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
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Licence: Public Domain Mark

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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    focal reaction, for which reason their occurrence in the blood is to be avoided. Therefore he claims that capacity for reaction should be maintained in tuberculin treatment. In spite of our complete acceptance of Wassermann's theory in itself, we cannot accept this explanation for reasons expressed by F. Meyer [2] : he was able to show that sera without complement- fixing antibodies could neutralize tuberculin in vitro; Citron proved that patients without antibodies may be insensitive to tuberculin ; Weil and Strauss proved that susceptibility to tuber- culin is independent of the content of complement-fixing anti- bodies in the serum; also according to Kretz's phenomenon, already mentioned, a fresh production of antibodies can occur in the focus in spite of apparent neutralization. It is, in addition, unintelligible that while the anti-tuberculin displays a neutralizing action in the serum, in the focus it is productive of reactions; according to Ruppel, the combinable amboceptors appearing after tuberculin injection may in animal experiment even exert a healing influence. Lastly there is the most important argument from a clinical point of view, and one we can ourselves confirm; it is just in patients with high antibody content and excellent general con- dition that unmistakable focal reactions can be observed after tuberculin injections. Friedberger [28] and we ourselves, in antithesis to Wasser- mann, hold that the insensitiveness to tuberculin is a healing process caused by the curative action of the previously formed antibodies. At the commencement of treatment, these are but scanty, and therefore set free anaphylatoxin, evident in the form of hypersusceptibility; but later in a successful course of tuber- culin they are increased, split up the tuberculin, and lead to insensitiveness. 0 , Now as an argument against the advisabilitv Roemers . . . & . P , ,J 01 producing immunity to tuberculin, the P ' work of Roemer [36] has been quoted, who ot Animals. showed that animals hypersusceptible to tuberculosis may be immune to a fresh infection. Therefore it is argued that it is a mistake to render patients insensitive to tuber- culin, and that, on the contrary, an effort should be made to increase their hypersusceptibility to tuberculin in order to protect them against re-infection. But hypersusceptible to tubercu- losis is by no means identical with hypersusceptible to tuberculin. Also, according to our experience extending ever many years, the occurrence of hypersusceptibility in the course of tuberculin treatment has never been of advantage to the patient in question, and this is the view of other experienced tuberculin