TUBERCULO-TOXOIDIN AND IMMUNIZATION SERUM. 383 



CLINICAL APPLICATION. 



Generally speaking, as has already been stated above, my immune serum 

 does not when injected subcutaneously cause any local or general reaction; 

 still, in some exceptional cases of idiosyncrasy, a reaction may be noticed. 

 When, however, the immune serum is administered internally as described 

 elsewhere, it produces nearly the same results as by subcutaneous injec- 

 tion, but without any reaction. Hence, except for cases demanding 

 quick or local results, it will be. found safer and more convenient to 

 administer it internally. 



The following cases require subcutaneous injection : 



(1) The cases of acute tubercular cerebral meningitis in which the 

 exudation is not yet marked. 



I have three records of satisfactory cures attained by injecting the 

 serum into children who had fallen into stupor from tubercular cerebral 

 meningitis. I have also several records of much alleviation by the serum 

 injection of cases of cerebral meningitis appearing in the course of 

 pulmonary tuberculosis. 



(2) The cases of tubercular peritonitis having painful indurations. 



(3) The cases of painful tubercular arthritis. 



In the following instances, either the injection or the internal admin- 

 istration is employed, as the circumstances demand: 



In cases of pulmonary tuberculosis with high fever or with disordered 

 nutrition, when the patients are unfit for the tuberculo-toxoidin treat- 

 ment, the serum injection is first to be resorted to. When the symptoms 

 are alleviated and the fever disappears and nutrition is restored, the 

 tuberculo-toxoidin is injected in the usual manner. 



According to the results of the serum treatment performed in my 

 sanatarium, out of a total of 189 patients, 43 were completely cured and 

 63 partially cured. These last two figures added together give 106, 

 being 56.08 per cent of the total number of patients. Those who, for 

 various reasons, discontinued the treatment, numbered 37; those who 

 died, 24 ; and the remainder, 22. 



( 1 ) The average number of injections for those who were completely or par- 

 tially cured was 55 per capita. 



(2) The increase and decrease of opsonins were greater during this treatment 

 than in the tuberculo-toxoidin treatment. 



(3) The body weight and vital capacity generally increase as a result of the 

 serum treatment. 



(4) The phenomena of agglutination, degeneration, and diminution of the 

 bacilli are similar to those of patients under the toxoidin treatment. 



Judging from the percentage results summarized in the figures above, 

 the result of the serum treatment appears to be somewhat inferior to that 

 obtained with tuberculo-toxoidin. As, however, the serum is employed 

 generally in the more serious cases, while the tuberculo-toxoidin usually 



