Tuberculin in diagnosis and treatment : a text-book of the specific diagnosis and therapy of tuberculosis for practitioners and students / By Dr. Bandelier ... and Dr. Roepke.

Bandelier, B. (Bruno), 1871-1924.

Date:: 1913

Credit: Tuberculin in diagnosis and treatment : a text-book of the specific diagnosis and therapy of tuberculosis for practitioners and students / By Dr. Bandelier ... and Dr. Roepke. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$with the quantity of tuberculin injected, and after cessation of the injections disappeared again, first rapidly, then more slowly. From these facts we see that we are dealing with a specific deviation of complement, i.e., with specific antibodies to tuber- culin, as Wassermann and Bruck have maintained from the very first. The substitution of the term anti-tuberculin for anti- body producing fixation of complement, is quite immaterial; it is also immaterial that the amount of anti-tuberculin and the susceptibility to tuberculin do not necessarily run parallel. The specificity of the antibodies in tuberculosis is also proved beyond dispute by other authors, recently by Llidke and Sturm [12], who both obtained diagnostic reactions in tubercular patients only by means of tuberculin preparations, never with extracts of streptococci, typhoid, dysentery, or colon bacilli. _., , Citron [ii~\ has somewhat modified and Citron's , L,OJ w , , TJr completed Wassermann s theory. He Modi ication. assumes that in the tubercular focus there are toxin-sensitive cells, which, by the injection of small doses of tuberculin, become rich in receptors (sessile receptors). The latter attract the injected tuberculin, produce the reaction, and are finally disposed of in the blood. Besides these cells in the foci, Citron holds that also all other cells in contact with tuber- culin form these specific receptors, which are shed into the blood- stream. Thus in many cases, instead of neutralizing the tuberculin, they may produce hypersusceptibility to tuberculin ; and this hypersusceptibility increases with the number of sessile receptors in the focus. Citron has also proved that such sera in conjunction with tuberculin and complement kill guinea-pigs. Thus the occurrence of hypersusceptibility to tuberculin after repeated injection of small doses is explained. According to Pappenheim [14], neither the appen eim. £ree nQr ^e sessile receptors produce the phenomena of the tuberculin reaction, which are caused by the fresh formation of these receptors due to the tuberculin injection. According to this, the tuberculin reaction would be simply the active anti-reaction of the organism. Koch. 2.—THE TOXIN THEORY. The first to explain the tuberculin reaction as a toxic action was R. Koch [3] himself. According to his original description, tuberculin produced deep- rooted changes in the nutrition of the tubercular tissue, causing its destruction. The toxic process is accompanied by fever and general reaction. On healthy people, the toxin only acts$