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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    some children, letting alone the fact that the dosage is very inexact and the result of the reaction correspondingly untrust- worthy when the instillation only imperfectly succeeds, or when it is diluted or completely washed out by a flow of tears. There- fore with children we make our diagnosis by safer and quicker methods. „ ., ... . Finally, the use of the conjunctival test is Possibility ot .. . ,' . .,.,., r 1 -• if . r limited by the possibility of simulation. It Simulation. ig pOSSjkle, at any time anc[ without trouble, to simulate conjunctival reaction by artificially produced irrita- tion, such as rubbing the inner surface of the lid with the finger- nail or a match, and the result of such irritation cannot be dis- tinguished in any way from a genuine normal reaction. This disadvantage has caused the medical department of the Prussian Ministry of War to reject this method for use in the Service by military doctors. The indications for the conjunctival test Indications. w^j ]3e seen to ^e very limited; we shall refer to them later in speaking of the various localizations of tuberculosis. Here we will only make the general statement that it cannot be considered anything like so safe a diagnostic method as the cutaneous and percutaneous tests. Although, thanks to the greatest caution and the observation of numerous contra-indications, we have not as yet seen lasting injuries to the eyes, we do not consider ourselves justified in recommending the general use of the conjunctival reaction in medical practice. Over the head of the practitioner hovers, like the sword of Damocles, his sense of responsibility, and in this case more especially, for the eye is the light of the body. He will therefore do well, as Schrumpf [85] suggests, to get the consent of the patient before proceeding to the instillation of tuberculin, pointing out the possi- bility, even though it may not be very probable, of injury to the eye. We should certainly anticipate then that patients would with one accord decline the conjunctival test. In private institutions (clinics, hospitals, sanatoria) it will not be necessary to take up quite this point of view as regards the conjunctival reaction, but its possible dangers must always be borne in mind, and in consequence it must only be used with special caution and careful selection when certain indications are- present. In public institutes, too, the conjunctival tuberculin test should not be used under any circumstances merelv for the purpose of scientific research. No Value in ^e conilinctlva^ reaction has, according to . our experience, no value in prognosis. We °n ' ' are not dissuaded from this opinion by the