TUBERCULOSIS OF THE EYE 353 



The rise in temperature will commence in the early morning. The first record 

 must, therefore, be taken at five o'clock. 



The height of the reaction occurs from eighteen to twenty-two hours after the 

 injection. Eises in temperature may occur for forty hours. An interval, therefore, 

 of forty-eight hours must intervene between two injections. If there be no result 

 from the first injection, after two days 5 milligrammes are injected. 



If a slight objective or subjective reaction has been obtained, which cannot be 

 called positive, another 1 milligramme should be injected after forty-eight hours. 

 Only after this injection has a negative result should we proceed with 5 milligrammes 

 and 10 milligrammes. If still no marked reaction occurs, the result can be considered 

 as not positive, but by this the tubercular nature of the process is not excluded. 



A general reaction is considered as positive when 



1. A rise of temperature to at least 37'5 C. (99'5 F.) occurs. 



2. There is a well-marked subjective reaction, such as headache, with malaise and 

 loss of appetite. 



In a few cases a local reaction in the eye, consisting of a severe ciliary injection, 

 and an increase of the inflammatory symptoms occurs. The injection fluid used 

 is a solution of 1 c.cm. of old tuberculin, 50 c.crn. phenol, and 100 c.cm. of distilled 

 water : ^ c.cm. of this lotion contains 1 milligramme of the old tuberculin. 



II. Therapeutical Injection of the New Tuberculin T.R. 



Method of von Hippel : 



The first dose is ^J<j milligramme of the dried substance. A second injection is 

 made every second day, and at each the dose is increased by - s fa milligramme. When 

 Jo milligramme is thus reached, the increment is raised to ^ milligramme, and from 

 i milligramme onwards the increase should be ^ milligramme, always provided that 

 the temperature does not rise above 38 C. (100'SOF.). More than 1 milligramme should 

 not be given. This dose should be continued until the disease is completely healed. 

 If the temperature rises above 38 C. with a smaller dose, that dose, or the next 

 lower, should be repeated until there is no reaction. 



In 1898 Zimniermann, as the result of his experiments, stated that the initial 

 dose should be jj<j milligramme, and that it should not be raised above 0'02 to 

 0'03 milligramme. 



In many patients the dose cannot be increased to 1 milligramme. 



The individual maximal therapeutical dose must be discovered for each patient 

 that is to say, that dose which will just avoid a reaction. Such a dose will con- 

 tinually change, as the patient becomes used to the medicament. It should also be 

 noted that the susceptibility of the body at first rises that is, there is a cumulative 

 action of the drug. 



Three solutions of increasing percentage are used as injections : 



I. A solution of 2 : 1000 ; 



II. 2: 100; 



III. 1 : 10. 



A. Beginning with ^ c.cm. of solution I. (^J^ milligramme), the dose is increased 

 by ^ c.cm. ( T J<j milligramme) up to 1 c cm. (Jjj milligramme). 



B. j!jj c.cm. of solution II. (^ milligramme) is then used, and this dose is 

 increased by fa c.cm. (fa milligramme) up to 1 c.cm. (1 milligramme). 



C. Continue with i c.cm. of solution III. (i milligramme), increasing by fa c.cm. 

 (fa milligramme) up to 1 c.cm. (1 milligramme). 



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