Tuberculin

“ Occurrence, then, of a subcutaneous tuberculin reaction does not indicate necessarily sanatorium or institutional treatment; neither does it absolutely indicate the necessity of tuberculin treatment. The decision rests on the consideration of all the clinical features of the case.
In the absence of any symptoms or physical signs of disease, a reaction should call for regulation of every day life, tending to increase the state of general resistance (improvement of nutrition, etc.) frequently without discontinuance of work. ”

“ Tuberculin should not be injected more frequently than about once in 10 or 14 days, and it is well not to increase the dose too rapidly. Wherever the temperature continues high, even a degree beyond normal, and where the pulse is over 100, it is not wise to give tuberculin, nor does it seem to be of any great value where the disease is making rapid headway or has become generalized, especially where there is meningitis or bleeding from the lungs. ”

“ The peculiar principles contained in tuberculin are, indeed, not highly toxic for the normal individual; and our experience in securing immunity to micro-parasites and their products has taught us that where no reaction or response to the introduction of the foreign poison is called forth, no degree of protection to larger doses or more virulent poisons of the same nature is to be expected. Toxic as is tuberculin to the tuberculous organism, it is almost innocuous to the tubercle-free body. ”

“ Whether adult persons in whom the conditions [Pg 50] are favorable for an intestinal infection with Tb. will develop primary tubercular lesions in the intestinal wall, or in the mesenteric glands and the peritoneum, will depend mainly on the circumstance whether or not, owing to a previous infection, they have become oversensitive to tuberculin. Individuals oversensitive to tuberculin are inclined to develop lesions at the point of entry of the tubercular virus, if opportunity is given for the introduction of the virus by means of leucocytic wandering cells. ”

“ Formation of antibodies takes place in the middle of the three layers encircling the tubercle, the layer damaged by toxins, but not yet rendered incapable of reaction.
c Wassermann maintains that the antituberculin found in the tuberculous process draws the injected tuberculin out of the circulation to the tuberculous focus. The interaction that takes place between antituberculin and tuberculin results in formation of ferments which digest albumin, resulting in the softening of tissue. Absorption of softened tissue causes fever. ”

“ As a period of two or three weeks is usually necessary to allow of an extensive development of tuberculosis, the method must be too often discarded on account of the delay in obtaining results.
Tuberculin test. Many stock owners still entertain an ignorant and unwarranted dread of the tuberculin test. It is quite true that, when recklessly used by ignorant or careless people it may be made a root of evil, yet as employed by the intelligent and careful expert it is not only perfectly safe, but it is the only known means of ascertaining approximately the actual number affected in a given herd. ”

“ The time may come when science will give us some tuberculin, or serum, or antitoxin, or antiseptic, that will kill the tubercle bacillus in its hidden lair, act its poisonous products, or reinforce the phagocytes in their attacks on it, but meanwhile sanatorial treatment gives expectations of recovery greater than those of any other kind of treatment that is known to us, and it seems to me inexpedient to say anything which may discourage the benevolent from putting it within reach of the poor and needy, or hinder the poor and needy, stricken with tuberculosis, from taking advantage of it. ”

“ Perhaps no one has done more to rehabilitate the tuberculin treatment than Sir Almroth Wright, who after a long series of experiments devised what he called the tuberculo-opsonic index, about which a few words may be of interest. It is well-known that certain cells in the human blood have the power of taking bacteria into their substance and there digesting them. ”

“ As a result of the tubercular poisoning, we would then have, at autopsy, the typical picture of a tuberculin reaction.
Tuberculin, in its action as a blood poison for an individual infected with tuberculosis, behaves like many other infectious poisons. Very small fractions of the amount sufficient to threaten life cause a distinct reaction. ”

“ They speak of this englobing capacity of the blood as 'opsonic index,' from the word meaning to prepare—to cater for; since the bacilli must first be prepared by substances in the blood serum before they can be ingested by leucocytes. The injection of tuberculin, when cautiously done, tends to bring about a rise in the tuberculous, of the 'opsonic index' which Wright believes is a measure of the good done, as an increase in immunizing substances in the blood is the cause of the rise. ”

“ Such an acute development of tuberculosis as a result of tuberculin injection is to be feared only exceptionally, and then in cases of advanced tuberculosis. It must not be forgotten that acute miliary tuberculosis by no means rarely accompanies an advanced tuberculosis of long standing. ”

“ Numerous tests made in almost every civilized country have demonstrated that in the majority of cases tuberculin is an excellent means for diagnosing the existence or nonexistence of the disease, but giving us no positive information as to the extent to which the disease has progressed. ”

“ Experimentally this same lymph of Koch gives symptoms of inflammation of the arteries which are not found in clinical tuberculosis.
Animals inoculated with progressive doses of Avian tuberculin, or with serum of tuberculous animals, undergo wasting and loss of appetite, and other general symptoms. They may die of cachexia, or may develop an isolated abscess ”

“ Tuberculosis. — In no quarter of the field of preventive medicine have more important results accrued from the discovery of a. specific infective organism than in the case of Koch's demonstration and separation in pure culture of the tubercle bacillus and the association of this bacillus with the transmission of tuberculosis. In connexion with diagnosis — both directly from observation of the organism in the sputum and urine of tuberculous patients, and indirectly through the tuberculin test, especially on animals — this discovery has been of very great importance ”

“ Other genera are immune from lung plague.
Tuberculosis is distinguished by the habitual absence of the high temperature, the numerous circumscribed areas of flatness with wheezing or other abnormal lung sounds, in the midst of a general field giving the normal respiratory murmur, by the enlargement or induration of superficial lymph glands, by the response to the tuberculin test, and by the lung tubercles and diseased lymph glands,—congested, indurated, caseated, calcified—found at the necropsy. Inoculation of other genera causes tuberculosis. ”

“ A negative reaction in adults (especially if repeated) signifies non-existence of tuberculosis (unless great deterioration of health, far advanced process, or tolerance to tuberculin established by tuberculin treatment) .
A positive reaction in children under two years of age signifies, generally, active tuberculous process; with the advance of age the determination of active tuberculous processes by means of cutaneous tuberculin test becomes impossible. III. CONJUNCTIVAL TUBERCULIN TEST
1. Synonyms: Eye Test; Ophthalmic Test; Wolff-Eisner's Test; Calmette's Test. ”

“ A thorough study of the history, thorough physical examination, examination of sputum (if any) give sufficient data for a reliable diagnosis in the vast majority of cases.
2. Cases, with uncertain symptoms or inconclusive physical signs, pointing to possible existence of tuberculous infection, may be treated as "suspicious" cases (without resorting to subcutaneous tuberculin test) , the treatment consisting of rearrangement of mode of life, diet, work, etc., that would tend to increase of general resistance of the patient. This can and should be done in the vast majority of suspicious cases. ”

“ It may be months, years, or decades before the infection leads to manifest disease. This depends on the virulence of the virus, which is generally much greater in the virus of bovine tuberculosis than in that of human tuberculosis. It also depends on the number of bacilli introduced per stomach, and whether such introduction is single or oft repeated. In the human being months and years may elapse before the infection is followed by any sensitiveness to tuberculin injections in the usual dose. ”

“ Bacteriological examinations during the past year have shown that more milks are tuberculosis-infected than is generally supposed, and the importance of carefully supervising milk supplies is becoming more and more acknowledged. Veterinary surgeons are practically agreed that tuberculin is a reliable and safe test for diagnosing the presence of tuberculosis in animals, but affords no index of the extent or degree of the disease. The test, however, will not produce tuberculosis in healthy animals, and has no deleterious effect upon the general health of the animals. ”

“ Although this test appears to be of considerable value, it fails to give any information in cases of advanced tuberculosis, of general miliary tuberculosis and of tuberculous meningitis. It certainly possesses one great advantage over the others — it does not give any reaction in the presence of dormant tubercle in persons clinically sound and healthy. The inflammation of the eye may, however, be so acute, especially where strong solutions of tuberculin are used, that considerable damage may be done, more especially should there be any dormant disease of the eye. ”

“ That woman left the hospital completely cured, and a year afterwards her health was still perfect. In my opinion this patient never had consumption; she was attacked with pseudo-phymic bronchitis, a complication which is very often found with influenza, and which may very easily be mistaken for tuberculosis; and in spite of the presence in the sputa of Koch's bacillus I would not register it as a case of tuberculosis, because, in contradistinction to that single case, I could mention twenty cases of tuberculosis whose symptoms neither Avian tuberculin nor any other such drug has cured. ”

“ The principal factors in the successful treatment of tuberculosis are : Life in the open, absolute rest in the febrile stages, plain, wholesome food in abundance, rigid adherence to regularity of habits, and the use of the tuberculin treatment in suitable cases.
The treatment of tuberculosis is a stern business problem. H the patient has courage and good judgment, he has a right to get well, or at least to greatly pro- long his life. ”

“ No tuberculin tests are given here, and all sputum examinations are made at the Health Department laboratory.
Medicines. A supply of simple drugs is kept in the medicine closet. This includes a few of the standard tonics, such as iron, quinine and strychnia, 188nux vomica, gentian and alkali, and so forth; there are also cough syrups, and heroin, codeine, cascara, etc. The tonics are usually bought in large quantities, in gallon jugs, and in her leisure moments the nurse pours them into four- or six-ounce bottles. ”

“ However, cattle showing any weakness, or the above symptoms, should be
tested for tuberculosis by a competent veterinarian who has had the
privileges of a veterinary education and experience in the
administration of tuberculin.
TREATMENT: It is not advisable to treat tuberculosis. Thus far, medicine
has failed to relieve the affected animal, or kill the bacillus of
tuberculosis in a living animal. The infected animals should be disposed
of on account of tubercular cows giving birth to tubercular calves, the
milk being unfit for human consumption, unless it is thoroughly
pasteurized. ”

“ The bacillus attacks every organ and tissue of the body, but some much more frequently than others. The commonest seats of tuberculous disease are the lungs, lymphatic glands, bones, serous membranes, mucous membranes, intestines and liver. Before the discovery of the bacillus its effects in different parts of the body received separate names and were classified as distinct diseases. For instance, tuberculosis of the lung was called "consumption" or "phthisis," of the bones and lymphatic glands "struma" or "scrofula," of the skin "lupus," or the intestinal glands "tabes mesenterica." ”

“ Nothing is more familiar to physicians than the slow progress of tuberculosis of the lymph-glands and bones, on the one hand, and its frequent rapid progress in pulmonary, abdominal, or encephalic organs on the other. It has on this account been rather difficult to persuade many of the etiological identity of scrofula and consumption. In experimental tuberculosis the same truth constantly crops up. Arloing and his followers found that the tubercle bacillus from the lymph-glands of man proved less virulent and deadly than that from the human lungs (Lecons sur la Tuberculose) . ”

“ Old tubercular glands in the abdomen, neck and elsewhere, and tuberculous disease of bones or joints, are common sources whence tubercle bacilli may become absorbed, and occasion a general dissemination of miliary tubercles in which the lungs participate. Where the source of infection is an old tuberculous bronchial gland or a focus of old tubercle in the lung, the pulmonary organs may be the only seat of- the development of miliary tuberculosis for a time; but even then, if life is sufficiently prolonged, other parts of the body become involved. ”