770 
SUMMARY OF CURRENT RESEARCHES RELATING TO 
with regard to patients suffering from diseases other than tuberculosis, 
as repeated experiments have proved. But the case is very different 
when the disease is tuberculosis ; the same dose of 0 • 01 cubic centimetre, 
injected subcutaneously into the tuberculous patient, caused a severe 
general reaction, as well as a local one. (I gave children aged from two 
to five years one-tenth of this dose — that is to say, 0*001 cubic centi- 
metre; very delicate children only 0*0005 cubic centimetre, and 
obtained a powerful, but in no way dangerous, reaction.) The general 
reaction consists in an attack of fever, which, generally beginning 
witli rigors, raises the temperature above 39°, often up to 40° and even 
41° C. ; this is accompanied by pain in the limbs, coughing, great fatigue, 
often sickness and vomiting. In several cases a slight icteric discolora- 
tion was observed, and occasionally an eruption like measles on the 
chest and neck. The attack usually begins four or five hours after the 
injection, and lasts from twelve to fifteen hours. Occasionally it begins 
later, and then runs its course with less intensity. The patients are very 
little affected by the attack, and as soon as it is over feel comparatively 
well, generally better than before it. The local reaction can be best 
observed in cases where the tuberculous affection is visible ; for instance, 
in cases of lupus : here changes take place which show the specific 
antituberculous action of the remedy to a most surprising degree. A 
few hours after an injection into the skin of the back, that is in a spot 
far removed from the diseased spots on the face, &c., the lupus spots 
begin to swell and to redden, and this they generally do before the initial 
rigor. During the fever, swelling and redness increase, and may finally 
reach a high degree, so that the lupus tissue becomes brownish and 
necrotic in places. Where the lupus was sharply defined we sometimes 
found a much swollen and brownish spot surrounded by a whitish edge 
almost a centimetre wide, which again was surrounded by a broad band 
of bright red. 
After the subsidence of the fever the swelling of the lupus tissue 
decreases gradually, and disappears in about two or three days. The 
lupus spots themselves are then covered by a crust of serum, which filters 
outwards, and dries in the air ; they change to crusts, which fall off after 
two or three weeks, and which, sometimes after one injection only, 
leave a clean red cicatrix behind. Generally, however, several injections 
are required for the complete removal of the lupus tissue. But of this more 
later on. I must mention, as a point of special importance, that the 
changes described are exactly confined to the parts of the skin affected 
with lupus. Even the smallest nodules, and those most deeply hidden 
in the lupus tissue, go through the process, and become visible in con- 
sequence of the swelling and change of colour, whilst the tissue itself, 
in which the lupus changes have entirely ceased, remains unchanged. 
The observation of a lupus case treated by the remedy is so instructive, 
and is necessarily so convincing, that those who wish to make a trial of 
the remedy should, if at all possible, begin with a case of lupus.” 
Dr. Koch next discussses the “local and general reaction to the 
remedy,” “ the diagnostic value of the method,” and “ the curative 
effect of the remedy.” 
Its Action on Tuberculous Tissue . — In what way this process occurs 
cannot as yet be said with certainty, as the necessary histological 
