. is maintained during this remittent progres- 

 sion until 0.0001 mg. has been reached. After that the increment may 

 be raised to 0.00001 mg. Thus, by successive stages, a maximum dose 

 is attained at a point determined for each individual by all the factors 

 in the case, including the rapidity of increase, character and intensity of 

 reaction, and maintenance of tolerance, as well as the focal and general 

 signs of improvement. The treatment is continued with intermissions 

 for many months, and may be resumed, if necessary, from time to time 

 over a period of years." 



Tuberculin has also been administered intrabronchially and by the 

 rectum without good results. 



Koch was the first to administer tuberculin intravenously, but this 

 route has not come into general favor, owing to the fact that even greater 

 control over dosage is necessary; there is, besides, no local reaction to 

 serve as a guide, and technically the administration is more difficult 

 than is subcutaneous injection. 



The Intrafocal Route. The use of tuberculin intrafocally, that is, a 

 method by which the tuberculin is brought into immediate contact with 

 the diseased area, has been advocated in the treatment of tuberculous 

 pleurisy, tuberculous peritonitis, and tuberculosis of other serous mem- 

 branes, such as those lining joints, the tunica vaginalis of the testicle 

 etc. Senger, Crocker, and Fernet advise the intrafocal use of tuber- 

 culin in the treatment of lupus; others have applied it directly to 

 broken-down glands and to sinuses. William Egbert Robertson 1 has 

 reported very good results in two cases of tuberculous pleurisy as a 

 result of withdrawing a small amount of fluid and injecting 5 mg. of old 

 tuberculin through the needle, which is left in situ for that purpose. 

 After some hours there was a slight reaction; the remainder of the fluid 

 was rapidly absorbed, and convalescence was promptly established, 

 1 Personal communication. 



