Volume 1

A manual of surgical treatment / by W. Watson Cheyne and F.F. Burghard.

Date:
1912-1913
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: A manual of surgical treatment / by W. Watson Cheyne and F.F. Burghard. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    modified opsonic method, the doses and intervals being about those which are usually found desirable when the method is controlled by the examina- tion of the blood. In general terms the doses are j^^qq mgr. of T.R. or less and the intervals seven to ten days, attention being paid to the symptoms and the length of time during which the patient seems to benefit after each injection. Good results may be obtained in this way, and no harm can result : it is, however, being rapidly given up in favour of the intensive method, in which the amount of tuberculin is gradually increased. (3) The intensive method should be preferred in all cases in which the patient can be kept under constant observation. In the earlier stages it is not altogether advisable for out-patients, but when doses of some size have been reached, the difficulties are less and the intervals between the doses longer, and a patient who can be seen twice a week may be treated in this way. It is necessary that an accurate record of the temperature should be kept, and it is also advisable to observe the pulse and the patient's weight, a progressive loss of the latter being an indication that the remedy is unsuitable or is not being properly applied. The doses are given at first at intervals of two or three days, and it is not as a rule desirable to go much longer than this or hypersensitiveness may ensue. In the later stages when large doses are reached, the interval increases, and the maximum amounts may be given at weekly intervals, or even more. The commencing doses of the various preparations will depend to some extent on the general health of the patient and on the presence or absence of fever, but in general terms may be stated as follows :— for old tuberculin, Yo^Q-jj oi' less ; for T.R., yotvtj mgr.'; for bacillary emulsion, ^^j^jj mgr.; for P.T.O., yj^i^y^ c.c. Each dose is larger than that which preceded it, the idea being to increase the amount given as quickly as possible consistently with the avoidance of reactions. In general terms each dose may stand to its predecessor in the proportion of 3: 2, i.e. each may be half as much more as the previous one, but this is only a rough rule, and each case has to be considered on its merits. Bandelier and Ropke give as an example the following series: yottotto ^-C- old tuberculin, c.c, jooljoo c-c, 1 c c c c '-^ c n -5. r c 'L 1 c c r c 1 000 0 1 0000 1 0000 1 000 0 l OOOO' 1 000 1 000 ^-^-t ' In the preparation of T. R. lo mgrs. of tubercle bacilli are used for i c.c. of the ultimate product, and the amounts quoted are calculated as if this were all present in the material as sold. As a matter of fact i c.c. only contains 2 mgrs. of dried substance, and unnecessary confusion has resulted from some writers, who calculate their doses in this way, stating their doses as one-fifth of those given on the old system for identical amounts. Bacillary emulsion contains 5 mgrs. in I c.c. foo C.C, J J'qq C' C C —3— c c J—