Thursday, January 15, 2009

Pirquet reaction

It was with that happy sense of serendipity that I noticed, just this morning, the name of Pirquet mentioned in the typescript speech of one S.E. Josephi, first dean of the University of Oregon Medical School and first president of the Portland Academy of Medicine. Regular readers might remember that we recently made a home for Pirquet's Allergie in the History of Medicine Collection here at OHSU, honoring the scientist who not only coined the term "allergy" but developed a reliable skin test for tuberculosis.

The book collections and the archival collections rarely come into contact, primarily because they tend to come in different donations and represent different collecting interests on the part of donors. So, it's always fun when you can tie a scientific advancement made outside of Oregon (and in Pirquet's case, outside of America) to a reaction by the local medical community.

In his speech as outgoing president of the Portland Academy of Medicine, delivered January 9, 1908, Dr. S.E. Josephi touches on a number of topics that he deemed "events of greatest prominence" in the year in medicine, including outbreaks of cerebrospinal meningitis, bubonic plague, and poliomyelitis; "secret nostrums"; the development of bacterial vaccines; the role of adrenalin in arteriosclerosis; new treatments for thryoid diseases; syphilis; and cancer. But the largest segment of his talk is reserved for tuberculosis, which he calls one of the two "universal scourges of our race" (the other being cancer).

After discussing recent trends in "institutional segregation" and other control measures, Josephi turns to scientific advances in diagnosis and treatment:
Early in the year von Pirquet announced that he had found "that if tuberculin is introduced into the skin of a tuberculous child there will appear at the point of innoculation a small papule not unlike the papule of vaccination, at first bright, later more dark red and lasting about eight days." This was called the cutaneous reaction to tuberculin and was said to be applicable chiefly in the first year of life. Later in the year further experimentation and observation seemed to throw some doubt upon the reliability of this test, yet to uphold a close connection between tuberculosis and von Pirquet's test. A transposition of this test from the skin to the conjunctiva was formulated by Calmette who showed that "if tuberculin were instilled into the eye there would be marked congestive reaction in the case of tuberculous patients, while the healthy or non-tuberculous responded with a very much milder reaction. Calmette makes use of a 1% aqueous solution of the precipitate obtained on the addition of alcohol to tuberculin." Similar work has been done by Chantemese who applied the same method to typhoid fever diagnosis. Should further study and observation establish the reliability of these methods they will prove of great value, not only in the case of the diseases named but in many others.
I don't know about the rest of you, but I'm quite glad that Pirquet's skin TB test won out over an alcohol-and-tuberculin eye wash, which sounds much more intrusive and not a little bit painful. And it's interesting to know that Josephi recommended waiting on either to see whether further study would prove the tests were efficacious, but that he also seems entirely ready to embrace whatever advancement science afforded. Many of his older peers no doubt remained highly skeptical of laboratory medicine and germ theories of disease.

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