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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    publications of Meissen, Schuster, and Baer, who take their material from one institution alone and differ widely in their arguments without proving the prognostic value of the reaction. What prognostic help can be afforded by a test which gives a faulty diagnostic result in 50 per cent, of cases ? That it is as good as no help at all was emphasized at the annual meeting of the British Medical Association in Belfast (1910) by Calmette himself, who has command of a very large material and would be the last to lower the value of his ophthalmic reaction. _ , , , L The general judgment of the conjunctival General Judgment . , J ° . . . . ,,J . 0 test mav be summarized as follows: A negative result does not prove the absence Conjunctival Test. Qf act[ve tuberculosis. A positive result only proves the presence of a tubercular focus in the body of the patient without giving information as to its activity or inactivity. We must expressly warn physicians against regarding the ■once repeated instillation as sufficient and its negative result as identical with tubercle-free or inactive tubercle not demand- ing treatment at the time. Wolff-Eisner's [84] assertion that the •conjunctival reaction, in contra-distinction to all other tuberculin tests, is the reaction of active tuberculosis has been and still remains refuted. And it would be a fatal backward step in diagnosis if Wolff-Eisner's estimate of the test were to be regarded as adequate even if only by a limited number of physicians. In addition to its uncertainty, there is the possibility of serious harm. This renders the test unsuitable for general practice, or ■only admissible with certain reservations. In private institutions, too, it should only be employed with observation of definite absolute and relative contra-indications. As a rule the con- junctival test is only indicated when a therapeutic measure is dependent on its result, and definite reasons justify its preference to other diagnostic methods. _,_ . .. Wolff-Eisner has recommended as a modi- Tuberculin r • r , • -1 • .» fication of the conjunctival test in practice Vaseline. the use of tuberculin vaSeline. With a sterilized glass tube a quantity of tuberculin ointment the size of a pea is introduced into the conjunctival sac, rubbing the oint- ment into the lower lid, which is drawn down, keeping the lids apart for about a minute by pulling down the lower lrd with the finger. The reactions thus attained are said to be similar in appearance and course to the conjunctival reactions produced by liquid dilutions. The exceptional durability of the preparation is mentioned as a special advantage.