John Ritter, M.D.
JAMA. 1928;90(20):1648-1649. doi:10.1001/jama.1928.02690470054029.
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To the Editor:  —A clinical note on this subject in The Journal, April 21, concerns a 3 year old child, who became suddenly ill and after ten months developed meningitis and died. A diagnosis of miliary tuberculosis was made. The most striking feature is the frequent negative Pirquet tests. These tests were from the beginning positive signs of a disseminated tuberculosis. Even a tuberculin test made some months before the sudden onset would in all probability have been negative. The infant from the onset was tuberculotoxic and in that state it is impossible for the body, with added tuberculin, to produce an allergic reaction, and the negative reaction pointed definitely to an active tuberculous condition.In the tuberculously infected, in the patient suffering from localized disease and in pulmonary tuberculosis, not too progressive or too far advanced, the tuberculin test is always positive and the test remains positive only as


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