THE TREATMENT OF TUBERCULOUS JOINT DISEASE WITH CARL SPENGLER'S "I. K." SERUM; WITH A REPORT OF SEVEN CASES

1 Our present knowledge of calculating the dosage is inadequate, better results can be gotten when the dosage has been perfected.

2. We have found Dr. Clarence W. Leigh's suggestion of but one dose in seven or eight days to be more satisfactory than the more frequent dosages.

3. Under the management of the inexperienced the most common and most detrimental error will be too large a dosage.

4. Marked disturbance of the patient's comfort is the best guide for reduction of dosage. Too great a desire to rush the treatment will usually rush the patient into discomfort or misfortune.

5. Contamination must be guarded against. Fifteen minutes boiling of syringe, needle, medicine glass to hold diluting solution and small bottles for excess dilutions, and cleaning the arm with alcohol, will insure safety. Red heat of platinum needle from alcohol lamp permissable.

6. The posterior extensor surface of the forearm, while the arm is held in flexion is the most convenient and least painful site for injection. Close skin puncture with collodion and cotton. Children seldom complain of the procedure if the solution is injected slowly.

7. Tincture of digitalis or strophanthus should be administered through the entire treatment. T. B. patients with severe or advanced organic heart lesions should not be treated with I. K. until entire compensation has been restored, and then only while in bed, and under the greatest of care and conservative dosage.

9. Jumping to ten-fold dosages is both dangerous and unnecessary. It is exceptional that a case can tolerate increase.

10. When rapid immunization is desired we believe that it is better to begin with a small dose of a higher dilution (fourth or fifth) than after an interval of seven to ten days increase 0.2 C.C. or more per dose up to lysis. In this manner it seems that the relatively small daily liberation of antitoxic immune substance could be better compensated by the physiological blood forces, than under the stress of the tremendous liberation of the ten-fold method.

11. After a somewhat extensive observation of patients treated by the usual orthopedic methods and parallelling these I. K. patients with other patients having similar affections in the same hospital treated as usual, we believe that I. K. has some curative properties and a gratifying constitutional effect on patients with tuberculous joints, and is undoubtedly worthy of further trial.

12. Our experience suggests that the treatments should be carried over a period of six to nine months so as to insure if possible complete closure of sinuses.

13. We have seen such remarkable results in one case of amyloid disease, that we hesitate to report it until a longer period of observation has passed.

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