Vol. 60, 1909 - University of North Carolina at Chapel Hill

230 THK CHAKi^OTTK MKDiCAL JOUKNAL.
ble mechanism and is ignorant of the appli- newer immunizing agents, both because o{
cation in a country practice. its more extensive and common use, and
I have found that most electric charms of also because of the longer period of time
clinical application are verifiable, and that over which its administration becomes necone
may do sterling work out of the actual essary, I wish, though, to emphasize at
beaten track indicated as practical by the this point, that what I will have to say reprofessors
who instruct doctors by book garding dose graduation in tuberculin will
lessons, which are mere finger boards to the be equally applicable to all biologic products,"
intelligent practitioner, who will advance the object of which is the increasing of tisbeyond
in the strange new field of scientific sue immunity,
enchantment. The plan of dosage of tuberculin quite!
In the narrow sp'^ce of a medical journal universally followed is in brief as follows
contribution it is impossible to do more Treatment is begun by a minimum dose,
than assure practitioners that electricity is the exact amount of which depends; first,
a medical necessity, if one would do some upon the condition of the patient; secondly, '-i
of the best paying practice that cannot be upon the particular variety of tuberculin
in dreams without the majestic current. I used. The initial dose is increased, at first,
did not find it a difficult lesson; but I began very gradually, and the interval between
experimenting with the old back number, the injections is comparatively short. Later
almost worthless batteries, and have fol- on, larger and larger amounts of tuberculin
lowed it up right along to this high degree are given with a corresponding increase of
progressive epoch, where lessons are clearlj' the interval. Finally, there comes a time
practical, much valuable instruction regu- when no further increase of dose can be
larly appearing in current medical journal tolerated. This dose of tolerance is a most
literature, written by physicians in active variable one, and depends upon many con- I
practice, not by collegiate theorists, just the ditions, the details of which cannot here be
aid the country doctor needs to guide him entered into. The one danger-signal to the
aright. physician who is giving this powerful drug '
1 am forty-three years in this fearful field is the reaction,—truly the "red-flag" to the
of tropical fevers, in the sickliest belts of administrator of tuberculin,
the Continent, without one day of vacation,
that has taught me some valuable lessons
To show the far-reaching harmful effects,
of faulty dosage, one has only to recall the'
all along the line of clinical emergencies,
being still in harness beyond my four score
history of the use of this same medicinal
agent. Shortly following the announceyears
of life; and electricity is' the future
that most interests me and is my study and
my desire, that absorb my else idle meditament
by Koch, that he believed that in
tuberculin we possessed a most valuable
remedy for the treatment of tuberculosis, its
tion in long rides over a broken, roadless administration was commenced by physiccountry
and midnight watches beside fever- ians all over the world, with the natural
ish cots; and I wish all readers hereof would and inevitable result of doing vastly more
take the same interest in the grand medical harm than good. Non-selection of cases,
mystery. over- dosage, and the too rapid increase of
the dose given, were responsible for that
Tuberculin Administration: A Perfect
memorable swing of the pendulum of popu
System ol Dose Gradnation.
,^^ disapproval, started by none other than
By Lucius B. Morse, :\I. D., Physician-in-Charge, Virchow, the extent of which has perhaps
Dr. Morse's Sanatorium, Chimney Rock, N. C.
^^^^.^^ ^^^^^ equalled itl the annals of medi-
In the administration of any powerful cine. It was over fifteen years before the
drug, the matter of dose is obviously an medical profession at large recovered from
important one. With most of the older its over-dose of this drug. The patient and
drugs the range of dosage is not very great, doctor alike experienced a reaction against
and, except in rare instances, it is not nee- tuberculin.
essary or desirable to gradually increase the The medical mind, however, of recent
amount of any medicament given; indeed years has changed its attitude. Ourpresent
the reverse almost always holds—the efforts knowledge of the nature and dosage of tuof
the physician being directed toward a berculin, of its indications and contra-indidiminution,
rather than an increase of dos- cations, is infinitely greater than was that
age. An exception to this general rule, of those who attempted its administration
though, obtains in the use of certain bio- in the early nineties. Not a few staunch
logic products. I refer to the increasing believers in the value of tuberculin, though,
number of such products as are given for are fearful that we are possiblv approachimmunizing
purposes. ing another similar reaction against this
My remarks will be limited to the use of agent;—less pronounced, perhaps, but none
tuberculin as the most representative of the the less certain. It is thought, now that
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