Toxic Products 725 



lous gujnea-pigs, animals ii which the disease runs, as is well known, a very rapid 

 course, may, therefore, take place only when the treatment is introduced early — 

 as early as one or two weeks after the infection with tuberculosis. 



"This rule avaUs also for tuberculous human beings, whose treatment must not 

 be begun too late. ... A patient who has but a few months to live cannot 

 expect any value from the use of the remedy, and it will be of little use to treat pa- 

 tients who suffer chiefly from secondary infection, especially with the streptococ- 

 cus, and in whom the septic process has put the tuberculosis entirely in the 

 background." 



One very serious objection, first urged against commercially pre- 

 pared TR by Trudeau and Baldwin,* is that it is possible for it to 

 contain unpulverized, and hence still living, virulent tubercle bacilli. 

 Thellingt could not observe any good effect to result from the use 

 of Koch's TR-tuberculin, and, like Trudeau, found Uving, virulent 

 bacilli in the preparation secured from Hochst. Many others have 

 since discovered the same danger. In the preparation of the remedy 

 it will be remembered that no antiseptic or germicide was added 

 to the solutions by which the effects of accidental failure to crush 

 every bacillus could be overcome, Koch having specially depre- 

 cated such additions as producing destructive changes in the TR. 

 Until this possibility of danger can be removed, and our confidence 

 that attempts to cure patients may not result in their infection 

 be restored, it becomes a question whether TR can find a place in 

 human medicine, or must remain an interestmg laboratory product.. 



Baumgarten and WalzJ find that the administration of tuber- 

 culin-R to guinea-pigs is without curative effect. They insist 

 that the results obtained are like those of the old tuberculin; that 

 "small doses are of no advantage, while the larger the doses one 

 employs, the greater are the disadvantages that 'result from their 

 employment." 



During his experiments upon the agglutination of tubercle bacilli, 

 to be described below, Koch§ found that animals injected with an 

 emulsion of tubercle bacilli showed great increase in the agglutinative 

 power of the blood. This led him to suggest that a new preparation, 

 "iacillary emulsion" Bazillenemulsion, be investigated for its im- 

 munizing and curative properties. 



It is almost impossible to make an accurate estimation of the 



usefulness or uselessness of therapeutic preparations of tubercle 



bacilli at the present time, not only because of their diversity of 



composition and the enthusiasm with which many have been 



exploited, but also because of our inability to compare the results 



attained with any definite standard. The advantages j| or 



disadvantages of any preparation, therefore, depend upon 



the personal opinions of those employing them rather than upon 



any demonstration regarding them — a very unscientific state of 



knowledge. 



* "Medical News," Aug. 28, 1897. 



t "Centralbl. f. Bakt.," etc., July s, i902,xxxii. No. i, p. 28. 



t "Centralbl. f. Bakt. und Parasitenk.," April 12, 1898, xxra, No. 14, p. 593' 



§ "Deutsche med. Wochenschrift," 1901, No. 48, p. 829. 



