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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    reactions carried out—so infinitely rare and in themselves so insignificant that they hardly deserve the name. In fact the cutaneous tuberculin reaction, carried out lege artis according to v. Pirquet's directions, is a diagnostic method as harmless as it is easy, which, thanks to its simplicity and freedom from risk, is suitable for use in the earliest childhood, and to which in respect of practical application no contra-indication can be raised. - r , The question, however, whether it is neces- sarv before making use of the cutaneous test Patient to obtain the permission of the patient, or in the case of children the permission of the parents, is answered by Bumm [57] in the affirmative from the legal point of view. Even from the point of view of expediency, however, the physician will do well only to inoculate when a patient or his legal representative has actively or passively given his assent. It is allowable for the physician to obtain his consent through a third person (a teacher, for instance), or it may be included in the general acceptance of the conditions of admission to the hospital. The indications are given by the course of Indications. the reaction and its effects. The following points must be considered in connection with these : — The specific nature of the intracutaneous test cannot be dis- puted for the same reasons as applv to the specificitv of the cutaneous and percutaneous reactions. The specific inflammatory symptoms of the cutaneous inocu- lation occur without accompanving rise of temperature or other symptoms of a general reaction; they indicate the presence of tuberculosis in an anatomical sense. The positive cutaneous reaction gives no Positive Result. information as to the sjte 0f the disease, or its activity or inactivity. It onlv shows that the body somewhere and at some time has been infected with tubercle bacilli. Therefore not only those manifestly tubercular react but also those who are clinically non-tubercular. That is specially important in the diagnosis of adults, in whom the positive cutaneous reaction alone does not afford any' practical conclusions as regards treatment. With adults the cutaneous reaction is onlv of importance when considered in conjunction with the clinical appearance of the disease. When it is very distinctlv positive, accompanied by considerable infiltration or extensive reddening in the vicinity of the inoculation site and only slowly disappears, then very thorough examination and observation of the patient is impera- tive.