lung tubercle and of lupus is that the former is treated with small doses daily, and the latter with large doses at intervals of one or two weeks. Tuberculosis of joints, bones, and glands is treated in the same way as lupus.
A first dose in early cases of lung tubercle in an adult should be either 0·001 c. c. or 0·002 c. c. If reaction follows this dose, then it should be repeated after the temperature has returned to the normal point. The same dose should be continued in this way until no reaction follows its use. The dose should then be increased by one, or at most two, milligrammes at a time; each dose being repeated until it is found that no reaction follows its administration, and so on until the dose of 0·01 c. c. is reached. The dose of the remedy should never exceed 0·01 c. c., except as a test to ascertain whether the utmost limit of benefit to the patient has been secured, and this test should be applied to every case. The duration of the treatment in early cases of lung tubercle Koch states to be, as I have already said, from four to six weeks. If after the administration of test doses of the remedy no evidence of the presence of disease is noticed, then the case, Koch says, may "be pronounced cured." I repeat, this statement refers to early lung tubercle only.
As regards the immunity from tuberculosis which may be enjoyed by the human patient after such a course of treatment, no evidence, so far as I know, has yet been brought forward concerning it in clinical records from hospitals, though the protective power of the remedy has been established as a fact by Koch's experiments as regards beasts. The doses of the remedy are prepared as follows: Two dilutions of the fluid are in general use, a one-per-cent dilution and a ten-per-cent dilution. The one-per-cent dilution is prepared by putting 0·5 c. c. of the remedy into a glass vessel graduated up to 50 c. c. The vessel is then filled up to 50 c. c. with distilled water containing a half per cent of carbolic acid. One c. c. of this solution contains a dose of 0·01 c. c. of the remedy. Koch's syringe is graduated in milligrammes up to a capacity of 1 c. c.; therefore, if 1 c. c. of this one-per-cent dilution be placed in that syringe, each marked milligramme of it will contain a dose of the remedy equal to 0·001 c. c. The ten-per-cent dilution is used exactly in the same way as the one-per-cent dilution. Every milligramme of it contains 0*01 of the remedy, and by means of this stronger dilution the larger doses may be given, or, by dilution, any less dose that may be needed. The subcutaneous injection of the remedy is made in the skin of the back, between the shoulderblades and the spine, or near the lumbar part of the spine. These parts are selected for this purpose because they are less sensitive than most parts of the skin, and because absorption takes place very quickly from their neighborhood. Before giving an injec-
