Nurses' Papers on Tuberculosis : / read before the Nurses' Study Circle of the Dispensary Department, Chicago Municipal Tuberculosis Sanitarium

by Chicago . Municipal Tuberculosis Sanitarium. Dispensary Department

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.

The occurrence of reaction, in the presence of slight symptoms or physical signs, calls, according to individual condition, either for home treatment with or without discontinuance of work, or sanatorium treatment.

14. Indications for the Subcutaneous Tuberculin Test:

The following considerations should guide its employment:

1. 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.

3. The subcutaneous tuberculin test is indicated in cases in which, in the absence of conclusive symptoms or signs, an absolutely positive diagnosis is desired; then the test should be applied, with the consent of the patient, after all other methods of diagnosis are exhausted (thorough study of the case, thorough physical examination, repeated examinations of sputum, etc).

4. The focal reaction (the reaction pointing to the seat of the disease) occurs in about ¹⁄₃, or less, of the general reactions following the subcutaneous tuberculin test; this enhances the value of the test in some cases where a focal reaction would clear the diagnosis.