The diseases of infancy and childhood : for the use of students and practitioners of medicine / by L. Emmett Holt and John Howland.
- Luther Emmett Holt
- Date:
- 1911
Licence: Public Domain Mark
Credit: The diseases of infancy and childhood : for the use of students and practitioners of medicine / by L. Emmett Holt and John Howland. 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.
1111/1178 page 1049
![pears, according to the severity of the i-eaclioii, in from twelve to forty- eight hours. It remains for several days and slowlv diHa])pears, being followed by pigmentation in the severer cases. A Comparison of the Different Tests.—Xo one of the tests is so ab- solutely conclusive as is the demonstration of the tul)ercle bacillus in the sj)utum, the cerebro-spinal fluid, or elsewhere. One should not therefore depend upon local tests and omit the search for bacilli, even though it involves greater labour. Wliile these tests when followed by a positive re- action furnish evidence of the existence of a tuberculous lesion, they do not enable us to distinguish between latent and active conditions. Thus, a child may give a positive skin reaction when suffering from acute pulmonary disease, which by its course is shown to be non-tuljerculous; although grave suspicion of an acute pulmonary tuberculosis may have existed and apparently be confirmed by the tuberculin test. Much need- less alarm niaj^ therefore be produced by a positive reaction, which really demonstrates only that somewhere the child has a tuberculous focus, but it does not prove that his present disease is of a tuberculous nature. Shortly before death, whether from general or any form of localised tuberculosis, as a rule there is no reaction to any of the local tests. Likewise, a child in an extremely asthenic condition from any cause Avhatever may give no reaction although he has a latent tuberculosis. During active measles also the test is of little value. J^o conclusions therefore can be drawn from tests made under these conditions. On the whole von Pirquet's cutaneous test is to be preferred for general use. Tuberculides of the Skin.—These are at times of considerable value in the diagnosis of tuberculosis in general.^ Although seldom seen in the acute varieties, they are not uncommon in the more slowly progress- ing forms. The distribution of the lesions is fairly constant. They are found chiefly on the buttocks, lower abdomen, genitalia and thighs. The number present is generally small, half a dozen to a dozen; but they are sometimes numerous and may be widely distributed. The lesion begins as a minute red papule, which is soon surmounted by a small vesicle. This dries to form a crvist. If the crust is removed a small pit-like depression remains, which heals quickly, leaving a white, glistening scar surrounded by a pigmented border. The lesion runs its entire course in two or three weeks. Tubercle bacilli are often jjresent but difficult to demonstrate. Tuberculides of the skin in 3'^oung children are evidence of a widely disseminated process and are a very bad prognostic sign. Such patients rarely survive more than a few weeks. General Prognosis of Tuberculosis.—The outlook for a young child with general or pulmonary tuberculosis is always bad. So long as the disease remains confined to the lymph nodes, the child is not usually in ' Tileston, Archives of Internal Medicine, July, 1909.](https://iiif.wellcomecollection.org/image/b21218407_1111.jp2/full/800%2C/0/default.jpg)
