Inoculations with Professor 
Koch’s "Tuberculin” 
BY \/ 
A. JACOBI, M.D. 
late president of the new yoke academy of medicine, clinical professor 
IN THE COLLEGE OF PHYSICIANS AND SURGEONS, ETC. 
Reprinted from the MEDICAL RECORD, February 28 and. March 7, 
NEW YORK 
TROWS PRINTING AND BOOKBINDING CO. 
201-213 East Twelfth Street 
1891 Inoculations with Professor 
Koch’s * Tuberculin” 
by w 
A. JACOBI, M.D. 
LATE PRESIDENT OF THE NSW YORK ACADEMY OF MEDICINE, CLINICAL PROFESSOR 
IN THE COLLEGE OF PHYSICIANS AND SURGEONS, ETC. 
Reprinted from the Medical Record, February 28 and March 7, 
1891 
NEW YORK 
TROW’S PRINTING AND BOOKBINDING CO. 
201-213 East Twelfth Street 
1891 INOCULATIONS WITH PROFESSOR KOCH’S 
“ TUBERCULIN.” 1 
Inoculations were commenced by me December roth 
in the Mount Sinai Hospital, on the very day when Dr. 
Kinnicutt made his first injections in St. Luke’s. On the 
following day I began in the German, two days after, at 
the suggestion of Dr. Reid, attending physician, in the 
Foundling Hospital. At a later period a case of epitheli- 
oma was observed, and inoculated for a while in the Skin 
and Cancer Hospital. The majority of the cases in the 
Mount Sinai Hospital belonged to the service of Dr. I. 
N. Heinemann, attending physician, a number were also 
furnished by the other physicians and surgeons of the in- 
stitution, and some of the most interesting material by 
Dr. Goldenberg. To Dr. Heinemann belongs the credit 
of having spent a great deal of time and labor on the nu- 
merous cases gathered in that institution, while I attended 
the other places. He will appear before you with the re- 
ports of what he has observed and accomplished. The 
cases which form the basis of my report number about 
sixty, fifty of which were observed in the German Hos- 
pital and are carefully tabulated. They comprise nearly 
all the varieties of tuberculosis, that of meninges, lungs, 
glands, bones, peritoneum, joints, every one of which was 
carefully watched by a most competent house-staff and 
painstaking nurses both day and night, and temperatures 
taken, with rare exceptions in rectum or vagina, almost in 
1 Read before the Medical Society of the State of New York, Feb- 
ruary 4, 1891. every case every two or three hours for weeks in succes- 
sion. I may be permitted to add a single remark, viz., 
that from the beginning I have tried to be as unbiassed 
in my observations and experiments as would be per- 
mitted by the overpowering sense of the influence of a 
scientific discovery of extraordinary weight and impor- 
tance. 
The effects claimed by Robert Koch for his “ Tuber- 
culin ” are as follows : 
Its action on tubercular processes of whatever nature, 
is specific. It is either general or local. Reaction in in- 
ternal organs cannot always be proven, because it is not 
amenable to direct observation, with the exception of in- 
creased cough and expectoration ; here the general re- 
action predominates. There are local changes in the 
visible tubercular processes. An injection of i ctgr. 
always has that effect. Therefore, the lymph is an in- 
dispensable means of diagnosis. When the diagnosis 
of tuberculosis cannot be obtained by the finding of ba- 
cilli or elastic fibres in the sputa, tuberculosis can with 
safety still be diagnosticated by the presence of the reac- 
tion. In the same way doubtful cases of glandular, 
osseous, and cutaneous disease can be recognized. 
The action of the lymph on the tissue surrounding the 
bacillus is marked. It produces changes resulting in ne 
crosis of that tissue without destroying the bacilli. In 
the beginning small doses are sufficient, afterward larger 
ones are required. When a tuberculous patient requires 
as large doses as a healthy person, at the same time ex- 
hibiting as little reaction as the latter, it is to be pre- 
sumed that all the tuberculous tissue amenable to re- 
action has been destroyed. 
Phthisical patients in the first—incipient—stage were 
relieved of all morbid symptoms in from four to six weeks, 
so that they could be considered as cured. 
Patients with cavities of moderate size were much im- 
proved and almost cured. Thus it is to be presumed that 
incipient phthisis can certainly be cured through this rem- 5 
edy. Relapses are possible, for the time of observation 
has been too short. Still it is fair to presume that re- 
lapses will be removed as quickly as the first attack. 
The general reaction means increase in temperature. 
It seldom appeared after an hour or two, generally after 
from four to nine hours, reached its maximum mostly 
about the ninth or twelfth hour, and diminished grad- 
ually. Sometimes after it had commenced to sink it had 
another rise, as you will remember to have seen in many 
of your cases of typhoid fever, where a double curve is 
not unusual. In a number of my children the tempera- 
ture rise was not marked. Proportionately large doses 
were required. There is a parallel, perhaps, with what 
we notice in other circumstances. For instance, cardiac 
stimulants require larger doses, comparatively, in chil- 
dren, and in them also the effect of the typhoid infection 
is less marked. Both the typhoid virus and the Koch 
virus are ptomaines. Still this is but a suggestion. 
The general reaction was noticed in many cases after 
doses of i or 2 milligr. That effect was not obtained 
when, after a brief time, ten or twenty times as much was 
injected. 
The increase of temperature would often correspond 
with pulse and respiration; sometimes these two would 
not, or not much, be affected. The general condition of 
the patient would mostly be altered with the change of 
temperature, but not always in the same proportion. 
Sometimes there was comfort with high temperature, 
sometimes great discomfort, languor, muscular pain ; once 
a localized pain in a distant organ (the left arm) when the 
right elbow was affected, rigor, perspiration, with a mod- 
erate temperature; in one case (with no rise of tempera- 
ture) there ensued very great dyspnoea, angina pectoris, 
fear of annihilation, which required active medicinal in- 
terference. 
Instead of rising after the inoculations, the temperature 
may fall, but the patient’s comfort may increase. At the 6 
same time, with a low temperature, and feeling comfort- 
able, he may improve, or not improve, or get worse. The 
temperature may also fall, but the patient, while getting 
worse, may also feel worse. 
In cases of non-tubercular lungs (suspicious or not) the 
temperature may rise, or no. In those of tubercular 
lungs I have seen inoculation raise the temperature, not 
influence the temperature, and reduce the temperature. 
The changes in the lungs were not uniform. The usual 
results of an inoculation were diffuse rhonrhi, sometimes 
dyspnoea, and increased expectoration, which became 
more mucous, and was a few times tinged with blood. 
Thus it happened that in one case the number of rales 
and of indurated areas increased in number and extent; 
sometimes with dangerous, either temporary or persistent 
results. Sometimes this effect remained more or less 
stationary, sometimes it wore off in a day or two. In 
other cases there were no direct local changes, and still 
there was an improvement of both subjective and objec- 
tive symptoms. The absence of bacilli in the sputum 
does not speak against the tubercular nature of the case 
as long as the time of observation is but a few weeks. 
Respiration was often accelerated and superficial, but 
seldom more than in its due proportion to the increase of 
temperature. Anorexia and nausea were frequent, vomit- 
ing not uncommon. Jaundice I have not seen, with the 
exception of a very slight touch in a single case ; a few 
times I met with small quantities of album’n in the urine, 
mainly during high temperatures. 
In a small number of cases, mainly such as had a high 
temperature, the spleen would swell and sometimes be 
painful, on the second day or later. Another symptom of 
ptomaine infection was the peculiar appearance of the 
tongue, accumulations of epithelium in the middle, eleva- 
tion and redness of papillse, intense raspberry or scarlet 
redness of the edges. 
Local reaction was sometimes observed round the site of 
injection; in many cases there was no pain, in others 7 
there was. In a minority there was some local redness, 
in a few some swelling, a day after the inoculation. The 
eruption was in one case of the size of a hand. A general 
eruption I have seen but once, when, three days after the 
first inoculation was made (this time of i|- milligr.), al- 
most the whole body of the child was covered with a 
papular rash; afterward 10 milligr. were injected with- 
out any such result. Another form of local reaction is 
that observed near the tubercular locality. It consists in 
local congestion, redness, swelling, sensibility of the 
affected parts, be it lupus, gland, sinus, or bone; or such 
changes in the pulmonary tissue as have been alluded to. 
It must be said, though, that this may also take place in 
tissues not affected by tuberculosis. 
For the purpose of diagnosis lymph was injected into 
Louisa K , aged twenty. She was admitted No- 
vember 14th, with the diagnosis of peritonitis, probably 
carcinomatous. There being a strong doubt expressed 
because of the youth of the patient and for other rea- 
sons, lymph was injected on four successive days—2 
milligr., 4 milligr., 5 milligr., 5 milligr. No reaction. 
The larger number of such administrations in tuberculo- 
sis proving successful in producing a reaction, the diag- 
nosis of carcinoma was considered justified. 
Maria T— , aged twenty, admitted January 17th. 
Had a cough since last summer with moderate expecto- 
ration. sometimes with a little blood, and some dyspnoea. 
Ten days ago a chill, pain in her throat; stopped work 
four days ago ; has a “ cold,” coughs considerably, bled 
from the nose once. Had no fever when admitted. 
Over right upper lobe anteriorly, dulness and coarse res- 
piration, some bronchophony. Posteriorly, prolonged 
respiration. Bacilli not found. On three successive 
days, 2, 4, and 6 milligr. were injected without any ef- 
fect. Meanwhile she improved while in bed. The phys- 
ical lung symptoms are probably due to the results of an 
interstitial pneumonia in early life. 8 
Lena K , aged nineteen, admitted December 31st, 
with symptoms of gastritis, and coarse respiration, with 
moderate dulness over right upper lobe both anteriorly 
and posteriorly. No response to 2 milligr. Probably 
the same conditions as in the previous case. 
Kate S , aged twenty-three, admitted November 
22d, with fibrinous pneumonia and pleuritis of the left 
side. When, about the middle of December, resolution 
was not complete, dulness and some cough, also rhonchi, 
persisting, the suspicion of the presence of tuberculosis 
induced me to use the lymph. Very soon bacilli were 
found. From December 16th to 23d she received five in- 
jections of from 1 to 4 milligr. Reactions were quite 
marked, and she felt badly. Therefore the treatment 
was interrupted ten days, and resumed with occasional 
doses of sor 6 milligr. Since January 22d she is on 
daily doses of 3 milligr., during which she had less fever 
than before and feels better. Still the physical examina- 
tion of her left lung and pleura is unsatisfactory ; partic- 
ularly as when there was a considerable reaction the 
whole chest was full of crepitant, subcrepitant, and sibi- 
lant rales. Indeed, she is one of the cases which appear 
to respond so thoroughly, locally, that the fear is justified 
that the congestion of the pulmonary tissue resulting 
from the injection may prove dangerous. 
Max H , aged four, admitted January 18, 1891 ; 
service of Dr. Kammerer. Scrofulous dermatitis of face. 
About the ascending ramus of maxilla, left side, the skin 
is red, indurated, and partly ulcerating and proliferating. 
Internal organs healthy. For the purpose of diagnosis 
some inoculations were made, twice of i milligr., once 
of 1, and once of 2 milligr. The latter dose raised the 
temperature to 102.6° F. within twelve hours, but there 
was no local reaction, and the inoculations were discon- 
tinued. 
Conrad S , aged forty-six, admitted November 
nth. Tumor in larynx and ulcerations. Dulness over 
right lung, rhonchi, no bacilli found in repeated examina- 9 
tions. Deglutition and articulation difficult. Had chan- 
cre twenty-eight years ago. lodide of potassium and 
inunctions proving rather inefficient, he was given the 
benefit of the doubt, and three injections were made on 
January 16th, 17th, and 18th, of 2, 5, and 7 milligr. As 
no reaction became visible, the anti-syphilitic treatment 
was resumed. 
Ernst S , aged forty-two, admitted January 2, 1891, 
with temperature 101.10 F., has a small ulceration on the 
right side of epiglottis, with some surrounding infiltration. 
One cervical gland. The diagnosis of syphilis very probable, 
but as there was a dull area over the right apex, he was 
given the benefit of the doubt. Injections were made 
January 2d. Two milligr. After six hours temperature 
fell to 99.50 F. 
January 4th. Four milligr. No reaction, except, 
perhaps, the temperature of xoi° F., which he had be- 
fore, thus the anti-syphilitic treatment was commenced in 
earnest. 
P , grocery boy, aged fifteen, admitted January 12 th, 
to Dr. Kremer’s service. Dermatitis genu chronica. 
Scrofula in childhood. Popliteal gland removed six 
months ago. Since an indurated area in the popliteal 
region six inches in length. Internal organs negative. 
For the purposes of diagnosis four inoculations were made 
on January 13th, 16th, 17th, and 18th, of 1, 2, 4, and 6 
milligr., without any reaction. The probability was that the 
dermatitis is not tuberculous, a piece of the skin was then 
removed for examination, and no bacilli found. 
Caroline L , domestic, aged thirty-six. Had the last 
of several pneumonias in February, 1889, frequent attacks 
of dyspnoea and catarrh since, and moderate cough. Some 
phthisis in the family. On December 21st, beside a 
number of gastric symptoms of which she complained, she 
had extensive dulness and diminished respiration on the 
right side, the seat of her last pleuro-pneumonia. 
One milligramme of lymph was injected at noon, De- 
cember 20th. Pulse rose from 90 to 100 at 2 p.m. j tem- 10 
perature from 98.6° to ioo° F., at 8 p.m. It remained at 
from ioo° to 101.20 F., until next noon, when 2 milligr.. 
were injected. It did not influence the temperature, which 
remained about the same (ioo° to 101.20 F.) until noon 
December 22d. The first two nights, however, she coughed 
more than usual, had dyspnoea, palpitation, and perspira- 
tion, also dizziness and headache. She expressed the 
same complaints the following days, lymph or no lymph, 
while her average temperature was less. Only once, on 
December 23d, it rose to 100.4° F., also on December 
24th, at 5 p.m. Then 3 milligr. were injected at 7 p.m. 
Ten hours afterward, at 5 a.m., December 25th, temper- 
ature 98.6° F., at 8 a.m., xoi°, the highest temperature of 
the day except 101.40 F., at 8 p.m. Temperatures up to 
101° F. were observed on December 26th; 100.8° F., 
also at 8 a.m., December 27th. After that time until 
January sth, when she left the hospital, the temperature 
was normal, though she complained of alleged chills, head- 
aches, back aches, stomach-aches. After all we can say 
that as the lymph had a negative result, both generally 
and locally, the changes in the lungs were not likely to 
have assumed a tubercular character—provided that the 
majority of lymph results are of the diagnostic importance 
attributed to them by Robert Koch. 
A. W , aged fifty six, musician, admitted December 
20th. Complained these three months. Has anorexia, 
ascites, icteric complexion, is feeble. Urine scanty. No 
history of alcoholism. On examination : Temperature, 
99.8° F.; pulse, 120, very feeble. Urine with trace of 
albumin. Heart negative. Over left lung, superiorly, 
dulness and coarse breathing. Ascites with but moder- 
ate sensitiveness. lodide of potassium, 2 gm, daily. 
Paracentesis with permanent drainage; 2,000 gm. on 
December 25th, 3,000 on the 26th, and 500 on the 29th. 
On the last two days the fluid was less clear, and con- 
tained blood and pus-cells. He was gradually sinking; 
no good, no harm could be done. One milligr. of Koch’s 
lymph was injected December 31st, at 7.50 p.m., while his rectal temperature was 9 7.50 F. No reaction of any 
kind; he continued to sink until January xst, when he 
died at noon. No autopsy permitted. 
Betty S , aged thirty, admitted November 22, 1890, 
six weeks after her sixth confinement, for general debil- 
ity, dyspnoea, abdominal and dorsal pain, leucorrhoea, pel- 
vic symptoms. Uterus large and catarrhal. Dulness 
over right lung, anteriorly, and coarse and prolonged ex- 
piration. For the purpose of diagnosis 1 milligr. of lymph 
was injected December 28th, with no increase of tem 
perature, but marked perspiration. On the evening of 
January 14th, 2 milligr. were injected, temperature being 
as always, 98.6° F. Within seven hours, at 2 a.m., it 
rose to 100.60 F., and had commenced to fall at 5 a.m., 
when it was 99.6° F. Left the hospital. 
Robert N , aged forty-four, working man, admitted 
November 29, 1890. Complained of his stomach these 
fourteen years. For three weeks vomiting, mucous ex- 
pectoration, and cough. Had chills and pleuritic pain, 
and lost flesh. Has some dulness over upper lobe, su- 
periorly, and sibilant and mucous rales during inspiration 
and expiration. No pus, no bacilli. Had temperatures 
in the first ten days, on December Bth, 103° F., but only 
once, after that temperature, mostly normal, some few 
times 101.20 F. On the afternoon of December 16th 
temperature rose once to 102.8° F., and again on the 
17th. For the purpose of diagnosis, 1 milligr. of lymph 
was injected on the evening of the 17th. For twenty-four 
hours subsequently the temperature changed between 
101.20 and 102.50 F., then it rose to 103.20 and 104.2° 
F., about twenty-four hours after the inoculation. There 
were more rhonchi, this time over the whole chest; more 
dyspnoea. Death occurred on the 19th. No autopsy per- 
mitted ; perhaps the question might have been settled 
whether through our congesting and softening the tissue 
which surrounded the nests of bacilli we hastened the 
man’s death. For though no bacilli were found, I have 
no doubt it was a case of tuberculosis 12 
Rosa J , aged thirteen, had undergone an operation 
for swollen cervical glands on the right side. Left in 
September apparently in good health. Admitted Decem- 
ber 31st, because of general indisposition and fever. At 
the upper end of the cicatrix a glandular swelling. Over 
the right upper lobe diminished respiration behind, and 
some dulness both anteriorly and posteriorly. A few 
days in bed restored her temperature almost to the nor- 
mal. After the evening of January 4th the temperature 
never rose. For the sake of diagnosis lymph was in- 
jected. One milligr. on the morning of the 3d; 2 
milligr. on the evening of the 4th; 5 milligr. on the even- 
ing of the 6th; 10 milligr. on the evening of the 7th; 
with not a trace of response. Inoculation was stopped. 
We also learned from Dr. Kammerer, who performed the 
operation in July, that the glands he removed were not 
considered tuberculous. This case would then be con- 
clusive of the motto ; “ No tuberculosis, no reaction.” 
A number of cases of external (“surgical”) tuberculo- 
sis, with two of epithelioma which were introduced as 
probable cases of lupus, are as follows : 
A boy, aged four, with tuberculosis of right knee, tuber- 
cular glands of neck, and infiltration of right apex; also 
an abscess of the right thigh in which bacilli were found. 
Inoculations were made, twelve in number, ranging from 
one-half to ten milligrammes. There was some slight 
response to the first, induced rather more by the first 
small injections than by the later ones, which were large. 
No correspondence between such response as was elicited 
by the lymph in the beginning and the pulse and respi- 
ration. This correspondence was more distinct on the 
last two days of the observation when no inoculations 
were made; but then the fever was considered the result 
rather of the suppurating thigh than of the lymph. The 
final dose of 10 milligr. was rather a large one, but no re- 
action distinctly attributable to it made its appearance. 
No change. 
Harry C , aged five years eight months, with tu- 13 
bercular abscess (bacilli found) in right inguinal region, 
presumably from lesions of lumbar vertebrae. Examina- 
tion of viscera negative. The first inoculation of half a 
milligramme resulted in a distinct reaction, which showed 
itself in a rise of temperature and of respiration, not of 
the pulse. Afterward the reactions were but trifling, or 
negative, even with a dose of 10 milligr. No improve- 
ment. 
E , aged four years eleven months, tubercular dis- 
ease of left hip; discharging sinus. Examination of 
viscera negative. Fourteen inoculations between De- 
cember 13th and January 3d, from one-half to ten milli- 
grammes. The first small inoculations resulted in posi 
tive reactions, the temperature rising to nearly io4°F. ; 
the last large ones in none, or none attributable to the 
remedy. No improvement. 
W. C , aged four years nine months; dorsal 
spondylitis; kyphosis. Lungs negative. No bacilli 
were found, and therefore no tuberculosis could be 
proven. There was, however, a pretty smart double re- 
action after the first injection of half a milligramme. 
Very little reaction took place after the subsequent doses, 
from one to ten milligrammes. Cervical glands became 
tumefied. Induration and moderate redness of the injec- 
tion site appeared a day after inoculation in this and the 
preceding three cases. Reaction, such as it was, took 
place in from four to fourteen hours. The pulse was 
more influenced than respiration. 
I. T , aged four years and a half. Cold abscess, 
probably from right sacro-iliac synchondrosis. Heart 
and lungs normal. Operations on September 26th and 
October 13th. Afterward the general condition good. 
No temperatures. Wound almost healed on December 
1 st, but his condition remaining stationary for some time, 
ten inoculations were made between December r3th and 
30th, gradually rising from Ito 5 milligr. On January 
1 st the examination of the boy showed condition gener- 
ally good, the wound, however, but slightly improved. 14 
The first injection of i milligr. showed the most marked 
results; reactions occurred in from ten to twenty-two 
hours, and grew less and less unless the doses were in- 
creased.1 
Auguste M , aged three. Tuberculosis of left 
tibio-tarsal articulation. Removal of sequestrum, etc., in 
September, after that temperature normal, moderate sup- 
puration of fistula, swelling of inguinal glands. 
December i ith, one milligr. at 4.45 p.m. After midnight 
temperature 102°, 102,5°, 102.8° F. As the temperature 
was still high on the twelfth, I injected only three-fourths 
milligr. Temperature rose in a few hours to 103.50 F., 
child somnolent, perspiring. Perspiration continued all 
night, though temperature was gradually falling. 
On December 13th temperature only 100.8° F., less 
suppuration, no pain. Injected i j milligr. 
December 14th. Child feels well, suppuration trifling. 
Temperature, 101.2° F. 
December 15th. Injected x milligr. Sinus is closing. 
December 16th. Injected 2 milligr. Perspiration; 
rhinitis. 
December 18th. Injected 3 milligr. No symptoms. 
December 20th. Injected 3 milligr. Temperature 
rose to 103.8° F., and remained above the normal all 
next day. 
December 22d. Injected 4 milligr. Temperature, 
101.4° F. 
On December 24th, 26th, 28th, 30th, and January 2d, 
injections of 5 milligr. each, with but slight elevation of 
temperature and improvement in the local symptoms. 
Within a week after the doses were increased, with but 
slight increase of temperature, until on January 13 th and 
16th 10, and on the 17th 15 milligr. were injected with- 
out a rise of temperature. Four days afterward the child 
had a temperature of 101° F., a flushed face and a rapid 
pulse, without any assignable cause, unless it be a retarded 
1 A detailed account of these five cases will be published_in tlie 
Archives of Pediatrics, March, 1891. effect of the inoculation. On January 27th the fistula 
greatly improved, not so deep as before, and with less 
secretion, still not entirely closed. The child in a fair 
condition. 
Elise W— , aged eleven. Cutaneous tuberculosis, 
admitted December 18th. Family is tuberculous. Child 
had eczema. Underwent an operation at elbow-joint five 
years ago. Has an ulceration of the size of a silver dol- 
lar on the right side of neck, also one two inches long on 
chest; lungs normal. Inoculations the only treatment. 
December 18th. Injection of 1 milligr. Highest tem- 
perature, 101.20 F. Itching on ulcerations. 
December 20th. Injection of 1 milligr. 101.2° F. 
December 21st. Injection of 1 milligr. Temperature 
normal. 
December 22d. Injection of 2 milligr. Highest tem- 
perature, 102.30 F. Epistaxis and headache. 
December 25th. Injection of 3 milligr. Tempera- 
ture, 102.8° F. 
December 26th. Injection of 3 milligr. No reaction. 
December 27th. Injection of 3 milligr. Highest 
temperature, 102.6° F. Epistaxis, headache, palpitation. 
December 29th. Injection of 5 milligr. Temperature, 
i 00.6° F. Mild collapse. Subcutaneous injection of 
camphor. 
December 31st. Injection of 6 milligr. No reaction. 
January 3d. Injection of 6 milligr. Highest temper- 
ature, ioi.i° F. 
January 4th. Injection of 6 milligr. Little reaction. 
January 6th. Injection of 6 milligr. No reaction. 
January 7th. Injection of 8 milligr. No fever. 
Epistaxis. Headache. 
January 9th. Injection of 10 milligr. No reaction. 
January 13th. Injection of 10 milligr. No reaction. 
January 16th. Injection of 10 milligr. No reaction. 
January 17th. Injection of 15 milligr. No fever. 
Epistaxis. 
January 27th. Injection of 10 milligr. No reaction. 16 
On this day the ulcerations were much improved, but not 
altogether well. 
Annie T , aged nineteen, housewife, admitted De- 
cember 13th. Diagnosis : tuberculosis of right knee. 
Swelling began a year ago ; also treatment, with variable 
results. Father died of consumption. All organs nor- 
mal. 
December 13th. Injection of one milligramme. Pain 
in the affected knee extending to hip; otherwise no 
change. On the 14th, swelling and fluctuation appear 
less. 
December 14th. Injection of 4 milligr. Slight pain 
and redness and swelling at point of inoculation. After 
seventeen hours temperature, 101.20 F. 
December 15th. Injection of 4 milligr. On the 16th 
highest temperature, 100.3° F. No other symptoms. 
December 17th. Injection of 5 milligr. Next day 
temperature, ioo° to 100.3° F. during twelve hours. 
December 19th. Injection of 6 milligr. After twelve 
hours, temperature, 100.1° F. 
December 20th. Injection of 8 milligr. After four 
hours, temperature, 101.40 F. 
December 22d. Injection of 10 milligr. 
December 30th. Injection of 10 milligr., with a 
temperature of 100.4° F. twenty-one hours after inocula- 
tion. 
By some mistake the impression was gained that no re- 
action had taken place after the several doses, and medi- 
ations were discontinued. They were renewed only after 
some weeks, when the true state of affairs was found out. 
At that time the apices also seem suspicious. No im- 
provement. 
Daniel D , aged forty-two, admitted December 
12th. Tuberculosis of right elbow-joint. Slight dulness 
over apices. Eight inoculations were made, of from one 
to five milligrammes in the course of a month, besides 
two surgical operations on December 16th and January 
7th. The reactions after the injections were very 17 
marked, particularly after the first three or four, but the 
general condition and the total trouble of the patient leave 
much to be desired. 
A , working-man, forty-three years of age ; admit- 
ted December 31st. Underwent a resection because of 
tuberculosis of ankle-joint years ago, with complete re- 
covery. Suppurating fistule in the cicatrix this last month, 
an inch and a half deep, terminating in carious bone. 
Over right upper lobe, anteriorly, slight dulness and 
slightly bronchial respiration. 
January 6th. Injection of 1 milligr. Temperature 
normal; pain in joint; headache, dizziness ; appetite im- 
paired. 
January nth. Injection of 2 milligr. Temperature, 
102.6° F. Severe headache; palpitation; oppression. 
January 13th. Injection of 2 milligr. Temperature, 
101.40 F., twenty-four hours after injection. 
January 16th. Injection of 3 milligr. Temperature, 
103° F. Palpitation, headache; feels “asif he were go- 
ing to die.” 
Refused to be inoculated. An operation on diseased 
joint. General condition good. 
Elise S——, aged sixty-two. Admitted December 
19th. Knee swollen a year ago, is painful and stiff; 
some cough; some dulness over right upper lobe ; uni- 
versal rhonchi. Temperature, 101.4° F.; pulse, no. 
December 22d. Injection of 2 milligr. After twelve 
hours, temperature, 103.i° F.; begins to fall six hours 
after. 
December 23d. Injection of 3 milligr. After sixteen 
hours, temperature, 102° F. Pain in knee. 
December 25th. Injection of 3 milligr. No change. 
December 28th, Injection of 3 milligr. Temperature, 
101.3° F. 
December 29th. Incisions into the joint on either 
side ; removal of tubercular granulations. Drainage and 
iodoform ; ether. Purulent secretion from vagina; pain 
in abdomen. 18 
December 31st. Injection of 6 milligr. The usual in- 
crease of temperature. 
January 4th. Injection of 6 milligr. After sixteen 
hours, temperature, 104.20 F.; pulse, 122. Pain; some 
cough. 
January 10th. New operation. More removal of 
granulations. Fever, dry tongue, intermittent and fre- 
quent pulse. Fever and increasing debility; pulse 
weaker ; some cough the following days. Dies January 
17 th. 
Autopsy : Tuberculous knee-joint; large abscess of 
fifth left rib; general miliary tuberculosis of lungs, liver, 
and spleen. 
Ida S , aged sixteen, caries of vertebrae and ribs. 
Admitted October 2, 1890. Was well up to two weeks 
before her admission, with the exception of general dis- 
comfort, debility, and emaciation, which had lasted five 
or six months. Family history, heart, lungs, and kid- 
neys negative. She was treated with incisions, scraping 
of the carious rib, injections of Thiersch’s solution and 
iodoform in oil. Temperature ranged from 990 to 104° 
F.; pulse, 90 to 135. Her general condition improved 
gradually. 
First inoculation of 1 milligr. on December nth, while 
temperature was 102.20 F. Next morning temperature, 
99.30 F., with pulse and respiration diminished accord- 
ingly, and less pus. 
December 12th. Injection of 2 milligr. Tempera- 
ture, 100.4° F., some perspiration ; some cough. After 
sixteen hours, temperature, 99.30 F.; pus much less. 
After sixteen hours, temperature, 98.7° F. 
December 13th. Injection of 3 milligr. Old sites of 
injections congested and painful. Feels well. Pale face. 
Next day more pus. Feels improved. 
December 14th. Injection of 3 milligr. 
December 15th and 16th. Injections of 4 milligr. Se- 
cretion less. 
December 17th. Injection of 5 milligr. 19 
December 18th. Injection of 7 milligr. Profuse per- 
spiration; thirst; secretion trifling. 
December 19th and 20th. Injection of 8 mifligr. each. 
Temperature normal. 
December 2 2d. Injection of 10 milligr. After twelve 
hours, temperature, 104° F.; pulse, 98; headache, rest- 
less. Six hours later, temperature, 970 F. 
December 25th. Injection of 10 milligr. After twelve 
hours, temperature, 100.4° F. 
December 27th. Injection of 15 milligr. Highest 
temperature, 100.4° F. 
December 31st. Injection of 20 milligr. After six- 
teen hours, temperature, 101.20 F.; pulse, 120. Face 
pale, eyes sunken, marked ansemia, but appetite good. 
Iron. 
No inoculations on January 3d and sth, with after- 
noon temperature of 101.40 F., and pulse, 120. 
January 6th. Injection of 30 milligr. Twelve hours 
afterward, temperature. 101.40 F., and pulse, no. Eigh- 
teen hours afterward temperature, ior.10 F., and pulse, 
112. Twenty-four hours afterward, temperature, 101.40 
F.. and pulse, 112. 
Inoculations were discontinued. General condition 
not changed. Fistula as deep as before, but secretion 
slightly less, purulent, contains bacilli. High degree of 
anaemia. Physical symptoms not altered. 
Wilhelmine K , aged nineteen, admitted Decem- 
ber 11, 1890, for lupus vulgaris of upper lip, nose, and 
eyelid. Father died of pulmonary tuberculosis nineteen 
years ago. She had, when young, conjunctivitis, cervical 
adenitis, scarlatina, and measles ; also eczema capitis. 
Lupus commenced eight years ago on the nose, and 
spread to upper lip and part of left cheek. Has been 
operated upon several times. The lower part of the 
nose is deformed by loss of substance, the nares impervi- 
ous ; the upper lip shows several hard cicatrices. Some 
noduli still present. Upper lobe of right lung somewhat 
dull: No bacilli found in sputum. 20 
December nth, 4.45 p.m. Injection of 1 milligr. 
Temperature rose to 100.2° F. within an hour; was sub- 
normal, 97.20 F., within two hours ; after five hours 
pain around site of injection ; after seven hours, nose 
and lip congested and with the sensation of tension. 
Afterward some cough ; little sleep. Redness and 
oedema of nose and cheek very marked within sixteen 
hours. Headache and dizziness. After eighteen hours, 
temperature 102° F., pulse 1120 F., respiration 26. 
Nose and lip purplish; pain in chest; chilly, hot, 
perspiring. After twenty - four hours, temperature 
ior.20 F. 
December 12th. Another inoculation of 2\ milligr. 
Pain ; cough. Some distinct pustules in the area of lu- 
pus. Cough and rigor; temperature, 103.x0 F. 
December 13th. Itching of nose and lip. Tempera- 
ture falls some ; rises again to 103° F.; normal at 10 
p.m. No injection. Still in the night two chills without 
a rise of temperature, and pain in left shoulder. 
December 14th. 7.30 p.m. Injection of 4 milligr. 
Temperature rises after nine hours to 104.50 F. within 
fourteen hours ; normal in twenty-six hours. Meanwhile 
four chills, headache, pain about chest. Nose and upper 
lip swelled and congested. Desquamation on nose. 
December 16th. Injection of 5 milligr., with the same 
result as to temperature. Less local congestion, hardly 
a rigor, the newly-formed pustules and the noduli of lu- 
pus much smaller. 
December 18th. Injection of 5 milligr.; highest tem- 
perature, 102.40 F. Coryza, scales fall off. 
December 20th. Injection of 7 milligr.; highest tem- 
perature, 102.2° F. 
December 22d. Injection of 8 milligr.; highest tem- 
perature, 101.70 F. 
December 23d. Injection of 9 milligr. Highest tem- 
perature, 100.2° F. 
December 24th. Injection of 10 milligr. Highest 
temperature, 99.2° F. 21 
December 25th. Injection of 12 milligr. Highest 
temperature, 100.i° F. after the lapse of twenty-four 
hours. 
December 26th. Injection of 15 milligr. Highest 
temperature, 99.90 F. 
December 27th. Injection of 15 milligr. Highest 
temperature, ioo° F. after twenty-four hours. 
December 29th. Injection of 20 milligr. Highest 
temperature, 100.2° F. after twenty-four hours. 
January 3d. Injection of 15 milligr. Highest tem- 
perature, ioo° F. 
January sth. Injection of 15 milligr. Highest tem- 
perature, 99.40 F. 
January 7th. Injection of 25 milligr. Highest tem- 
perature, ioo.B° F. after twenty-two hours. 
January Bth. Injection of 40 milligr. No rise of 
temperature. After thirty-three hours, 97.40 F. A few 
hours after the injection an attack of angina pectoris, 
pain, oppression, fear of impending death. Inhalations 
of amyl nitrite relieved her. 
January 16th. Injection of 50 milligr. Highest tem- 
perature, 101.80 F.; pulse, 40. 
January 18th. Injection of 60 milligr., without any re 
action. 
January 24th. Injection of 80 milligr. Some hours 
after, without a change of temperature, attack of angina 
pectoris, face pale, pulse so frequent as not to be count- 
able. Pain and sense of constriction; distinct blowing 
murmur at apex. Morphine did not relieve her, amyl 
nitrite did. 
January 29th. Injection of 30 milligr. No change of 
temperature, but palpitation and pain in chest. After 
seven weeks’ treatment the lupus is very much improved, 
the deformed nose is of normal paleness, the lips still red 
in places, some lupus noduli on lip still perceptible, lip 
still hard, part of this hardness, however, due to old 
cicatrices resulting from operations. Though there be no 
cure, the improvement is such, when compared with the 22 
results of any operative procedures known, as to be very 
encouraging. 
Amos D , aged sixty-six, admitted December 31, 
1890. Diagnosis : Epithelioma of face, right side (was 
announced as lupus). Ulceration of face was observed 
fifteen years ago. Many attempts at a cure. Lately in 
Chicago arsenic paste, with the result of digging a square 
large hole into the malar bone which is superficially 
necrotic, and destroying the external angle of right eye. 
Normal organs. Insisted upon lymph treatment. 
January Ist. Injection of 2 milligr. Eruption began 
to rise half an hour later. Temperature was 101.20 F. 
after three hours; fell; rose again, until after twelve 
hours it reached 101.80 F. It was not normal until 
thirty-six hours after inoculation. Wound not changed, 
but eyelids swollen and red. 
January 3d. Injection of 2 milligr. Temperature, 
100.3° F. four hours after inoculation, and slight rigor. 
January 4th. Injection of 3 milligr. 
January sth. Injection of 5 milligr. No increase of 
temperature; some pain in eye and about the site of in- 
oculation. 
January 6th and 7th. Injection of 10 milligr.*each. 
January Bth. Injection of 15 milligr. 
January 9th. Injection of 20 milligr., after which, on 
the next day, temperature, 101.50 F. 
January nth and 13th. Injection of 25 milligr. 
January 16th, 20th, 22d, and 30th. On the 19th he 
had once a temperature of 100.8° F., but in no connec- 
tion with an injection. 
January 25th. Injection of 40 milligr. Through all 
these days no rise in temperature, and no local effect. 
The wound healed slowly under a boric and salicylic acid 
ointment. 
Reactions set in at first as they do in the well, in from 
one-half to twenty-two hours. This effect was obtained 
with 2 milligr., while afterward 20 and 40 had no effect 
whatsoever. There was no apparent effect on, or im- 23 
provement of, the local lesion attributable to the use of 
“ tuberculin.” 
James C , aged forty-one ; admitted January 3d, 
for alleged lupus, which proved epithelioma of the eye- 
lids and temporal regions of left side. It had lasted 
seven years and had undergone several operations in the 
last two years. Five milligrammes were injected January 
4th at 4 p.m. at a temperature of 98.4° F. Nine hours 
later it was 970 F.; fifteen hours, 96° F.; seventeen 
hours, 98° F. During this time slight fulness in head, 
pulse smaller and somewhat quicker. 
On January sth injection of 10 milligr. Slight increase 
of temperature and swelling of spleen on the 6th. 
On January Bth injection of 30 milligr. at 9 a.m. Tem- 
perature rose soon, and reached 103° F. within ten hours. 
Lymphatic glands enlarged on the side of his chest, which 
were quite painful. 
January nth. Injection of 40 milligr. Temperature 
rises only to 100.20 F. Feels perfectly well. 
January 15th. Injection of 50 milligr., with no effect 
whatsoever. 
January 18th. Injection of milligr. No effect. 
January 21st. Injection of 66| milligr. Temperature 
eight hours after, 101.40 F.; otherwise no effect either 
local or general. 
January 25th. Injection of milligr. No effect at 
all; complains, however, on the 26th that his bones ache 
and his shoulders are lame. Better on the 27th. 
January 28th. Injection of 72J milligr. No effect, 
and the ulcerations in about the same condition as in the 
beginning; some new granulations on the edge of lower 
eyelid. No improvement. 
A child nineteen and one half months of age was in- 
oculated in the very last stage of tubercular meningitis on 
December 12th, with one half of a milligramme, on the 
13th, with one milligramme of “ tuberculin.” There were 
no changes in her hopeless condition attributable to the 
injection. 24 
E. R , boy aged eleven, admitted October 23d, with 
tubercular peritonitis and ascites. Disease began six 
months previously, with frequent but moderate pain, but 
no fever or rigor. Convolutions of intestines are easily 
distinguished (adhesions). Constipation. Never a tem- 
perature beyond 99.50 F., never one below 98° F., until 
December 26th, when the first milligramme was injected 
at 6 p.m. Temperature at 9 p.m was 97.8° F.; pulse 80. 
At 12 m. on the 27th, 970 F.; pulse 88. At 3 a.m., ioi°F. ; 
pulse 100. At 6 a.m., 1020 F.; pulse 120. At 9 a.m., 
103.30 F.; pulse 114. At 12 m., ioi.6° F.; pulse 116. 
At 3 p.m., 101.80 F.; pulse 112. At 6 p.m., 102.20 F. ; 
pulse 116. At 9 p.m., ioo° F.; pulse, 108. 
The first temperature of 99° F. was reached at 3 a.m. on 
the 28th, at noon it was again 97° F., still with a pulse of 
106. Second inoculation of 1 milligr. at 6 p.m. ; only 
rise (101.20 F.) at 9 p.m. On the 29th at 6 p.m. 2 milligr., 
also on the 30th. No rise, several times 970 F. On 
January 2d, 3 milligr. at 6 p.m. At 9 and 12 p.m., and 
at 3 and 6 a.m. on January 4th the temperatures were 
97.8° F., 97.40 F., 97-98° F. No rise. 
January 4th, 6 p.m., injection of 3 milligr. Tempera- 
ture at 9 p.m., 96.5° F.; at 12 M., 970 F. 3 a.m. of the 
sth 99.40 F.; 6 a.m., xoo.30 Fq the only rise. That 
night temperature for many hours was 97°, 96,2°, 
96.9° F. 
January 6th at 6 p.m., with a temperature of 97.30 F., 
5 milligr. were inoculated. For twelve hours afterward 
temperature was between 97° F. and 96.2° F. No rise 
except once, to ioo° F., at midnight of January Bth. 
This was the only time when the pulse was as low as 
70. 
On January 10th 10 milligr. were injected, temperature 
sank again to near 96° F., as heretofore, rose and fell, 
once at midnight of the 13th to 95.8° F., with a pulse of 
62. 
On January 16th with a temperature of 97.20 F., at 6 
p.m., xo milligr. were injected. The first effect was again 25 
a fall to 97.8° F., and 97.20 F.; then, at 3 a.m., a 
rise to 102° F. and pulse, 116. At 6 a.m., 99.4° F.; 
pulse, 108. At 9. a.m., xoi.2° F.; pulse, 120. At 
12 M., 1020 F. ; pulse, 122. At 3 p.m., 99-6° F.; 
pulse, 108. At 6 p.m., i 00.6° F.; pulse, 130. After 
that the temperature fell, with the exception of mid- 
night the 19th, when it was once ioi° F. It then fell 
a few hours, rose again in the morning hours of the 20th 
and remained twelve hours from 100.2° F., to 101.7° F. 
On the 23d, about noon, I made an inoculation of 20 
milligr. At 6 p.m temperature was 104.4° F., with a 
pulse of 112. All next day it remained above ioo° F. 
He left the hospital on the 26th. During all these weeks 
he felt very comfortable except when under the influence 
of high temperatures, and his general condition improved. 
Still, it had improved before the lymph treatment was be- 
gun ; his strength increasing and ascites diminishing. 
M. C , aged five years and six months. Tubercu- 
lar peritonitis, ascites. Was said to have been sick a 
week with tumid abdomen and loss of appetite. For 
some days after admission the highest afternoon tempera- 
ture was 100.50 F., morning temperature as low as 98 40 
F. First inoculation of half a milligramme at 8.45 p.m. 
on January 3d. Within five hours the temperature was 
103.20 F.; pulse, 148; respiration, 30. The tempera- 
ture rose to 104.5° F., and the accompanying symptoms 
became so alarming that phenacetin and brandy were ad- 
ministered several times. Not before the 6th was the 
temperature again below 100° F. After the next inocu- 
lation reactions would always show themselves, but the 
effect grew less gradually, though the doses were in- 
creased from one half to 2 milligr. Very suddenly and 
unexpectedly, eighteen days after the treatment was be- 
gun, the temperature rose again to 104.6° F., with corre- 
sponding rise of both pulse and respiration. No particu- 
lar change in the three weeks she was in the hospital. 
The following are a number of cases of pulmonary tu- 
berculosis in different stages: 26 
Mrs. R , twenty-five years of age. Admitted De- 
cember 17th. Singing lessons from seventh to seven- 
teenth year; haemoptysis at seventeen ; acute pulmonary 
complaint two years ago and a year ago. For eight 
years occasional dyspnoea, cough, and expectoration. Left 
upper lobe, extensive dulness and coarse respiration; 
right lower lobe, local dulness and rhonchi. Bacilli. 
December 18th. Injection of 1 milligr. at 6 p.m. 
December 19th. Slight rigor in afternoon, with tem- 
perature of 101.30 F., and perspiration ; 9 p.m., 102° F. 
(highest temperature). Pain in site of inoculation. First 
normal temperature returned December 21st at 9 a.m. 
At 12 m., 1 milligr. After twenty-four hours, December 
22d, 9 a.m., 100° F. Spleen enlarged. Highest tem- 
perature at 6 p.m.; at 9 p.m., below ioo° F. Headache 
all day. December 23d some cough. At 12 m. temper- 
ature roo.20 F.; 6 p.m., 100.60 F. 
Injection of 2 milligr. at 7 p.m. on December 24th; 2 
milligr. the 26th; 3 milligr. the 29th ; 4 milligr. the 31st; 
also the 2d, 4th, and 6th of January. The highest tem- 
perature on the 25th was 101.40 F.; the 27th, 102° F.; 
the 30th, 101.20 F.; January Ist, 100.70 F. ; January 3d 
T030 F; the sth, 102.40 F.; the 7th, 99.40 F. These 
temperatures were reached in from sixteen to twenty-two 
hours after inoculation. During all this period her gen- 
eral discomfort, local pain, cough, and perspiration be- 
came lessened. 
Inoculations were made on the Bth, 6 milligr.; the 9th, 
7 milligr. ; the nth, 8 milligr. ; the 12th, 9 milligr. ; the 
14th, 10 milligr.; the 16th, 11 milligr.; the 17th, 13 
milligr.; the 18th, 13 millgr.; the 21st, 23d, and 24th, 
each 15 milligr.; the 25th, 20 milligr.; and the 26th, 25 
milligr. During all this time her general condition im- 
proved ; her temperature was mostly between 98.5° and 
99.50 F., and seldom rose to 100.20 F. 
John H , aged twenty-eight, admitted January 15th. 
Tuberculosis pulmonalis et laryngis. Family history of 
phthisis, ot which a brother and a sister have died. 27 
Hoarseness, dry throat, and occasional haemoptysis more 
than two years ago. Permanently sick for a year, cough, 
some expectoration in the morning. Both increased 
three weeks ago. No pain, fever, or night-sweat. Short 
breath on exertion. Condition fair. Some retraction 
of left supra- and sub-clavicular region, dulness, crepi- 
tant rales down to third rib ; posteriorly the same. About 
the middle of thorax some bronchial or prolonged expira- 
tion, a similar condition on the right side on percussion 
and auscultation. 
Inoculations on January 15th, of 1 milligr.; January 
16th of 2 milligr.; 17th of 3 milligr. ; 18th of 4 milligr.; 
20th of 6 milligr. had no visible effect whatsoever, the 
rectal temperature remaining at 99.6° F. 
On the 21st, 10 milligr. were injected, with the re- 
sult of raising the temperature to 103° F. within five 
hours and producing much cough. On the 25th, 5 
milligr. were injected, the 25th, xo milligr.; the 26th, 15 
milligr. with no response on the part of temperature. 
It is probable that the dose of 10 milligr., if it had been 
the first, would have had the same result, and that this 
effect would have justly been claimed as pathognomonic 
for tuberculosis; though a later dose of xi centigr. did 
not in the least show the same effect. Six milligrammes, 
however, elicited no temperature response ; while other 
cases respond to smaller doses so readily that, if larger 
doses were given to them, danger might be incurred. 
Thus for instance : 
E. V— , aged twenty-five, with undoubted pulmo- 
nary tuberculosis, dulness, bronchial respiration, purulent 
expectoration, bacilli, and night-sweats had x milligr. 
injected on January 25th, with no result; another on 
January 26th, with aix increase in temperature, which 
reached its maximum, 101.80 F., after fifteen hours. 
In this case it is remarkable that the second effective 
dose was not larger than the first which refused its 
effect. Still, it is possible that the reaction following 
the first inoculation occurred only after more than a day 28 
after—in accordance with some other observation of the 
same kind. 
G. P , aged thirty-two, admitted December nth, 
with the diagnosis of incipient tuberculosis of the lungs. 
Had dulness and crepitant rales over clavicle and supra- 
scapular region of the right side. Respiration over fossa 
supraspinata diminished. Sputum not copious, but con- 
tains bacilli. Weight, 127 pounds. 
Inoculation of 2 milligr. on December 12th; 3 milligr. 
the 13th; 4 milligr. the 14th; 4 milligr. the 15th. Tem- 
perature rose to 101.60 F. in twenty-two hours. Injec- 
tion of 5 milligr. on the 17th with no visible effect. Pa- 
tient weighs 137 pounds on the 19th. Injection of 6 
milligr. on the 20th was followed by a temperature of 
102.4° F. on the 21st; 6 milligr. on the 23d by iox° on 
the 24th ; 7 milligr. on the 25th by 101.80 on the 26th; 
7 milligr. on the 28th by 101.2° on the 29th; 9 milligr. 
on the 30th by iox° on the 31st. 
On January xst no inoculation, and no temperature 
above xoo° F. (This but once.) 
On the 2d of January a new start was taken with 2 
milligr., and thirteen inoculations were made up to the 
19th, when the treatment was discontinued. Meanwhile 
the doses had been gradually increased to 10 milligr. 
But twice was there a temperature as high as xoo° F. 
during that time. The general condition improved from 
day to day, and about the end of the month the patient 
was discharged in good health, without cough, and with- 
out any rales and any dulness. Recovery (?). 
J. W. B , aged twenty-five, tuberculosis pul- 
monum. Father died of consumption; patient had 
symptoms these several years. Bronchial respiration 
over upper lobes both right and left posteriorly, also 
slightly over the left lower lobe ; loud bronchial respira- 
tion over left upper lobe in front; moderate dulness over 
total right side. From December 20th to the end of 
January, when she left, twenty-two inoculations were made, 
ranging from 1 to 15 milligr., the latter dose being given 29 
four times. The first rise of temperature occurred on 
December 26th, after a dose of 3 milligr. on the 25th; 
the first temperature of 102° F. was reached January 10th 
after a dose of 7 milligr. had, been given twelve hours 
previously. The same was reached again on January 
26th, sixteen hours after the fourth dose of 15 milligr. 
(the first on January 20th) had been administered; also 
on January 27th, sixteen hours after 15 milligr. on the 
26th. It must be added, however, that after the tem- 
perature had come down to 98° F. in the early morning 
hours of the 28th, it rose to 102.90 F. in the afternoon. 
Thus it remains doubtful whether the higher temperatures 
of the afternoon (mostly sixteen hours after the inocula- 
tion) were due to the injection or to the pulmonary proc- 
ess. For when the patient left about the end of January, 
her claim of feeling improved was not justified by either 
increase of weight or any appreciable change in her lungs. 
M. P , aged twenty-one, admitted December 12th. 
Tuberculosis pulmonum et laryngis. Color of vocal cords 
grayish red ; edges eroded, fossae Morgagni ulcerated, pos- 
terior wall of larynx slightly thickened. Extensive rhon- 
chi over chest, dulness below right clavicle. Bacilli numer- 
ous. Inoculations were made, December 13th, 1 milligr.; 
14th, 2 milligr.; 16th and 18th, 5 milligr. each; 21st 
6 milligr.; 23d, 25th and 28th, 5 milligr. each. Reac- 
tions were quite marked after the first inoculation, though 
they required nearly a day for their maximum. Cough, 
expectoration, and temperature increased, larynx became 
sensitive. At no time was the temperature anything like 
normal. Examination on December 26th revealed: No 
change in larynx, complete aphonia; over left upper 
lobe dulness, coarse respiration, moist and sibilant rales, 
over apex cavernous breathing; over almost the whole 
right lung bronchial respiration, and moist and sibilant 
rales. As his condition was so much impaired, I hesi- 
tated giving the same doses, being under the impression 
that possibly the injection might add to his high tempera- 
tures and the extension of the morbid process. There- 30 
fore after waiting five days, during which the general con- 
dition and the temperature of the patient showed no 
difference from former observations, I injected 2 milligr. 
on January 2d. The last injection of this new series, 
which consisted of fourteen inoculations of from 2 to 5 
milligr. was made on January 20th. No perceptible 
effect. Death on January 25th. 
M. A , aged nineteen, admitted January yth. Pul- 
monary tuberculosis. Began with a pleurisy, October, 
1889. Languor, cough, fever, night-sweats last spring, 
expectoration with bacilli, but seldom in bed. Right up- 
per lobe has prolonged expiration and sibilant rales. 
Left, normal. Posteriorly, over right apex, wheezing and 
moist rales. Some dulness over right upper lobe, ante- 
riorly. 
Inoculations were begun January 9th, from the 9th to 
the 19th. They were repeated daily, commencing with 
1 milligr,, and gradually rising to 9 milligr. From Janu- 
ary 21st to 29th eight inoculations were made, each of 
10 milligr. During all this time no improvement took 
place ; she coughed but little, with exceptions, perspired, 
felt often languid, expectorated some, slept well most of 
the time. During the first week (sixth day) the temper- 
ature reached 102° F. ; but once, toward the end of the 
second week, it reached 102.50 F., touched 104.50 F. 
several times in the third, and more in the fourth week. 
Toward the end of the month the temperature fell below 
103° F. Meanwhile, though the patient’s rales would in- 
crease from time to time, the dulness did not extend ; 
still, her general and local condition did not improve. 
A. H , aged twenty-one, admitted December 
29th; tuberculosis pulmonura. Had pneumonia a year 
ago; coughed almost all the time since with the excep- 
tion of some months passed in the mountains. Dulness 
over both apices (mainly left), both anteriorly and pos- 
teriorly. Rhonchi over both upper lobes, in some places 
during cough only. 
Inoculations: December 31st, i milligr.; January Ist, i milligr.; January 3d to 7th, four inoculations of 2 mil- 
ligr. each; January 9th to 25th, a daily dose of 3 milli- 
gr., with the exception of the 14th, 19th, and 22d; Janu- 
ary 26th, 4 milligr.; 27th and 28th, 5 milligr. each; 29th, 
6 milligr.; 30th, 7 milligr.; 31st, 8 milligr. After the 
smallest doses the temperature would rise, sleep was rest- 
less, there were headaches and mild chills, also much 
perspiration, also palpitation. The temperatures till 
January 22d varied from ioi° to 103.50 F.; in very rare 
instances only would they fall below xoo° F. In the last 
week of the month, however, most observations showed 
temperatures below ioo° F., many below 990 F., very 
few as high as iox° F. About that time her general 
condition, which had not been good at all, improved very 
much indeed. 
I , a girl aged five, with undoubted pulmonary 
tuberculosis, slight dulness over left lung both anteriorly 
and posteriorly, and higher pitch in right side than left, 
but no rales, had her first inoculation of 1 milligr. on 
January 6th. The case is remarkable for its punctual 
reactions. Within four hours, once after two, the 
temperature would rise without affecting either pulse or 
respiration after the first two injections. Only with the 
third, and every subsequent injection, both pulse and 
respiration rose correspondingly. The reactions lasted 
about twenty-two hours, a little less than one-half of this 
time being spent on the rise. Respiration, with a single 
exception, returned more readily to the normal than the 
pulse, which remained accelerated for some time. Still, 
when a sufficient time was afforded, temperature, pulse, 
and respiration returned to the original condition previous 
to any inoculations. Not improved in three weeks. 
S. S •, aged thirty-two, pulmonary tuberculosis, with 
infiltration of both upper lobes. The first injection of 1 
milligr. appeared to have but little effect, the third of 3 
milligr. given two days afterward increased his tempera- 
ture within six hours. The maximum was xoi.B°F., and 
was reached twenty-four hours after. Normal tempera- 32 
ture on the following day (January 14th). On the 15th 3 
milligr. with rise of temperature within twelve hours; 
maximum of 102.6° F. within eighteen hours; at the same 
time perspiration, cough, great discomfort. On the 18th 
3 milligr. were again given without any such effect. 
Five milligr. on the 20th increased the temperature with- 
in six hours, to a maximum of 103.90 F. within nine 
hours. The same dose on the 23d had no similar effect. 
But when given on the 25th it had again the effect of rais- 
ing the temperature within seven hours, with a maximum 
of 103.8° F. within nineteen hours. It appears, therefore, 
that the same dose may lose its effect, and recover it at a 
later time, the intervals between the several administra- 
tions being the same, viz., two days. 
F. T , aged thirty-six. Pulmonary tuberculosis. 
Had fifteen injections from December 28th to January 31st, 
in doses of from one to eight milligrammes, with but little 
reaction and little effect. The smaller doses appeared to 
prepare the patient for readily tolerating the larger ones. 
J. F. L , aged thirty-nine. Pulmonary tuberculo- 
sis. Had a pneumonia nearly two years ago, and never 
lost his dyspnoea. For five months past, cough, expecto- 
ration, emaciation, night-sweats, bacilli. Over upper 
halves of both upper lobes, dulness, and crepitant rales. 
Thirteen inoculations between December 17th and Janu- 
ary 6th, amounting to from one to twenty milligrammes. 
The latter dose was repeated on the 16th and the 20th, a 
few days after he left the hospital. The brief observa- 
tions permitted resulted in the following : The third in- 
oculation (first of 3 milligr.) was the first that raised the 
temperature to 102.8° F. at 9 a.m. and 102.50 F. at 12 m., 
fourteen and seventeen hours after the inoculation. Nearly 
the same temperature was reached three and six hours 
after the next inoculation of 5 milligr. It was never 
reached again, either spontaneously or after increased 
doses. Indeed there appeared a gradual downward ten- 
dency from day to day. The general condition certainly 
improved, and he gained a few pounds. 33 
A. B , aged thirty-three ; admitted November 25th- 
Puimonary tuberculosis. For a year and a half past, 
cough, four attacks of haemoptysis, expectoration, night- 
sweats, emaciation, hoarseness. Bacilli. Family his- 
tory negative. Supra- and infra-clavicular regions re- 
tracted. Dulness over both apices, also diminished res- 
piration and some rhonchi. Over right lower lobe, 
posteriorly, dulness and bronchial respiration. During 
December, fifteen injections of from 1 to ro milligr. ; in 
January, seventeen of from 2 to 50 milligr. After the 
first inoculation the patient coughed much, both cough 
and expectoration grew less after the second, and re- 
mained so. At no time was there a temperature which 
had to be attributed to the action of the lymph; it sel- 
dom reached ior° F., then only in the afternoons (about 
a day after the injection) and for a short time. Within 
a week the patient felt better. Still, the examination of 
his chest made on December 26th revealed no changes 
except the disappearance of the rhonchi. During Janu- 
ary, temperature almost normal; but little cough and 
expectoration. Increase of weight in one month, nine 
pounds. General improvement. 
A. H , aged thirty-nine, admitted December 4th 
with dulness over both apices and crepitant rales, and 
bronchophony over right apex. Bacilli. From December 
13th to the end of the month thirteen injections were 
made of from 1 to 10 milligr. During the course of 
January sixteen injections were made, from 2 with rapid 
increases to 60 milligr. The first injection of 1 milligr. 
raised the temperature of 98.5° F. to 105° F. within an 
hour and a half, with intense perspiration, followed by a 
rapid fall afterward to 990 F. Maximum temperature 
in the afternoon of the 12th, 101.70 F.; of the 13th, 
101.20 F. At that time 3 milligr. were injected, with no 
increase of temperature or any other signs of reaction. 
No such temperature was ever reached again, and the pa- 
tient felt more comfortable from day to day. Still, the 
physical condition of December 26th revealed dulness 34 
posteriorly over left upper lobe, with considerably in- 
creased voice. On the right side bronchophony posteriorly 
over upper lobe, dulness over the two upper lobes. Tem- 
perature remained normal throughout January, weight in- 
creased by twelve pounds, cough became less, also expec- 
toration, crepitant rales disappeared, dulness remained. 
Great improvement in the general condition. 
In some cases of tuberculosis small doses of the lymph 
appear to reduce the temperature without giving rise to 
any other symptoms except the sensation of comfort. 
Patients will apparently not react on the administration 
of i milligr., then the dose is increased from day to day, 
slowly; the later doses will not affect the system any 
more than the first; indeed, 10 milligr. the tenth day is 
attended with the same lack of consequences as i milligr. 
given the first day, in accordance with the fact that when 
a serious reaction is experienced after a single milligramme 
has been administered, very much larger doses are soon 
required to accomplish the same end. 
A lady, aged thirty-five, Mrs. M , mother of a num- 
ber of children, one of whom died a few years ago of 
miliary tuberculosis, had tuberculosis of the lungs and 
abdominal lymph-bodies, probably also the peritoneum, 
these ten years. The abdominal symptoms were very 
much improved compared with what they were a few 
years ago. But for years she has expectorated, coughed, 
was emaciated, formed large cavities in both apices, both 
of which have diminished in size for a year past, has had 
numerous attacks of pleuritis and pneumonia, and brings 
up bacilli in almost every sputum. Besides the extensive 
cavities she has large areas of dulness and coarse respira- 
tion, besides all kinds of rhonchi. Lately she had a se- 
vere pneumonia of which she got fairly well. Still, she 
went on with her old symptoms, and high fever, which re- 
quired repeated large doses of digitalia and antipyrin. 
The first milligramme was injected January 25th while 
she had a temperature of ioi.°B F., which fell as low as 
99° F. January 26th it rose in the morning to 100.4° F. 35 
Injection of 2 milligr. at that time. Temperature sank 
to 98° F. Next morning again 100.40 F. and 3 milligr. 
Again 100.4° F. and 4 milligr. on the 28th ; on the 29th 
the same and 5 milligr.; on the 30th the same and 6 
milligr. in the afternoon. For the first time this week 
she had a temperature of 100 8° F. in the night through 
the course of a few hours. The following morning, Jan- 
uary 31st, temperature below roo° F.; 8 milligr. at noon. 
First elevation twenty-four hours after, on February Ist, 
100.5° F., rose to 100.8° F., was roo° F. again at 6 p.m., 
and fell below. Through all this week there was less 
cough, less expectoration, less perspiration, more appetite 
and comfort, in spite of the three daily doses of medicine 
being reduced to one, and that one reduced in size.1 
A similar observation was made in E. L , aged 
nineteen, admitted December 25 th. He had been sick 
in bed seven weeks, his condition had been carefully 
watched, and temperatures recorded. They were seldom 
as low as xoi.50 F., mostly from 102° F. to 104.50 F.r 
and sometimes higher. Has been reduced to pounds, 
Dulness and fine rhonchi, crepitant and sibilant over the 
left upper lobe, also bronchophony. Over the right up- 
per lobe posteriorly, over large area, dulness, rhonchi 
crepitant and sibilant, and bronchophony • anteriorly, dul- 
ness, bronchial and cavernous breathing, and rhonchi. 
Bacilli. Had twenty - nine inoculations from Decem- 
ber 25th to February 27th, the latter day 5 milligr.; all 
the rest from Ito 4 milligr., with a slow increase. On 
December 27th, the first temperature of ioo° [F. was 
reached, the lowest in seven weeks; 99.8° F. on the 28th; 
99.40 F. on January 2d; 990 F. on the 3d, 9th and 10th;. 
1 Four weeks have elapsed since. There has been some afternoon 
rise of temperature every day which could be controlled by a daily 
dose of digitalin and antipyrin. Meanwhile daily doses of tubercu- 
lin have been injected; they reach at present a decigramme without 
the slightest feverish reaction. The cough is reduced to one-fifth of 
what it was, expectoration is much less and easier, the rales are au- 
dible on one side only, large areas have their vesicular respiration 
restored to them, and the weight of the bbdy has increased by more 
than six pounds. 36 
98.4° F. on the 14th; 98.6° F. on the 23d. All this oc- 
curred while his local symptoms did not improve. On 
contrary his cavity in the right apex is increasing in size, 
expectoration still copious and bacillary, though more 
fluid. Lately he has again temperatures of 102° F., and 
even 103° F., which cannot be taken as the result of 
lymph-action, but are undoubtedly the outcome of the 
destructive process, which is not checked. This case 
shows that the patient may feel very much improved with- 
out an actual change in his pathological condition, even 
while getting worse.1 
E. A. B , aged thirty-three, admitted January 3d. 
Since January, 1890, loss of weight (now pounds) and 
strength. For some months past hoarseness. The pos- 
terior wall of larynx hyperaemic; left vocal cord un- 
healthy, will £be described later on. No night-sweats. 
To those who saw him before admission, he looked fe- 
verish. Being a doctor, he never took his temperature. 
Right lung over clavicle : Dulness and during a cough 
crepitant rales ; posteriorly crepitant rales over the whole 
upper lobe. Left lung: Dulness trifling over clavicle, 
slightly coarse respiration. Between January 3d and 
13th, ten inoculations were made, from 1 to 10 milligr., 
increasing by 1 milligr. from day to day; on the 14th, 
10 milligr. ; 16th 17th, 18th, 15 milligr.; 20th, 20 milli- 
gr. The injections were made about 7 p.m., the only 
temperature above roo° F. would be found in the after- 
noons, the highest ever noticed being xoo.B° F., and that 
only once; low temperatures were observed, down to 
98.2° F. On several days the temperatures never reached 
ioo° F. During all this period no bacilli were found, 
and therefore I stopped the inoculations on January 20th, 
when the last one of 20 milligr. was made. On that day 
the highest temperature was ioo° F.; on the 21st, 100.1° 
F.; a single time, the 22d, ioo° F. ; a few evening hours, 
the 23d, over 100.8° F. very exceptionally. On that day 
1 In the course of the last few weeks, the general condition of the 
patient improved sufficiently to enable him to take long walks. 37 
the sputum, which was always scanty, was again examined, 
and a large number of bacilli found, many of them broken 
up as described in Deutsche Med. Wochenschrift, No. 46. 
At 11.10 a.m. 25 milligr. were injected. At midnight 
the temperature was far below xoo° F., and remained so 
(down to 98 6° F.) until 9 p.m. on the 24th—indeed the 
first day when there was no increase in the afternoon. 
On the 24th, at 8.30 p.m., 30 milligr. From 6 a.m. to 
9 p.m. the 25th, temperature from ioo° to 100.7° F., the 
first indications of a response such as every healthy per- 
son would show. The same occurred after 40 milligr., 
which were injected at 8.25 p.m., the 25th. Temperature 
rose, 9 a.m. on the 26th, to 100.3° F., reached 101.40 F. at 
noon, and was below xoo° F. late in the evening. Two 
days later 60 milligr. were injected with no more marked 
result. 
That case shows conclusively that the lymph did not 
cause any reaction pointing to the presence of tuberculo- 
sis when injected in doses varying from 1 to 60 milligr. 
The slight responses met with in these high doses may be 
found in the healthy. Besides, the case is noticeable as 
one of those in which bacilli may not be found for some 
time and still be present. The question whether the ba- 
cilli were freed by the action of the lymph must be an- 
swered in the negative ; for there were no marked rhon- 
chi during the period of inoculations, and we have a 
right to conclude that the tissue surrounding the bacilli 
nests was not congested and softened by the action of the 
lymph. 
This case is interesting from an additional point of 
view. On January Bth there was a flat, slightly granulat- 
ing ulceration of the posterior half of the left vocal cord, 
paresis of the adductors, the whole mucous membrane 
quite pale. On the 22d two-thirds of the ulceration had 
closed, paralytic symptoms improved, the mucous mem- 
brane just as pale as before. There was no local reac- 
tion at any time after an administration of lymph, all of 
which shows that not only the general but also the local reaction may fail, but still a local improvement may take 
place. 
In the case of H. C , aged nineteen, admitted De- 
cember 15th, similar observations were made, though not 
so conclusive for the following reason. He had been 
sick with cough, purulent and bloody expectoration nine 
months, was emaciated, feeble, and feverish. There were 
dulness, crepitant and sibilant rales, coarse respiration, 
bronchial respiration over both upper lobes. Bacilli copi- 
ous. The first inoculation of 1 milligr. was made on the 
15th, the 9th of 9 milligr. on the 25th, with the result of 
reducing his temperature. He entered with temperature 
103° F., which he did not reach again. Indeed, most of 
his temperatures were below ioo° F., once 98.6° F., 
reached ioi° F. but seldom, and were 101.70 F. but 
twice, and for a short time only. Two days after the 
first inoculation he slept well in the night, perspired less, 
cough but trifling, feels comfortable. But after the sixth 
injection, on the 20th (7 milligr.), cervical and axillary 
glands and a long string of lymph bodies were found 
swollen and painful on both sides of chest. On the 26th 
I stopped the inoculations because those lymphatic 
glands were increasing considerably, and in spite of the 
lowered temperatures the general condition of the patient 
was bad. On the first day when no injection was made, 
his temperature rose to 102.50 F., the next to 102.40 F., 
the third, 103.i° F.; the fourth, 104° F.; the fifth, 
103.70 F., with general malaise, vomiting, and some al- 
buminuria; the sixth, 103.6° F.; the seventh only iox.70 
F.; the eighth, 102.i° F. But there were some temper- 
atures below ioo° F., and his general condition was bet- 
ter, the glands also smaller; thus I resolved to keep him 
as I thought under the constant influence of the powerful 
remedy by giving a daily dose of only 2 milligr. ; this 
has been repeated sixteen times up to January 19th. 
When the first 2 milligr. were given there was no longer 
any albumin in the urine. The temperature decreased 
gradually, the periods of less than ioo° F. became longer, 39 
on the Bth it did not rise at all beyond iox° F., and did 
not reach this figure at all between the 9th and 14th. On 
the 19th, when no inoculation was made, 102. i° F. was 
again reached through five or six evening hours. His 
general condition is not improved; has left for the 
South. 
E. S , aged thirty-two, admitted December 16th, 
with the diagnosis of tuberculosis pulmonura. Bacilli 
have never been found, there being very little sputum. 
But has coughed these two years, had night sweats, and 
some fever these four weeks. No history of tuberculosis 
in the family. On the right side dulness and fine crepi- 
tant rales over the clavicle, also below. Posteriorly the 
same. Over the lower right lobe diminished respiratory 
murmur and some dulness. On the left side, above and 
below the clavicle and in the supraspinal region, some 
crepitant fine rales during cough. This patient proved 
peculiarly immune against the effect of the lymph. He 
entered with a temperature of ioi° F., and over, but 
never reached it again, seldom ioo° F., was more fre- 
quently 98° F. than 990 F., and reached 97.20 F., lymph 
or no lymph. On December Ist, 1 milligr., and further 
on 2, 3, 5, 6, 10 (on the 30th), again on January 3d, 20 on 
the Bth, 25 on the 10th, 30 on the 14th, 40 on the 16th, 
20 on the 23d and 25th; 50 on the 26th, 60 on the 27th, 
70 on the 29th, 80 on the 30th. The doses were more than 
large enough to affect a healthy person. If it were not 
for the negative result of the search for bacilli, there 
would be no doubt in regard to the diagnosis. Ido not 
feel, however, that I have a right to deny the presence of 
tuberculosis in the presence of all symptoms except ba- 
cilli. I have spoken of a case in which a two weeks’ 
search for bacilli was in vain, and still they were present. 
Here, then, is an individual who in that condition is not 
affected by 360 milligr, administered within a week. Are 
we to call this absence of an effect the result of an idio- 
syncrasy ? Though that term does not mean much and 
be only an expression of convenience, it shows that there 40 
is an occasional person that is not affected by a reasonably 
large dose of the lymph. 
The condition of the patient is very much improved. 
Dulness has disappeared and there are no rhonchi. Evi- 
dently the pulmonary tissue has expanded, and the secre- 
tion stopped entirely. Improved, perhaps well. 
Conclusions.—After an inoculation of tuberculous pa- 
tients with tuberculin the temperature of the body 
would rise in from two to twenty-eight hours. Or it 
would not be influenced at all, in a few cases. Or it 
would fall first and then rise some. Sometimes it would 
rise, then fall and again rise. Still the rise is the usual 
occurrence. The descent from the maximum would in 
most cases take a longer time than the ascent. Unex- 
pected rises of temperature were occasionally met with in 
inoculation of persons not tubercular. Perhaps there are 
other conditions besides tuberculosis in which tuberculin 
has the same effect. It is therefore not absolutely reli- 
able in ferreting concealed tuberculosis. As a means of 
diagnosis it is not positively infallible. The doses re- 
quired to obtain a reaction would vary considerably. 
Some patients would respond readily to a milligramme, 
some demanded ten times that amount. Children re- 
quired relatively large doses, except the cases of tubercu- 
lar peritonitis One of them, at one time, after having 
shown high temperatures following previous inoculations, 
had a rectal temperature of 95.8° R, with a pulse of 62. 
The nature of the cases—whether bone, gland, skin, or 
lung—did not influence the effect of the doses. Lupus 
and pulmonary tuberculosis would be influenced by very 
small, or sometimes by large doses only. Therefore it is 
not safe to begin anywhere with 10 milligr,, as has been 
advised, particularly as possibly the reaction may be 
retarded, and a second inoculation may have a cumula- 
tive effect. The therapeutic effect did not appear to de- 
pend on the energy of the reaction; on the contrary, 
some of the most favorable cases were those in which 
no, or very little increase of temperature was observed; while others, which exhibited high fever, and other symp- 
toms of reaction, were endangered by dyspnoea, rhonchi, 
and the progress of local disturbance in the lungs. It 
seems advisable to begin with small doses in every case, 
and rather avoid than covet striking effects. At all 
events it is impossible to predict or calculate the effect of 
the remedy. Every case appears to require its own ten- 
tative treatment. 
Other results of the inoculations were changes in pulse 
and respiration. In some these would correspond with 
the rise of temperature ; in a few they would not be in- 
fluenced. Sometimes the pulse, other times respiration 
would be more readily affected. The comfort or dis- 
comfort of the patient would not always be in accord- 
ance with the variations of temperature, pulse, or respira- 
tion. The site of the induration would sometimes 
smart, and flush after a while ; indurations there were 
but few, abscesses none, local erythema extending beyond 
the site of injection a few, general eruption but one. No 
erysipelas. We have observed pain in the diseased part, 
in other limbs, swelling of glands sometimes in distant 
patts, perspiration, headache, rigors, languor, insomnia, 
palpitations, angina pectoris, nausea, increase of appetite, 
very slight jaundice, albuminuria in a few cases, increase 
of cough, diminution of cough, dyspnoea, rhonchi on ex- 
pected and unexpected places, new regions of dulness, 
more expectoration—mostly in the beginning of treat- 
ment, change of its purulent into mucous character, 
increase or mostly decrease of secretion from accessible 
tuberculous parts, swelling of spleen and a peculiar 
form of glossitis in a few cases. 
The results of, or events after, a protracted course of 
inoculations, may briefly be summed up as follows: 
Tuberculosis of right knee. No change. 
Dorsal spondylitis. No change. 
Tubercular abscess in right inguinal region. No im- 
provement. 
Tubercular disease of right hip. No improvement. 42 
Tuberculosis of right knee. No improvement. 
Tuberculosis of right elbow. No improvement. 
Tubercular ankle-joint, fistula. No improvement (in 
sixteen days). 
Tubercular knee-joint. Death from miliary acute tu- 
berculosis. 
Caries of vertebrae and ribs. No improvement. 
Cold abscess from right sacro-iliac synchondrosis. 
Slight improvement. 
Tuberculosis of left tibio-tarsal articulation. Improve- 
ment. 
Cutaneous tuberculosis. Great improvement. 
Lupus vulgaris of nose and lip. Great improvement. 
Epithelioma of right temple and face. No improve- 
ment. 
Epithelioma of left temple and eyelid. No improve- 
ment. 
Tubercular meningitis, almost moribund. No change. 
Tubercular peritonitis. Two cases. Not influenced. 
Pulmonary tuberculosis. Five cases. Improved. 
One of them relapsed and got worse. 
Pulmonary tuberculosis. Four cases. Much im- 
proved. 
Pulmonary tuberculosis. Two cases. Disappearance 
of local symptoms. Recovery. (Bacilli found in one.) 
Pulmonary tuberculosis. Four cases. Not improved. 
Laryngeal tuberculosis in one of these much improved. 
Pulmonary tuberculosis. One case. Died. Laryn- 
geal ulcerations much improved. 
I repeat: Of eleven cases of tuberculosis of bones and 
joints, eight were not improved, one died, two were im- 
proved. 
Two cases of epithelioma not improved. 
Two cases of cutaneous tuberculosis (one lupus) greatly 
improved. 
- Tubercular meningitis and peritonitis not influenced. 
Of sixteen cases of pulmonary tuberculosis one died, 
four were not improved, five were improved, four were 43 
much improved, two recovered, even with disappearance 
of local pulmonary changes. 
The two cases complicated with laryngeal tuberculosis 
did not thrive. One was not improved, one died. But 
in either the laryngeal ulcerations improved.1 
I do not wish to compare these results with any other 
statistics, but offer them simply as contributions to the 
general stock of observation. The number of favorable 
cases of joint and bone tuberculosis strikes me as small, 
of pulmonary tuberculosis as large. When I ask myself 
what became of sixteen average cases of pulmonary tu- 
berculosis admitted to our hospitals, before the inocula- 
tion epoch, the answer is very discouraging. It is true 
that most of the patients whose cases have been detailed 
above were placed in better conditions than ever before, 
and thus were given a more favorable chance for improve- 
ment. But so were all those who were admitted with 
tuberculosis any season, and any year; with hardly any 
resting place awaiting them but the dead-house. 
Altogether, tuberculin has proven a remedy of great 
power for good, and for possible evil. It required cred- 
ulous people believing in miracles to expect the impossi- 
ble, and it took all the accumulated ignorance of centu- 
ries to believe in the possibility of reversing the rules of 
nature, which is as impartial in restoring as it is pitiless 
in destroying, subject to irrevocable laws. When great 
genii like Pasteur and Koch enrich the world with new 
discoveries in the fields of pathology and therapeutics, 
even then we must not look for infallibility. Tuberculin 
has been heralded as witchcraft by sensationalists. What 
it has done, and can do, is more than any other remedy 
—except climatic treatment in pulmonary tuberculosis 
and surgical interference in select cases of local tubercu- 
losis—has succeeded in accomplishing. From what little 
I have observed it would appear that the next future of 
1 A number of cases treated have not been accounted for, for the 
reason that the time of observation was too brief to yield any reliable 
result. 44 
successful treatment of pulmonary tuberculosis consists 
in the combination of climatic cures with the careful and 
persistent use of tuberculin. That is what we have to be 
thankful for even at this early date. At all events it is 
more becoming to honor our great men by appreciative 
criticism than to apotheose them first and exile them 
afterward. The former is the way of professional intel- 
lect and decorum, the latter that of a whimsical and 
flighty personal “ government.” 1 
* To the house staffs of the German, Foundling, and Skin and Can- 
cer Hospitals, I herewith express my appreciative thanks for their 
many and persistent labors connected with the accumulation of facts 
referring to the inoculations. They were indeed labors of love, with 
all of them.