384 ISHIGAMI. 



is injected in less advanced cases, the above figures are not strictly 

 comparable with each other. If the advanced patients are first treated 

 with the serum until the symptoms are alleviated and are then injected 

 with tuberculo-toxoidin, a much better result is obtained. 



INTERNAL ADMINISTRATION OF TUBERCULO-TOXOIDIN AND IMMUNE SERUM. 



The subcutaneous injection of the tuberculo-toxoidin is, as stated 

 above, the safest and most efficacious of all modem therapeutic methods 

 for the alleviation of tuberculosis. However, as this form of injection 

 always requires proper precautions, there are many patients who are 

 prevented thereby from receiving the treatment. Moreover, sometimes, 

 though rarely, there are encountered patients of constitutional idiosyn- 

 crasy in whom the injection of the serum causes a reaction. For such 

 cases we are necessarily obliged to resort to a simpler method of admin- 

 istering these cures. 



I have ascertained by experiments on animals that the internal admin- 

 istration of the tuberculo-toxoidin and immune serum is harmless and 

 efficacious. Consequent^', I have tried the same method on patients for 

 the past few years and found it comparatively efficacious and free from 

 any reaction. 



It is difficult to obtain results by administering the tuberculo-toxoidin 

 and the immune serum in liquid form. If administered in the form of 

 pills, however, they are partially absorbed without change, as is seen from 

 the following facts : 



( 1 ) Those patients in whom the injection of tuhereulo-toxoidin causes fever 

 are also subject to the rise of temperature by the internal administration of the 

 toxoidin pills in comparatively large doses. 



(2) Those patients in whom urticaria is produced by the injection of the 

 serum also develop the same symptoms on administration of the serum, pills in 

 comparatively large doses. 



When patients in an advanced stage receive the toxoidin injection, I 

 administer the pills at the same time in the following manner : 



The serum pills are given first until all the symptoms are sufficiently 

 alleviated. The toxoidin pills are then substituted and, in the meantime, 

 the number of injections is gradually diminished. The administration 

 of the pills is maintained for a long time after stopping the injections 

 in order to prevent the diminution of the immunity attained. This 

 particular method of treatment has proved -itself to be most effectual. 



In the liquid state, the efficacy of the tuberculo-toxoidin and of the im- 

 mune serum is uncertain, probably because of changes due to the action of 

 the gastric juice. In the form of pills they seen partially to escape the 

 action of the digestive juices and to be absorbed from the intestinal wall. 



