TUBERCULIN. — Koch's new T-R tu berculin has been used with considerable success by several dermatologists. Koch advises that a small dose (1/0o milligramme) be first used, and that this be as rapidly increased as possible, avoiding any constitutional reaction, and not re peating the injection until the tempera ture has fallen to the normal point or near it. Twenty milligrammes should constitute the dose to be reached if pos sible.
Up to a certain point tuberculin T. R. has a beneficial influence on lupus vul garis. Its greatest benefit is seen in the ulcerative forms of the disease, while in the nodular forms its effects are trifling or negative. Local injections apparently give better results than those applied to a distance from the diseased area. In order to secure a permanent result, the use of tuberculin T. R. should be fol lowed by the prolonged administration of thyroid extract. The drawbacks of the treatment are (1) the expense and (2) the length of time required. Crocker Brit. Med. Jou•.. Oct. 23. 19021.
In four cases in which the new tuber culin was used Leslie Roberts (Brit. Med. Jour., Jan. 15, '9S) noticed that the effect was most marked when the lymph- and blood- vessels most actively participated in the tuberculous process. In the dry, non-irritative form of the disease, when the tuberculous nodules seemed to be more or less isolated by inert disease, the improvement was far less obvious. The local changes consisted in shrinking of the tissues in the immediate vicinity of the tubercles, and in an arrest and heal ing of ulceration. The reduction of oedematous swelling of the lips and gums was very remarkable.
Tuberculin gradually applied is never hurtful, and it is useful in resolving lupous or tuberculous infiltrations of long standing. Before applying tubercu lin, it is necessary to get rid of any septic phenomena which may be present. The use of the thermocautery at the same time is advisable to destroy any nodules as soon as they appear. Cam pana (I1 Policlinico, Feb. 1, '93).
When the above means cannot be re sorted to, lactic acid is probably the best agent at our disposal. The crust having been, if possible, removed, the parts are sprayed with a 4-per-cent. solution of co caine, and the edges, after three or four minutes, are carefully moistened with the acid, using a small cotton pledget or a camel's-hair pencil for the purpose. Galvanocautery may be used, but it is, as a rule, more objectionable to the pa tient. Lysol applied pure has been rec ommended. The thyroid preparations
have recently been tried with apparent success, but in doses which appear, at least, dangerous.
Good results with thyroid extract in two cases of lupus. By degrees one ease took as much as 75 grains; the other 90 grains daily, but later about 15 grains was the dose administered. Treatment was continued over a period of eight months, both cases then being absolutely well. F. G. I'roudfoot (Brit. Med. ,Jour., Jan. 2, '97).
N. R. Finsen (Sem. AIM., No. 59, '97) has recently obtained good results by means of a simple apparatus: the rays— either sunrays or electric arc-rays—con centrated on patches of lupus.
Professor Finsen has further (level- :‘ oped his "phototherapeutic" method of treating this disease, and the results ob tained have proved encouraging. The bactericidal influence of light-rays has long been known, but the mode of util izing them advantageously required de velopment, and this feature has received Finscn's attention. Not only sunlight, but artificial light, was found to pos sess the quality mentioned; but the rays had to be rendered harmless, the bactericidal properties residing in the chemical rays, especially in the ultra red (heat) rays and ultraviolet, and giving rise to inflammation when merely concentrated by means of lenses upon the skin. The heat-rays involved had therefore to be excluded. In the per fected electric-light apparatus this is ac complished, according to H. W. Stel wagon (Univ. Med. Mag,., Dee., 1900), "by filling in the space between two of the lenses in the tens-tube with distilled water, and, in order to prevent this from becoming overheated, surrounding this section with an enveloping tube or jacket through which cool water is kept running. The sun-condensing apparatus consists of a band of metal with glass on each side properly adjusted to form a lens; the space between these two glasses is filled with water colored with an ammoniacal solution of copper sul phate. The heat-rays are further con trolled, in both plans, by a disk with glass ends, through the central hollow part of which cool water is constantly circulating; this is placed over the part being treated. This disk has still another very essential purpose; Finsen found that the blood in the part was in itself an obstacle to the deep pene tration of the chemical rays, to remove which this transparent disk is kept firmly pressed down upon the surface treated, and the light projected through it.