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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    in miliary tuberculosis and tubercular meningitis; in severe cases of the last two, repeated inoculations of the same patient may even give varying results. The cutaneous reaction seldom fails where tuberculosis occurs along with some other disease; in this case the late reaction acquires a certain importance in the diagnosis whether it appears late after the first inoculation or only becomes positive on a repetition of the test. The knowledge of the non-appearance of the positive cutaneous reaction in spite of the presence of tuberculosis leads us in such cases to abandon cutaneous inoculation altogether from the very first, or at least to be very cautious in our estimate of the result. ,^. ,- /-v , ■ j_ Apart from these exceptions and the failure Diagnostic Certainty ^ ,.rr . . . ... .to differentiate between active and inactive tubercular processes, the diagnostic cer- tainty of the cutaneous reaction is in other respects great. From our own experience the cutaneous reaction with undiluted tuber- culin was positive in 96 to 98 per cent, of adult tubercular patients [59]. This percentage decreases in cases in the third stadium of the disease. Other statistics show similar results, especially those of v. Pirquet for children : 97 per cent, of the positive reactions showed undoubted naked-eye appearances of tuberculosis at the autopsy, whereas all the children who were found on the post- mortem table to be free from tubercle had given a negative reaction. _ . From the prognostic point of view, cuta- Prosrnosis & ' neous inoculation is of little value, and only to be considered in conjunction with the results of the clinical examination, any possible complications, hygienic conditions and other external circumstances. Considered by itself, neither a positive nor a negative cutaneous tuberculin reaction justifies prognostic conclusions. On the other hand the repeated failure to obtain a cutaneous reaction in obvious tuberculosis generally points to a bad prognosis and that often at an earlier period than the clinical examination. And a well-marked positive cutaneous reaction can be looked upon as an almost certain indication of the power to tight against the tubercle bacillus. That is to say, when it is attained with diluted tuberculin it aids in making a relatively favourable prognosis of the course of a case of manifest tuberculosis. Whether repeated graduated inoculations at long intervals have any prognostic significance is still doubtful. It is probable that an increased and more rapid cutaneous reaction is general in favourable clinical improvement of active tubercular processes, just as high cutaneous reactivity of patients not undergoing