easy as to the consequences of this, even in some cases of lung tubercle in its early stages, and especially in tubercle affecting the larynx, where the swelling, which is part of the effect of the remedy, might conceivably prove dangerous. Experience has, however, shown that, in the considerable number of such cases already treated, no serious risk has arisen. It is a fact that the mucous membranes of the tubercular larynx, while under this treatment, do not swell to such an extent as to interfere very seriously with respiration. Even in advanced cases of lung tubercle, with excavation of considerable portions of lung tissue, there have been no ill effects from the treatment when it has been conducted with careful attention to the regulation of the dose of the remedy.
The remedy is a transparent, reddish-brown fluid, not unlike brown sherry in appearance. It has no sediment, and when undiluted does not readily decompose. When diluted with distilled water it is, on the contrary, apt to decompose. Bacterial growths quickly appear in it, and it becomes turbid. In this condition it is unfit for use. Its decomposition in dilution is prevented by boiling it, but that process is not necessary if the dilution be made with a half-per-cent solution of carbolic acid in distilled water. It should be remembered that both by the frequent boiling of the dilution, as well as by the mixing of it with carbolic acid in the way described, the vigor of action of the remedy is impaired, and therefore fresh dilutions ought only to be used. Experience has, however, shown, I am told, that a one-per-cent dilution of the remedy made with distilled water containing one half per cent of carbolic acid remains efficient at the end of one week. The remedy is introduced into the body subcutaneously by means of a syringe which Koch devised for his bacteriological work. It has no piston or washers, and consists of four parts an India-rubber ball, with a small hole in it. This ball is fixed upon a hollow metal stem furnished with a stopcock; into the other end of the metal stem there fits a glass tube, pointed at the farther end, and graduated to one cubic centimetre, each division representing a milligramme. Upon the pointed end of the glass tube there fits a hollow needle. In using this syringe the glass tube, with the needle affixed, is detached from the metal stem and filled with absolute alcohol. The metal stem and ball are then replaced in position, and the alcohol gently expelled. Every day before using the syringe I think it well to disinfect the metal stem and the India-rubber ball. Alcohol, however, causes cloudiness in the dilutions of the remedy, and therefore it is necessary to get rid of it as much as possible. For that purpose I wash out the syringe with a little distilled water.
The dose of the remedy has been sufficiently well fixed for
