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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    specific treatment usually goes hand in hand with favourable general condition and large content of antibodies. On the other hand, the graphic record of the course of the reaction—normal, rapid, prolonged reaction—is of no assistance in prognosis, not even to distinguish active from inactive tuberculosis. Qln order to distinguish active processes of uantitative , , , • r • .• t?u , tuberculosis from inactive, hllermann and es Erlandsen [61] have experimented with the quantitative method of cutaneous inoculation, using graduated concentrations of tuberculin. For these very finely graduated inoculations they chose concentrations of a standard tuberculin of oT per cent, rising to 50 per cent, and noted the dilution which produced absolutely no cutaneous reaction. The re- ciprocal value of this tuberculin dilution is then a measure of the power of reaction, the tuberculin titre of the organism. According to the experiments of Erlandsen and Petersen [60], the tuberculin titre should be o in persons free from tuberculosis, it should remain below 100 when the tuberculosis is inactive, and rise to 200-400 when active tuberculosis is present. It should go back to below 100 when the tuberculosis has become inactive and drop sharply a short time before death. Only in cases of tuberculosis of the glands and bone would there be generally a high tuberculin titre for a very long time. Although one cannot diagnose tuberculosis from such estimations alone, yet, in conjunc- tion with other clinical aids, a high tuberculin titre supports the diagnosis of active, and a low titre the diagnosis of inactive, processes of tuberculosis. Erlandsen [61] has lately drawn up a table for calculating the tuber- culin titre. The breadth in millimetres of a papule corresponding to a 4 per cent, tuberculin solution (pj and the difference in the breadth of this papule in millimetres after twenty-four and forty-eight hours (d ) are determined. The tuberculin titre can then be read off from the table. Lossen, S. Moller, Mirauer, Wallerstein, Waltershofer, and others have come to the conclusion from their own experiments that graduated tuber- culin concentrations are of no practical use in distinguishing active and inactive tuberculosis. We also, from our own experience with quantitative cutaneous tuberculin tests, must reserve our opinion and cannot recommend them in practice. The idea that the cutaneous reaction can only be useful in the case of adults when graduated doses of tuberculin are used may be excellent, but the method of applying it is open to too many inexactitudes and inaccuracies to be reliable. More- over, we are dealing with conditions of great hypersusceptibilitv which are characterized by too great individual variations and do not give reliable information for the diagnosis of the nature of the tuberculosis. For this reason we do not consider the method recommended by Ditthorn and Schultz [62] of cutaneous inoculations with iron tuberculin (iron precipitates of tubercle bacillary substance)