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The tuberculin treatment of pulmonary tuberculosis by the percutaneous exhibition of tuberculin (Philip's method)
I64
THE BRITISH JOURNAL OF TUBERCULOSIS
THE T U B E R C U L I N T R E A T M E N T O F . P U L M O N A R Y TUBERCULOSIS BY THE P E R C U T A N E O U S E X H I B I T I O N OF T U B E R C U L I N (PHILIP'S METHOD) By J. H. BLACKBURN,
L.R.c.s., L.~.C.~.f~D.),LR.F.~.S.CocAS.), Medical Superintendent, WestwoodSanatorium,Westwood,Queensland.
THE routine method known to most workers in pulmonary tuberculosis is the injection one (subcutaneous route), and I have adopted for the last few years the percutaneous one which was first suggested by Sir Robert Philip, Professor of Tuberculosis at the University of Edinburgh, who claims to be able to detuberculise his tuberculous patients in this way and effectively prevent the extension of the disease, and in m y experience such is the case. Moro has pointed out that a local skin reaction follows the inunction of tuberculin incorporated with a suitable base, and suggested that this reaction might be used for diagnostic purposes. °
Advantages. i. It does not appear to the patient as an operation. 2. It produces a certain amount of reaction which can be used as an index and the dose thus regulated. 3. It certainly does not interfere with the patient.in any way. 4. The treatment can be performed either by the nurse or other responsible person should it be advisable. 5. As it is already prepared for immediate use, it obviates all the necessary apparatus required for preparation and dilution.
Preparations. The " Commonwealth " Tuberculin Ointments are obtainable only from the Director, Commonwealth Serum Laboratories, R o y a l Park, Melbourne, Victoria, in the following two strengths and composition, the quantities being in 1-ounce and ½-ounce pots.
:
CLINICAL: CASES
~6 5
NO. I (STRENGTH IO PER CENT.). Old tuberculin (o- 5 per cent. phenol added) F a t t y bases . . . . . . . . . . . . Eucalyptol . . . . . . . . . . . .
..
IO per cent. 85 ,, 5 ,,
NO. 2 (STRENGTH 25 PER CENT.). Old tuberculin (o. 5 per cent. phenol added) F a t t y bases . . . . . . . . . . . . Eucalyptol . . . . . . . . . . . .
••
25 per cent. 7° ,, 5 ,,
N o T E . - - T h e s e are p r e p a r e d in batches and n u m b e r e d as obtains on all biological products from the C o m m o n w e a l t h S e r u m Laboratories.
Modes of Administration. I. E a c h patient is t h o r o u g h l y e x a m i n e d p r i o r to beginning t r e a t m e n t , which includes charts and s p u t u m examination. 2. I always begin with the IO per cent. o i n t m e n t as a routine, a n d each patient receives at least f r o m twenty-four to thirty-six applications o f that strength, a n d all being well passes on to the 2 5 per cent. series and receives m a n y dozen applications, until e x a m i n a t i o n proves t h a t same can be dispensed w ~ . I f need be it is reapplied. 3- E a c h ai~plication is d o n e weekly and a different area o f the back being selected for each operation, the area being one to two square inches. T h e time taken is a b o u t t w e n t y minutes. 4. Should there be a sudden rise in t e m p e r a t u r e a c c o m p a n i e d with malaise, etc., it is advisable to postpone t r e a t m e n t for a week or a fortnight. 'Results. T o date 72 patients h a v e received the p e r c u t a n e o u s m e t h o d o f tuberculin, o f which 53 have been arrested and 19 i m p r o v e d (the last figure includes 2 asthmatics, and also In patients who left the s a n a t o r i u m before completing t r e a t m e n t ) . I t is well k n o w n that some asthmatics respond to tuberculin (protein shock t h e r a p y ) . REFERENCES ON TUBERCULIN. I. SIR R. PHILIP: Tuberculin in the Diagnosis and Treatment of Tuberculosis. British Medical Journal, March 24, I9~3. 2. HALLmAYSVTmmLAND,M.D.: The Tuberculin Treatment of Pulmonary Tuberculosis, in The General Practitioner of Australia and Wew Zealand, Special Number on Tuberculosis, April r5, 1935. 3- HALLmAYSUTrmRT.~U~D,M.D.: The Tuberculin Treatment of Pulmonary Tuberculosis, in The British oTournal of Tuberculosis, January, 1935. 4. The Medical aTournal of Australia, Special Tuberculosis Number, August 8, I93 I. 5" J.~Es AL~.XA_'~DF.RMILLER, Pulmonary Tuberculosis, Clinical Aspects, in Nelson. New Loose-Leaf, Medicine, vot. i., pp. 388-389. 6. LAWV~aON BROWN AND Fvam H. I-IEIsE: Tuberculosis in Nelson. New Loose-Leaf, Medicine, Surveys of Current Literature. •
THE BRITISH JOURNAL OF TUBERCULOSIS
THE T U B E R C U L I N T R E A T M E N T O F . P U L M O N A R Y TUBERCULOSIS BY THE P E R C U T A N E O U S E X H I B I T I O N OF T U B E R C U L I N (PHILIP'S METHOD) By J. H. BLACKBURN,
L.R.c.s., L.~.C.~.f~D.),LR.F.~.S.CocAS.), Medical Superintendent, WestwoodSanatorium,Westwood,Queensland.
THE routine method known to most workers in pulmonary tuberculosis is the injection one (subcutaneous route), and I have adopted for the last few years the percutaneous one which was first suggested by Sir Robert Philip, Professor of Tuberculosis at the University of Edinburgh, who claims to be able to detuberculise his tuberculous patients in this way and effectively prevent the extension of the disease, and in m y experience such is the case. Moro has pointed out that a local skin reaction follows the inunction of tuberculin incorporated with a suitable base, and suggested that this reaction might be used for diagnostic purposes. °
Advantages. i. It does not appear to the patient as an operation. 2. It produces a certain amount of reaction which can be used as an index and the dose thus regulated. 3. It certainly does not interfere with the patient.in any way. 4. The treatment can be performed either by the nurse or other responsible person should it be advisable. 5. As it is already prepared for immediate use, it obviates all the necessary apparatus required for preparation and dilution.
Preparations. The " Commonwealth " Tuberculin Ointments are obtainable only from the Director, Commonwealth Serum Laboratories, R o y a l Park, Melbourne, Victoria, in the following two strengths and composition, the quantities being in 1-ounce and ½-ounce pots.
:
CLINICAL: CASES
~6 5
NO. I (STRENGTH IO PER CENT.). Old tuberculin (o- 5 per cent. phenol added) F a t t y bases . . . . . . . . . . . . Eucalyptol . . . . . . . . . . . .
..
IO per cent. 85 ,, 5 ,,
NO. 2 (STRENGTH 25 PER CENT.). Old tuberculin (o. 5 per cent. phenol added) F a t t y bases . . . . . . . . . . . . Eucalyptol . . . . . . . . . . . .
••
25 per cent. 7° ,, 5 ,,
N o T E . - - T h e s e are p r e p a r e d in batches and n u m b e r e d as obtains on all biological products from the C o m m o n w e a l t h S e r u m Laboratories.
Modes of Administration. I. E a c h patient is t h o r o u g h l y e x a m i n e d p r i o r to beginning t r e a t m e n t , which includes charts and s p u t u m examination. 2. I always begin with the IO per cent. o i n t m e n t as a routine, a n d each patient receives at least f r o m twenty-four to thirty-six applications o f that strength, a n d all being well passes on to the 2 5 per cent. series and receives m a n y dozen applications, until e x a m i n a t i o n proves t h a t same can be dispensed w ~ . I f need be it is reapplied. 3- E a c h ai~plication is d o n e weekly and a different area o f the back being selected for each operation, the area being one to two square inches. T h e time taken is a b o u t t w e n t y minutes. 4. Should there be a sudden rise in t e m p e r a t u r e a c c o m p a n i e d with malaise, etc., it is advisable to postpone t r e a t m e n t for a week or a fortnight. 'Results. T o date 72 patients h a v e received the p e r c u t a n e o u s m e t h o d o f tuberculin, o f which 53 have been arrested and 19 i m p r o v e d (the last figure includes 2 asthmatics, and also In patients who left the s a n a t o r i u m before completing t r e a t m e n t ) . I t is well k n o w n that some asthmatics respond to tuberculin (protein shock t h e r a p y ) . REFERENCES ON TUBERCULIN. I. SIR R. PHILIP: Tuberculin in the Diagnosis and Treatment of Tuberculosis. British Medical Journal, March 24, I9~3. 2. HALLmAYSVTmmLAND,M.D.: The Tuberculin Treatment of Pulmonary Tuberculosis, in The General Practitioner of Australia and Wew Zealand, Special Number on Tuberculosis, April r5, 1935. 3- HALLmAYSUTrmRT.~U~D,M.D.: The Tuberculin Treatment of Pulmonary Tuberculosis, in The British oTournal of Tuberculosis, January, 1935. 4. The Medical aTournal of Australia, Special Tuberculosis Number, August 8, I93 I. 5" J.~Es AL~.XA_'~DF.RMILLER, Pulmonary Tuberculosis, Clinical Aspects, in Nelson. New Loose-Leaf, Medicine, vot. i., pp. 388-389. 6. LAWV~aON BROWN AND Fvam H. I-IEIsE: Tuberculosis in Nelson. New Loose-Leaf, Medicine, Surveys of Current Literature. •