Archives of internal medicine . We can distinguish several periods in this type of weak tuberculousinfection. During the first weeks (a to b in Fig. 12) tubercle bacilli areslowly growing with no clinical reaction. This is a period in whichtubercle bacilli may be found only microscopically, or by injection of thetissues in animals (Bartels lymphatic state). Between b and c theantibodies slowly increase Just as the tuberculous process does, but theformation of toxin is a slight one, so that the general symptoms do notreach the threshold of clinical manifestation. Between c and d the strug-gle i
Archives of internal medicine . We can distinguish several periods in this type of weak tuberculousinfection. During the first weeks (a to b in Fig. 12) tubercle bacilli areslowly growing with no clinical reaction. This is a period in whichtubercle bacilli may be found only microscopically, or by injection of thetissues in animals (Bartels lymphatic state). Between b and c theantibodies slowly increase Just as the tuberculous process does, but theformation of toxin is a slight one, so that the general symptoms do notreach the threshold of clinical manifestation. Between c and d the strug-gle is at its height, leading for some time to general symptoms, such asloss of appetite, anemia, fever, but is terminated by the successful fightof the antibodies against the bacilli. In the period d to e therefore theallergen, i. e., the tubercle bacillus, does not play any role in the generalsystem, but the existence of the antibodies can be proved by the tuberculin ^m . , test b ill ^- f tCierculin^ f Cutaneous test. reactions Reaction aft«T4- days Fig. 13.—Cutaneous and subcutaneous reaction in a case of healed tuber-culosis (latent inactive tuberculosis). reaction. After e the antibodies fall below the level of the cutaneousreaction. With this level I introduce a new conception. The antibodiesmust be present in the tissues of the skin in a certain concentration, inorder to give a positive cutaneous test with undiluted tuberculin. If weinject the tuberculin into the subcutaneous tissue, we can stillelicit positive reactions. The level of the subcutaneous reaction is alower one, as is shown in Figure 13, which is supposed to form the con-tinuation of Figure 12 after point e. A minimal amount of antibodies ispresent, an amount not only below the cutaneous but even below the sub-cutaneous level. An application of tuberculin in any way arouses arenewed formation of the antibodies in the same way as is seen in Figures4 and 8. When the new-formed antibodies enter the c
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