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.

    85/350 (page 65)
    _ rIn relation to harm resulting from the con- Two Grades of ... . . .. ° junctival inoculation we recognize : — Mischief ^ 'Yhe severe conjunctivitis following the Distinguished. instillation, with its highly unpleasant sub- jective symptoms. (2) The local changes attended with actual danger to the eye. In order to avoid the former as far as possible the points already mentioned should be borne in mind, especially the use only of an absolutely clear old tuberculin dilution, i per cent, for adults and J per cent, for children for the first instillation; for the repetition in the other eye 4 per cent, and 1 per cent, dilutions respectively. Further, the following must be emphatically avoided : — (1) A second instillation in the same eye Warnings. after positive reaction, no matter at what interval. (2) A conjunctival instillation immediately after a subcu- taneous tuberculin test. (3) A subcutaneous tuberculin injection after a conjunctival reaction before the latter has completely disappeared, and that for several days. If (1) and (2) are not observed, very violent con- junctival irritation is created; if (3) is transgressed a recrudes- cence of the inflamed conjunctiva takes place. n . The recrudescence of the conjunctival Recrudescence . . , . . . J . . . reaction after subcutaneous injection of the after Subcutaneous ,, . , „ r + 1 r • 1 • 1 smallest doses of tuberculin is explained Injection. ^y tjie reactive combination of the remains of the tuberculin left behind in the conjunctiva with the anti- bodies newly formed by the subsequent injection, and is decidedly harmful to the treatment. M. Wolff [83] first drew attention to the fact that there are cases—and we ourselves have observed several of them—in which the conjunctival reaction recurs after every therapeutic injection of tuberculin, even with the smallest dose, sometimes most severely. Therefore we have repeatedly found ourselves obliged to cease tuberculin treatment altogether. That is a very weak point in the conjunctival method, because after establishing the diagnosis, it renders the most efficient treatment, that with tuberculin, unavailable. Wolff-Eisner [84] indeed looks upon this recrudescence of the conjunctival reaction as an advantage not possessed hitherto, a measure for the doses to be used, which are excessive when the reaction reappears, and considers the conjunctival reaction decidedly advisable as a control of the treatment. We cannot, however, accept this attempt to turn a disadvantage of the conjunctival reaction into an advantage.