For the preparation of T-R it is neces sary to use young, highly-virulent cult ures. The immunizing substances are conserved by the addition of 20-per-cent. glycerin.
Administration and dosage are simple. The injections, as in tuberculin. are given beneath the skin of the back. The fluid contains 10 milligrammes of solids per cubic centimetre, and before using is diluted with saline solution; the in augural dose is milligramme. The injections are repeated every second day, and the dosage is gradually increased. Personally it has generally been pushed to 20 milligrammes. In the case of hu man tuberculosis the remedy is of little use in advanced stages or in those in which secondary infection has occurred. Robert Koch (La Semaine Med., Apr. 7, '97).
Twenty-three cases were treated in Mosler's clinic with the new tuberculin, 235 injections being given in all. Only early cases of phthisis were selected, and the tubercle bacillus was also found in the sputum.
There were no lasting unpleasant symptoms, but there was no cure. Stempel (Munch. med. Woch., Nov. 30, '07).
By a judicious selection of the cases and a careful use of tuberculin-R no harm will be done, but apparently no striking or specific effects are to be looked for. Huber (Berl. klin. Woch., Feb. 14, '9S).
Anlistreptococcic Serum.—This serum is indicated in low altitudes where strep tococci are present at all abundantly in the sputa. After one or two injections of 10 cubic centimetres each, the germs disappear temporarily. At altitudes of two thousand feet or more these germs disappear under climatic influences alone. The United States Government is now experimenting with a view to clueing a serum that shall be antagonis tic to both the tubercle bacillus and the streptococcus.
Inhalations.—Hot-air inhalations are used extensively and more or less suc cessfully when troublesome cough or profuse expectoration are present. bined with oxygen, these inhalations give great relief in many cases of dynia and asthmatic dyspnam. Ha.:‘• mnoptysis and scanty expectoration would seem to be contra-indications for their use.
The temperature of the inhaler should range between 300° and 400° F and the drugs most advantageously employed are ichthyol, creasote, camphor, eucalyp tus, turpentine, tar, origanum, and men thol.
Moist, hot inhalations are useless, if not absolutely harmful.
Cold, moist inhalations as generated by a multinebulizer are of undoubted value in eases of mixed infection and cavation; the drugs mostly used in the nebulizer are creasote, oil of pine, men thol, eucalyptus, tr. benzoin, camphor, albolene, tar, carbolic acid, extract of balm of gilead, etc.
Both forms of inhalations mentioned are also useful as inducing deep breath ing.
Probably the best method of treating tuberculous phthisis is to obtain bacilli from the expectoration, cultivate them, pass over them various volatile sub stances until one is found which will arrest their growth, and then adminis ter it by inhalation. William Murrell (Brit. Med. Jour., Jan. 2S, '09).
Irydrotherapy.—In the past few years hydrotherapy has assumed an important place in the treatment of pulmonary tuberculosis. The expense attached to the installation of a proper plant and to its administration are too great to ad mit of its use in private practice. It promises, however, to become, year by year, of greater value as one of the recog nized treatments of this disease in sani tariums.
The outfit consists of a table contain ing apparatus for applying various forms of douches to different portions of the body, bath- and sitz- tubs, hot-air cabin ets, massage-tables, hot- and ice- water tanks, weighing scales, etc.
Exercise.—There is too great a tend ency toward absolute rest in the treat ment of phthisis. The key-stone of suc cessful treatment is conserving and building up the physical resources of the patient by climate, hygiene, diet, and an out-of-door life. Up to the present time all other agencies employed must prop erly be termed auxiliaries, the aim being to build up a solid physical condition, a hardy, resistant one.
Exercise, prudently carried out, is essential. All incipient tuberculars whose temperatures range below 100° P. should exercise freely and systematically. Where tachycardia or dyspncea exists, the amount of exercise should be regu lated by the physician.