Tuberculin in diagnosis and treatment / by Louis Hamman ... and Samuel Wolman.

  • Hamman, Louis, 1877-1946.
Date:
1912
Catalogue details

Licence: Public Domain Mark

Credit: Tuberculin in diagnosis and treatment / by Louis Hamman ... and Samuel Wolman. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    from ten to fourteen days and it is a disadvantage to delay the completion of the test longer than is necessary. If following an injection of tuberculin there is any evi- dence of a reaction, however slight it may be, the amount must not be increased but the same dose repeated. In many instances such a repetition will be followed by a defi- nite reaction but if no reaction occurs a larger dose may then be given. As evidence of such mild premonitory re- actions we may note alterations in the temperature, in the general constitutional condition or at the site of the injec- tion. We practically never obtain convincing evidence of a focal reaction without accompanying g*eneral symptoms. The temperature is the most delicate index and a rise of half a degree or more should at once awaken a suspicion which becomes an assurance if a local reaction is also dis- covered. The same dose repeated will then almost con- stantly produce a decided reaction. A local reaction, red- ness and infiltration at the site of injection, without tem- perature elevation, is not so important an indication. It is the rule that injections preceding the one liberating a gen- eral reaction produce local reactions and indeed each suc- ceeding dose may be followed by extensive infiltration at the site of injection, although no febrile or constitutional reaction be produced. Still when a well-marked local re- action occurs it is advisable to proceed cautiously if we desire to avoid a severe general reaction. Patients will occasionally complain that they feel depressed and indis- posed following the injection of tuberculin although there is no other indication of a reaction. It is, however, very rare to obtain definite constitutional symptoms in the ab- sence of temperature elevation. The best terminal dose in subcutaneous tuberculin diag- nosis has been keenly discussed. Bandelier,1 in a lengthy 1 Bandelier: Die Tuberkulindiagnostik in den Lungenheilstatten. Beitr. z. Klin. d. Tuberk., 1904, ii, 285.