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
Catalogue details

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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    decreases, the redness fades, passes over into violet, and gradu- ally into a pigmentation which may remain visible for weeks. Then follows a slight peeling of the epidermis. From this fundamental type of cutaneous reaction there are numerous variations in respect of latent period, development and disappearance. Thus a reaction beginning after from six to twelve hours, generally very weak and ceasing after twenty-four hours, is described as a rapid reaction ; it is so very rare that it is of no practical importance. More frequently a prolonged reaction is observed, which occurs after from six to fifteen hours, and remains as a very marked papule more than four days, sometimes for weeks and months. .. , _ If the latent period exceeds twenty-four Aberrant Types . . . , f . : . , J ,. hours it is a late reaction, which, according ot Keaction. tQ y^ pjrqUetj occurs principally in cases clinically unsuspected, and only exceptionally (torpid reaction) in manifest tuberculosis. In respect of colour the papules show the most various grades; in general they are bright red in well-nourished subjects with healthy skin colour, pale red in anaemic patients, and colourless (without hyperaemia) or livid (without exuda- tion) in the last stage of fatal forms of tuberculosis. In those cases in which the papule is only recognizable by the sense of touch or by lateral illumination, v. Pirquet speaks of a cachectic reaction. Finally the scrofulous reaction deserves special mention, a reaction observed by v. Pirquet chiefly in scrofulous children and with its small warty nodules in the immediate neighbourhood of the papule proper, reminiscent of the appearance of lichen scrofulosorum. Of such reaction we have seen isolated examples in phthisical adults. If the cutaneous inoculation is doubtful or negative, and is then repeated after some days, a positive reaction frequently appears; now and then also a late reaction at the previous site of inoculation. This so-called secondary reaction manifests itself in v. Pirquet's experience with children principally when the tubercle cannot clinically be demonstrated, corresponding to the torpid or primary late reaction already mentioned. The specific nature of the cutaneous tuberculin reaction, occur- ring as it does only in the organism infected with tuberculosis, is practically confirmed by observations at the bedside and -post mortem. Specially conclusive in this respect are the experiences of v. Pirquet [53] and Ganghofner [54] with a large number of