Evening star. [volume] (Washington, D.C.) 1854-1972, 1890-12-26
HOW PROF. KOCH INoCULArEs.
A Description Of the Method Of Using the
Lymph In Berlin.

| A Description Of the Method Of Using the
Lymph In Berlin.
Under date of Berlin, December u, the Ned.
| ic0l Record publishes the following dispatch
from wellknown physician, giving details Of
the method of lymph incubation followed by
Prof Koch and his associates:
| From reports which have reached here from
America It would appear that the methods used
there are somewhat different from those en-
ployed here. Absorption of the Koch syringe
has already been given and need not be re-
peated. II will surprise some, perhaps, to learn
that this instrument is not universally used
| even here, and that some prefer the ordinary
hypodcrmic syringe, which has, of course, been
made aseptic. One reason for this is that the
measuring Of the quantities is easier of regula-
lation and more accurate.
From the original Kochs lymph q small
quantity Zone cubic centimeter) is diluted ten
times with half per cent solution of carbohc
acid. This marked accordingly as ten per
| cent solutions what may be called the stock
solution from which the ultimate preparation
for the injection is made. This is done by
diluting the stock solution again ten times ie.,
one cubic centimeter stock solution and nine
cubic centimeters of solution Of half per cent
OF carbolic acid. This, then, is the one per
cent solution which is injected. OF this deci-
gram of the Koch syringe will correspond with
one milligrsm of the original lymph, two deci-
grams equaling two milligrams, &c. This one
per cent solution will keep from eight to ten
days. after which it loses its efficacy. This be-
ing the case it is always advisable that it should
not be made in larger quantities than will be
consumed in that period.
The rule here regarding the time and fire.
quency OF the NEGOTIATIONS is governed by the
following circumstances: II after a small dose,
which is considered to be o milligram, neither
the increased temperature nor any other reac-
within he Srok <xvop txy-fo
the incubation can be repeated with twice the
quantity. Some clinicians wait longer than
that. sometimes for three days. II, however,
the reaction is pronounced it is considered
necessary to wait until the temperature and all
other symptoms become normal, when the in
oculation. in the same quantity, may be re-
peated. II after the second injection the tenn
perature shows a tendency. to fall from the
the first reaction, the third Injection can be in
creased by one milligram. may say, in pass
ing, that the usual rate of increase is one MILL
gram for each succeeding injection. When the
reaction is very intense QO6 degrees Fahren-
heit) after the first incubation the next injec-
ton must be reduced. and care must be taken
that ut the time of its administration all reac-
tlonary symptoms are absent. In general terms
the size Of the dose will depend upon the de-
gree OF reaction produced in different individ-
uals. The usual quantity used in cases of
phthisis is one milligram, gradually increased
to one centigram. Occasionally it is even more
euoii tAiis. ne Tdplulty OF the increase de-
ponds upon the responding fall Of the reaction,
and OF course varies in different individuals.
I'm surgical and lupus cases large doses have
been given from the beginning, but at present
there is q tendency to be careful as to the
amount even in these. The maximum dose for
lupus, tubercular glands and tubercular joints
has been one centigram. the minimum being
one milligram. Usually, however, a COM
mencement is made with two milligrams. 1t
must be borne in mind that even in what are
supposed to be good cases for treatment alarm
ing symptoms may sometimes follow q first
incubation, such. for instance, rs an unusually
This circumstance has proved to be the strong
est argument against the treatment of cases in
private practice. which cannot be closely
watched from hour to hour, as in the hospital
ward. AS far as have learned no case of death
has occurred in this city as the direct result of
the incubation. This is explainable by the
fact that prompt assistance has always been
available when alarming symptoms showed
themselves.
1.-The duration of the inoculative treatment
is generally from four to six weeks. By this
must be meant that at the end of that period
the reactions cease. 1t must also be under
stood that the case is not then considered
cured, inasmuch as the physical signs of
Phthisls as rule still exists and even the
bacilh ore found in fhe sputum. Therefore it
il considered desirable to begin treatment in
those incipient cases in which only small spots
OF the lung are affected and in which the
chances OF repair are proportionatly greater