Report on Early Diagnosis of Tuberculosis
A. C. KLEBS, J. H. MUSSER, F. BILLINGS, J. C. WILSON, H. R. M. LANDIS
1905
Boston Medical and Surgical Journal
on the right side of the neck about in the middle of the sterno-mastoid muscle. On palpation there was a good-sized packet of soft lymph-nodes on both sides of the sterno-mastoid muscle. In addition there were numerous discrete lymph-nodes in the posterior and lower portion of the same side of the neck. The skin was normal and not adherent over the swelling and the lymph-nodes were movable. He complained of some pain when I palpated the neck or moved his head. The temperature was not elevated
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... this time; the tongue was somewhat coated. The tonsils were slightly enlarged and clean and the mucous membrane of the soft palate and pharynx was reddened. A culture from the throat showed a growth on blood serum of streptococcus, but I could not reconcile the absence of symptoms with a streptococcic infection capable of producing enlarged lymph-nodes. In addition, the enlargement was not at the angle of the jaw, but there was a distinct space between it and the enlarged packet of glands. Two or three days later the lymph-nodes enlarged on the leftside of the neck, but not to the same extent. The character and location of the swelling were similar on both sides. After about a week the swelling subsided rapidly to a certain point and then diminished slowly, so that some enlargement could be detected at the end of four weeks. During this time the child was quite pale and became fatigued rather easily, otherwise he seemed to feel as usual. About one week later I was called to one of my patients, a boy seven years old, with a similar swelling on one side of his neck. His temperature was 101°F. and he complained of tenderness in the neck when handled and of pain when he moved his head. Swallowing also caused some pain. These symptoms together with some maaise began on the day previous. The throat was slightly reddened. À culture on serum showed no pathogenic organisms. On the following day his fever had subsided and the tenderness was less marked. On the fourth day he was allowred to go out because he felt so much better. The swelling persisted for several days, but affected only one side. The mothers of two other patients of mine reported similar swellings in the neck, but the subjective symptoms were so slight that I was not asked to see them. Since then I have heard of several other cases in Boston and its vicinity. In two of these cases the disease was not of so mild a type as those which I have described. One of these children was confined to the house for two weeks and the fever persisted for several days. This brief description may be of assistance to those who are not familiar with the disease. REFERENCES.
doi:10.1056/nejm190506011522203
fatcat:lc5id4qsufc3thf5hismxej3ya