Nurses' Papers on Tuberculosis :: read before the Nurses' Study Circle of the Dispensary Department, Chicago Municipal Tuberculosis SanitariumChicago (Ill.). Municipal Tuberculosis Sanitarium. Dispensary Department
Science
Nurses' Papers on Tuberculosis :: read before the Nurses' Study Circle of the Dispensary Department, Chicago Municipal Tuberculosis Sanitarium
Chicago (Ill.). Municipal Tuberculosis Sanitarium. Dispensary Department
Tuberculosis
Patient to keep quiet in bed, or reclining chair, for two or three
days before injection.
Take temperature every two or three hours for two or three days
(daytime).
If the test is to be applied, highest temperature should not be above
99.1 F, by mouth, according to Koch; not above 100 F, according to
others.
Site of injection--back, below the level of the shoulder blades,
alternately on the two sides.
Rub skin with ether or alcohol.
An exact record of physical signs, _just before injection_, should be
made by the physician.
5. TIME OF INJECTION:
Between 8 and 10 A. M. (Bandelier and Roepke).
Late in the evening, 9 or 10 P. M., or later (others).
6. DOSE:
According to Koch: Begin with 1/2 mg., or 1 mg., according to
condition of patient; give larger dose if no reaction. Order of
increase: 1 mg.; 5 mg.; 10 mg. (last dose repeated if necessary).
Interval between injections: two or three days.
Present Usage: First dose in adults, 1/2 mg., or 1/5 mg., or smaller,
according to physical condition.
First dose in children: 1/10 mg., or 1/20 mg., or even smaller.
Thus, in adults: 1/2, or 1, 3, 5, 8, and rarely 10;
In children: 1/10, 1/2, 1, 3.
Loewenstein and Kaufmann's Scheme: Repetition of small dose, relying
on exciting hypersensibility--2/10 mg.; in 3 days, 2/10 mg.; in 3
days, 2/10 mg.; in 3 days, 2/10 mg.
Some use 1/10 mg., or 3/4, or 1-1/4, in same way.
This scheme is based on hypersensibility created by repetition of same
dose in tuberculous subjects. Scheme not used at present.
Some advise single dose: 3 or 5 mg., (on the ground that gradual
increase of doses creates tolerance).
7. RULES TO FOLLOW IN INCREASING DOSE:
_a_ If no reaction with one dose, give a larger one next time, according
to _b_.
_b_ If temperature rises less than 1 degree F, repeat same dose; otherwise
increase.
_c_ Avoid large doses in cases of weakness, nervous temperament, children,
etc. In a majority of cases smaller doses suffice.
8. AFTER INJECTION:
_a_ Rest in reclining chair two or more days, unless severe reaction
requires absolute rest in bed.
_b_ Take temperature every 2 or 3 hours for 2 or 3 days.
9. GENERAL REACTION:
_a_ Rise of Temperature. Positive reaction, if temperature rises at
least .5° C. (.9° F.), higher than previous highest temperature.
Degree of reaction according to Bandelier and Roepke: Slight reaction
if temp. rises to 38° C. or 100.4° F. Moderate reaction if temp.
rises to 39° C. or 102.2° F. Severe reaction if temp. rises above
39° C. or 102.2° F.
Typical reaction temperature curve: Rapid rise, slower fall, normal
temperature after 24 hours.
Rise begins, in average case, 6 to 8 hours after injection (may begin
within 4 hours or be delayed for 30 hours).
Acme of rise in 9 to 12 hours.
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