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THE TUBERCULIN TEST, AND THE NEED OF A MORE COMPLETE DIAGNOSIS OF TUBERCULOSIS.

THE TUBERCULIN TEST, AND THE NEED OF A MORE COMPLETE DIAGNOSIS OF TUBERCULOSIS. of the last but and this died. spoken by gentleman one, patient is a But what would be delayed doses, diagnostic guide. With to a I would infer it that regard doing hemilaminectomy, a sufficient dose is not known it is a in advance; prob- a because a is the was difficult operation, hemilaminectomy affair. And it-—comes in lematic here—I take the ex- removal of a bone in but in to the a surface, tech- deep regard in the case I it and the some cases known to first did rongeur chisel; in of of the Doctor's nique, by planation why second case Devilbiss I is the which think a very by forceps, be did not react. too be tubercular, If small dose given, here as well as on the brain. In useful instrument, doing and are to intervene—before several allowed the days these made incision and back tissues I one the operations pared next dose—a case is tubercular on either side and xVfter the I took slightly thereby acquir- packed. denuding point, small one the I introduced a or a and, of laminae, tolerance which trephine, opening ing partial immunity precludes this instrument to bite out of tissues. the any we are an the reaction after. Just re- so, very already Dr. C. not do lumbar J. Munro, a Boston—Why puncture sistant local person, having infection, encapsulated in of if relief of of form of the place any laminectomy pressure or tuberculosis—i. scrofular fluid is is A has no or all that tubercle, glandular e., spinal sought? hemilaminectomy from of view. course not to over a adenoid of react an insuffi- advantage complete operation any point glands—will The latter be done in minutes can operation ordinarily twenty cient if it be not soon dose; especially repeated enough and with shock. As to the lamina? little after very wiring to the overcome tolerance This tol- already existing. there to be I have seen a number is operation, nothing gained; increased intervals of cases of of several laminae without removal any erance, progressively by appropriate subsequent lamina? removed in blocks between is we are trouble, one had what after in the patient having eight injections, just of four. treatment of with tuberculosis tuberculin—now better believe in if it is As for I it not too early. operating early, still test with extract—but the under discussion, watery In the ease of a man falls five or six stories and breaks who to while he in it is is intended for his it is bad to is necessary back, I believe hardly state, only surgery operate until reaction it is better to sets delay in, latent cases of those not known profound shock; tuberculosis, positively fatal would be at will be when the which first, operation, easily to be or as a of affected, proof cure. The absence of sensation but or of slight importance. presence 2. I As to the maximum dose: believe that the dose other is not of itself contraindication to factors a operation; found use that Dr. Otis limits himself 10 to 12 must be I have not it to considered. necessary to, namely mg., have all taken ether well. in. cases; they is insufficient for and a oxygen my some correct cases, consequently Patterson's in In reference to Dr. laminectomy meningitis, be missed. von Ruck to Dr. diagnosis might gave him-, times and I think it has been done a be of good many may 25 I self and 35 in order understand, but lumbar will an- mg., again, mg., benefit occasionally, ordinarily puncture to sure and be that a rebellious swer the "cold," suspicious signs, purpose. think the use the Dr. I should that of that forceps Bailey did not infection from his so much signify dealing but there is no use in the would be good, lengthening suggests have with the tuberculous. I succeeded in a few cases and I sure that aid in am operation, my forceps materially in of latent tubercular infection, both and difficulties. becoming positive overcoming delay with and 25 the of 20, cases 15, mg., though majority tested to to 5 or less. began respond mg. THE TUBERCULIN TEST, AND THE NEED OF to of method is make a 1 cent, solution the My per in A MORE COMPLETE DIAGNOSIS OF crude tuberculin3 a .75 cent, carbolic in acid per distilled water. Of this .10 1 then, e.c. TUBERCULOSIS. equals mg. The dose then would be from 1 to 2 commencing mg. M.D. BY CHABLES DENISON, A.M., for and sensitive tubercular suspiciously person—a COLO. DENVER, in her for instance—and 3 to 6 a for less girl teens, mg. at work on similar am much been lines1, Having adult for instance. impressible male, person—an in interested the of the excellent finished, perusal, just I to arm for the this or object hypodermic injection, B. on the of Dr. Edward "Value of the Otis, paper to for it where to local in- any choosing place liability Test in Tuberculin the of Tuberculosis2." Diagnosis the flammation cloud result. Underneath the might am too in friend Otis that I may say my sanguine My and on shoulder that side blade, usually his I will return such a uppermost of discussion paper. compli- is best if when the the sleeping, spot. Then, is too temper- ment that he conservative, saying especially by ature is of the known to be and patient regular even, with in in his conclusions. For, though agreeing him, or been has taken for two or three regularly days of the I he have prev- think could his estimation test, high at in and 8 order to 9, o'clock, catch iously, 1, 4-, he any 10 to 20 cent. to his had added from successes, per habitual to commence the variation, are daily you ready its his or estimated results. varied procedure differently the one of the dose, daily nearly doubling used: it to previous day, 1. to the tuberculin While As allowing until a reaction. first if not you get Then, satis- fully as to to use the same standard material be preferable an another increase after interval of or two fied, a day it not the make\p=m-\if be particular pure\p=m-\does virulency, will settle the As clearly diagnosis. already intimated, I be for much if the followed count so plan propose the maximum dose be 10 and it be may mg. may to double the dose, out, namely, nearly previous day's to the but the at which mg., according case; re- have stage some or reaction shall until systemic temperature as action occurs is used a measure of the be susceptibility be said that thus there will oc- occurred. It may and latent tubercular infection of the tested. patient a cumulative effect. That is what casioned precisely 3. What is a sufficient and reasonably clear, diagnos- as a measure of the sus- can be estimated diagnostic to is tic reaction? The answer this of capable question or tuberculosis in the the latent existing ceptibility, wider I than that taken range, believe, Dr. taking by tested. person Otis. As he it is to the states, unfortunate, owing a not to start If sufficient dose be with, given object character of his "that local clinic, con- "Allow "ambulatory" to rule made to Dr. Otis' apply, namely, being dition test was not after the and that the noted," to before the ex- per- several test," elapse repeating days sonal sensations of the had to be relied as to patient on, would where a doubtful or in- say, you get cepting, or not reaction had I whether a occurred. believe that or are a case reaction, testing already showing complete visual of the and evidence local increase by stethoscopic changes a exacerbation of fever. In that case the daily in or unknown diseased and from the suspected in areas, subsidence the interim between of that and its fever, in variations the others would temperature, resulting "A Plea for the Better of the Tuberculin Test in the been Appreciation have found to have reacted. of Latent Tuberculosis." Jour. of April, 1899. Diagnosis Tuberculosis, Journal, Oct. 28, 1899. Obtained from Victor Koechl or & Von Ruck's Co., Laboratory. Downloaded From: http://jama.jamanetwork.com/ by a University of California - San Diego User on 06/06/2015 Aside from sensations or until a the has broken forth malaise, all of sudden disease grippy general tivity, there be a in tubercular or in a state not to tenderness into of that growths, angry any say may vigor layman, or cervical adenoids and a of doctor of could understand. glands stiffening up lung medicine, due to increased 11. test been even The tuberculin has seldom used, tissue—peribronchial glands—perhaps In areas this is vet- excited there. affected the five when the of leucoeytosis lung during past years, experience to me on divers Its detection erinarians in state of the and of depends instructively diagnostic. every Union, and after with a sufficient "the before all over the was investigation country, taking" physicians amply The of to convince a fearful and over-cautious exaggerated good sound-transmitting stethoscope. profession than be- test. bronchovesicular the harmlessness of this excellent breath-sound, higher pitched comparative or in in a which show thus be found are few of the criticisms character, These a fore, puerile may only I or in few cases. detected this local nine and the need of care sign eight years proficiency diagnosis greater when was in tu- crude tuberculin first used before we can ahead of treatment, ago, get by physicians universally, I have in few but succeeded but i. detect it in its impressing physicians berculosis, e., incipiency. its or a with fault of either existence, The of climatic, importance, perhaps treatment, hygienic, questions in cases has here technic. several it located for or are not considered However, constitutional specific, being me an area in a affected I am or even mentioned. previously unsuspected spot. considering diagnosis only; nicest we have re- It is one of the of with and invalids, confirmatory diagnoses experience twenty-six years all of the uncertain of to me of brother from ferred previously finding physical explora- physicians by courtesy tion us is not and and who of has basis for auscultation, over the encountering ample delivering country, given I sure I these uncertainties ? am do Others here is all and this "kick." The climate frequently. right diagnostic I of for could frame an the to 20 cent, to recoveries otherwise will add 10 the must, arraignment average per of for or what is of the revised records carelessness, more, ignorance obtainable in low but physician altitudes, an what should not be uncertainties. This truth that individual cases confirm and enforce the arraignment would based on such of facts as fol- tuberculosis is needed. be some earlier better of summary and diagnosis lows : excellent work In Dr. E. C. Dudley's lately reading 1. almost the I was definiteness of by on the Physicians everywhere, measuring gynecology, impressed by im- fees do not estimate the of the line be- and the demarcation they charge, adequately shown, description know. was of their examination. doe- what we not It tween what know and do portance physical Country we more services tors often but little for such than in contrast to our of thoracic marked vague knowledge charge to a for others too little time crit- the visits; and blood diseases. After ordinary give all, superficial, drifting ical examination. in have of medicine, may complained general laxity, 2. 5 cent, in the United Not of the its in the inferior estimate the doctor himself excuse per physicians an States tabulated records of their exam- on and his services, laity's ig- keep physical unappreciative puts inations. of the of detail and norance thoroughness importance 3. characteristic Too often the chest has been a reflex of this is during exploration only inefficiency perhaps or been is so much of the thorax have times. Tuberculosis the of the accompani- unexposed, parts entirely is to the overlooked. ment of that an incentive wanting poverty been of detail 4. In no has ar- out of that and country practice generally plan nicety thoroughness carrying to variation of tem- in which wealth makes Therefore, which determine the possible. daily ranged by diagnosis boards as if institutions, it seems perature. publicly-supported not 1 cent, and 5. Mensuration has been and of health, especially dispensaries hospitals ought defective, per most accurate to with and to utilize the of the have be measure, supplied physicians accurately, by compared and the of tuberculosis, the movements of the two sides of the chest. means for early diagnosis test. the tuberculin 6. 5 cent, them Not of several thousand examinations among per others known of have had by stethoseopic percussion valuable means we the most have for OPHTHALMIA NEONATORUM. tried, detecting or and areas of excavation. Another outlining softening BY DUDLEY S. REYNOLDS, A.M., M.D. method as often is auscultation nearly neglected during in Professor of Ophthalmology, Otology and Medical Jurisprudence, a a in the of of the valuable method the College Medicine, Medical Department very Hospital cough, determining of Kentucky; Surgeon to the Eye and Central University commencement of softening. of the Louisville City Hospital; Ear Department In not than 1 cent, 7. more of examina- the Street per Gray Infirmary, etc. probably have manometer been KY. tions the and LOUISVILLE, spirometer used, instruments so needful to and throw on is to confirm neonatorum a disease assumed occur light Ophthalmia a correct on an incorrect or and doubt false coincident with birth. it means diagnosis, Clinically, always one. inflammation of the some form of conjunctiva. purulent 8. in Six-sevenths of the use are denominated It has been as catarrhal, muco- stethoscopes quite variously in deficient and the fact It as and a sound-transmitting qualities, blenorrheal, purulent, gonorrheal. appears and are that so or inflammation the many catarrhal of phonendoscopes auscultoscopes suppurative conjunc- in bears of sold itself the more or less the lids. attended with of proof diagnostic "inprofi- tiva, swelling of the American to the average It makes its from ciency" physician. appearance, according Swanzy, 9. The so-called "stomach second to the fifth after birth. fixes the time coughs," "typhoid pneu- day Noyes "bronchial catarrhs" and "chronic bronchitis" be as late monias," "at about the third but as day, may delayed are too far often as the of conditions it on the the third given explanation eighth day." Nettleship says appears tuberculous from the it a on after birth. Fuchs as the evidently beginning. rule, day says appears, The has been micro- is writers on second or third It all the expectoration previously day. agreed by in 10 cent, studied less than of the cases per that the disease occurs between the scopically subject uniformly in too seen the last ten and when years, often, examined, after second and birth. eighth day a to at be the has negative result, stage, expected given at Read before the Tri-State Medical Chattanooga, Tenn., Society, into harmful lured the and his inac- physician patient Oct. 25,1899. Downloaded From: http://jama.jamanetwork.com/ by a University of California - San Diego User on 06/06/2015 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA: The Journal of the American Medical Association Unpaywall

THE TUBERCULIN TEST, AND THE NEED OF A MORE COMPLETE DIAGNOSIS OF TUBERCULOSIS.

JAMA: The Journal of the American Medical AssociationJan 6, 1900

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of the last but and this died. spoken by gentleman one, patient is a But what would be delayed doses, diagnostic guide. With to a I would infer it that regard doing hemilaminectomy, a sufficient dose is not known it is a in advance; prob- a because a is the was difficult operation, hemilaminectomy affair. And it-—comes in lematic here—I take the ex- removal of a bone in but in to the a surface, tech- deep regard in the case I it and the some cases known to first did rongeur chisel; in of of the Doctor's nique, by planation why second case Devilbiss I is the which think a very by forceps, be did not react. too be tubercular, If small dose given, here as well as on the brain. In useful instrument, doing and are to intervene—before several allowed the days these made incision and back tissues I one the operations pared next dose—a case is tubercular on either side and xVfter the I took slightly thereby acquir- packed. denuding point, small one the I introduced a or a and, of laminae, tolerance which trephine, opening ing partial immunity precludes this instrument to bite out of tissues. the any we are an the reaction after. Just re- so, very already Dr. C. not do lumbar J. Munro, a Boston—Why puncture sistant local person, having infection, encapsulated in of if relief of of form of the place any laminectomy pressure or tuberculosis—i. scrofular fluid is is A has no or all that tubercle, glandular e., spinal sought? hemilaminectomy from of view. course not to over a adenoid of react an insuffi- advantage complete operation any point glands—will The latter be done in minutes can operation ordinarily twenty cient if it be not soon dose; especially repeated enough and with shock. As to the lamina? little after very wiring to the overcome tolerance This tol- already existing. there to be I have seen a number is operation, nothing gained; increased intervals of cases of of several laminae without removal any erance, progressively by appropriate subsequent lamina? removed in blocks between is we are trouble, one had what after in the patient having eight injections, just of four. treatment of with tuberculosis tuberculin—now better believe in if it is As for I it not too early. operating early, still test with extract—but the under discussion, watery In the ease of a man falls five or six stories and breaks who to while he in it is is intended for his it is bad to is necessary back, I believe hardly state, only surgery operate until reaction it is better to sets delay in, latent cases of those not known profound shock; tuberculosis, positively fatal would be at will be when the which first, operation, easily to be or as a of affected, proof cure. The absence of sensation but or of slight importance. presence 2. I As to the maximum dose: believe that the dose other is not of itself contraindication to factors a operation; found use that Dr. Otis limits himself 10 to 12 must be I have not it to considered. necessary to, namely mg., have all taken ether well. in. cases; they is insufficient for and a oxygen my some correct cases, consequently Patterson's in In reference to Dr. laminectomy meningitis, be missed. von Ruck to Dr. diagnosis might gave him-, times and I think it has been done a be of good many may 25 I self and 35 in order understand, but lumbar will an- mg., again, mg., benefit occasionally, ordinarily puncture to sure and be that a rebellious swer the "cold," suspicious signs, purpose. think the use the Dr. I should that of that forceps Bailey did not infection from his so much signify dealing but there is no use in the would be good, lengthening suggests have with the tuberculous. I succeeded in a few cases and I sure that aid in am operation, my forceps materially in of latent tubercular infection, both and difficulties. becoming positive overcoming delay with and 25 the of 20, cases 15, mg., though majority tested to to 5 or less. began respond mg. THE TUBERCULIN TEST, AND THE NEED OF to of method is make a 1 cent, solution the My per in A MORE COMPLETE DIAGNOSIS OF crude tuberculin3 a .75 cent, carbolic in acid per distilled water. Of this .10 1 then, e.c. TUBERCULOSIS. equals mg. The dose then would be from 1 to 2 commencing mg. M.D. BY CHABLES DENISON, A.M., for and sensitive tubercular suspiciously person—a COLO. DENVER, in her for instance—and 3 to 6 a for less girl teens, mg. at work on similar am much been lines1, Having adult for instance. impressible male, person—an in interested the of the excellent finished, perusal, just I to arm for the this or object hypodermic injection, B. on the of Dr. Edward "Value of the Otis, paper to for it where to local in- any choosing place liability Test in Tuberculin the of Tuberculosis2." Diagnosis the flammation cloud result. Underneath the might am too in friend Otis that I may say my sanguine My and on shoulder that side blade, usually his I will return such a uppermost of discussion paper. compli- is best if when the the sleeping, spot. Then, is too temper- ment that he conservative, saying especially by ature is of the known to be and patient regular even, with in in his conclusions. For, though agreeing him, or been has taken for two or three regularly days of the I he have prev- think could his estimation test, high at in and 8 order to 9, o'clock, catch iously, 1, 4-, he any 10 to 20 cent. to his had added from successes, per habitual to commence the variation, are daily you ready its his or estimated results. varied procedure differently the one of the dose, daily nearly doubling used: it to previous day, 1. to the tuberculin While As allowing until a reaction. first if not you get Then, satis- fully as to to use the same standard material be preferable an another increase after interval of or two fied, a day it not the make\p=m-\if be particular pure\p=m-\does virulency, will settle the As clearly diagnosis. already intimated, I be for much if the followed count so plan propose the maximum dose be 10 and it be may mg. may to double the dose, out, namely, nearly previous day's to the but the at which mg., according case; re- have stage some or reaction shall until systemic temperature as action occurs is used a measure of the be susceptibility be said that thus there will oc- occurred. It may and latent tubercular infection of the tested. patient a cumulative effect. That is what casioned precisely 3. What is a sufficient and reasonably clear, diagnos- as a measure of the sus- can be estimated diagnostic to is tic reaction? The answer this of capable question or tuberculosis in the the latent existing ceptibility, wider I than that taken range, believe, Dr. taking by tested. person Otis. As he it is to the states, unfortunate, owing a not to start If sufficient dose be with, given object character of his "that local clinic, con- "Allow "ambulatory" to rule made to Dr. Otis' apply, namely, being dition test was not after the and that the noted," to before the ex- per- several test," elapse repeating days sonal sensations of the had to be relied as to patient on, would where a doubtful or in- say, you get cepting, or not reaction had I whether a occurred. believe that or are a case reaction, testing already showing complete visual of the and evidence local increase by stethoscopic changes a exacerbation of fever. In that case the daily in or unknown diseased and from the suspected in areas, subsidence the interim between of that and its fever, in variations the others would temperature, resulting "A Plea for the Better of the Tuberculin Test in the been Appreciation have found to have reacted. of Latent Tuberculosis." Jour. of April, 1899. Diagnosis Tuberculosis, Journal, Oct. 28, 1899. Obtained from Victor Koechl or & Von Ruck's Co., Laboratory. Downloaded From: http://jama.jamanetwork.com/ by a University of California - San Diego User on 06/06/2015 Aside from sensations or until a the has broken forth malaise, all of sudden disease grippy general tivity, there be a in tubercular or in a state not to tenderness into of that growths, angry any say may vigor layman, or cervical adenoids and a of doctor of could understand. glands stiffening up lung medicine, due to increased 11. test been even The tuberculin has seldom used, tissue—peribronchial glands—perhaps In areas this is vet- excited there. affected the five when the of leucoeytosis lung during past years, experience to me on divers Its detection erinarians in state of the and of depends instructively diagnostic. every Union, and after with a sufficient "the before all over the was investigation country, taking" physicians amply The of to convince a fearful and over-cautious exaggerated good sound-transmitting stethoscope. profession than be- test. bronchovesicular the harmlessness of this excellent breath-sound, higher pitched comparative or in in a which show thus be found are few of the criticisms character, These a fore, puerile may only I or in few cases. detected this local nine and the need of care sign eight years proficiency diagnosis greater when was in tu- crude tuberculin first used before we can ahead of treatment, ago, get by physicians universally, I have in few but succeeded but i. detect it in its impressing physicians berculosis, e., incipiency. its or a with fault of either existence, The of climatic, importance, perhaps treatment, hygienic, questions in cases has here technic. several it located for or are not considered However, constitutional specific, being me an area in a affected I am or even mentioned. previously unsuspected spot. considering diagnosis only; nicest we have re- It is one of the of with and invalids, confirmatory diagnoses experience twenty-six years all of the uncertain of to me of brother from ferred previously finding physical explora- physicians by courtesy tion us is not and and who of has basis for auscultation, over the encountering ample delivering country, given I sure I these uncertainties ? am do Others here is all and this "kick." The climate frequently. right diagnostic I of for could frame an the to 20 cent, to recoveries otherwise will add 10 the must, arraignment average per of for or what is of the revised records carelessness, more, ignorance obtainable in low but physician altitudes, an what should not be uncertainties. This truth that individual cases confirm and enforce the arraignment would based on such of facts as fol- tuberculosis is needed. be some earlier better of summary and diagnosis lows : excellent work In Dr. E. C. Dudley's lately reading 1. almost the I was definiteness of by on the Physicians everywhere, measuring gynecology, impressed by im- fees do not estimate the of the line be- and the demarcation they charge, adequately shown, description know. was of their examination. doe- what we not It tween what know and do portance physical Country we more services tors often but little for such than in contrast to our of thoracic marked vague knowledge charge to a for others too little time crit- the visits; and blood diseases. After ordinary give all, superficial, drifting ical examination. in have of medicine, may complained general laxity, 2. 5 cent, in the United Not of the its in the inferior estimate the doctor himself excuse per physicians an States tabulated records of their exam- on and his services, laity's ig- keep physical unappreciative puts inations. of the of detail and norance thoroughness importance 3. characteristic Too often the chest has been a reflex of this is during exploration only inefficiency perhaps or been is so much of the thorax have times. Tuberculosis the of the accompani- unexposed, parts entirely is to the overlooked. ment of that an incentive wanting poverty been of detail 4. In no has ar- out of that and country practice generally plan nicety thoroughness carrying to variation of tem- in which wealth makes Therefore, which determine the possible. daily ranged by diagnosis boards as if institutions, it seems perature. publicly-supported not 1 cent, and 5. Mensuration has been and of health, especially dispensaries hospitals ought defective, per most accurate to with and to utilize the of the have be measure, supplied physicians accurately, by compared and the of tuberculosis, the movements of the two sides of the chest. means for early diagnosis test. the tuberculin 6. 5 cent, them Not of several thousand examinations among per others known of have had by stethoseopic percussion valuable means we the most have for OPHTHALMIA NEONATORUM. tried, detecting or and areas of excavation. Another outlining softening BY DUDLEY S. REYNOLDS, A.M., M.D. method as often is auscultation nearly neglected during in Professor of Ophthalmology, Otology and Medical Jurisprudence, a a in the of of the valuable method the College Medicine, Medical Department very Hospital cough, determining of Kentucky; Surgeon to the Eye and Central University commencement of softening. of the Louisville City Hospital; Ear Department In not than 1 cent, 7. more of examina- the Street per Gray Infirmary, etc. probably have manometer been KY. tions the and LOUISVILLE, spirometer used, instruments so needful to and throw on is to confirm neonatorum a disease assumed occur light Ophthalmia a correct on an incorrect or and doubt false coincident with birth. it means diagnosis, Clinically, always one. inflammation of the some form of conjunctiva. purulent 8. in Six-sevenths of the use are denominated It has been as catarrhal, muco- stethoscopes quite variously in deficient and the fact It as and a sound-transmitting qualities, blenorrheal, purulent, gonorrheal. appears and are that so or inflammation the many catarrhal of phonendoscopes auscultoscopes suppurative conjunc- in bears of sold itself the more or less the lids. attended with of proof diagnostic "inprofi- tiva, swelling of the American to the average It makes its from ciency" physician. appearance, according Swanzy, 9. The so-called "stomach second to the fifth after birth. fixes the time coughs," "typhoid pneu- day Noyes "bronchial catarrhs" and "chronic bronchitis" be as late monias," "at about the third but as day, may delayed are too far often as the of conditions it on the the third given explanation eighth day." Nettleship says appears tuberculous from the it a on after birth. Fuchs as the evidently beginning. rule, day says appears, The has been micro- is writers on second or third It all the expectoration previously day. agreed by in 10 cent, studied less than of the cases per that the disease occurs between the scopically subject uniformly in too seen the last ten and when years, often, examined, after second and birth. eighth day a to at be the has negative result, stage, expected given at Read before the Tri-State Medical Chattanooga, Tenn., Society, into harmful lured the and his inac- physician patient Oct. 25,1899. Downloaded From: http://jama.jamanetwork.com/ by a University of California - San Diego User on 06/06/2015

Journal

JAMA: The Journal of the American Medical AssociationUnpaywall

Published: Jan 6, 1900

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