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Tuberculosis is an infectious disease that primarily involves the lungs. This simple test can show if you may have been exposed to tuberculosis. The test consists of injecting a small amount of fluid under the skin on your forearm and is harmless to your body. This fluid contains a protein derived from the organism of tuberculosis. It is rare that you would have an allergic reaction to this fluid. |
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The test result must be examined by a Health Center clinician within 48 to 72 hours and the results are determined by a visual inspection of your forearm. It will be necessary to repeat the test if you are not examined within this 72-hour period. Redness, which may occur at the test site, does not indicate a positive test. If swelling (also called an induration) is present, this area is measured. A nurse will determine if this measurement indicates a positive or negative test. |
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A positive skin test does not mean that you have tuberculosis; rather, that you may have been exposed to the organisms at some time in the past. In this case, a chest x-ray must be obtained in order to be certain there is no active disease. Additionally, if the reaction is positive, we will want to review your history and talk to you about what you should do in the future. |
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Tuberculosis testing is performed in the Preventive Medicine Clinic on Monday, Tuesday, Wednesday, and Friday during the hours 1:00 to 2:30 p.m. or by appointment (3332702). No tuberculosis testing is performed on Thursday or on weekends. |
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Information given to students by the health center at the University of Illinois. |
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| Source: http://www.uiuc.edu/departments/mckinley/health-info/dis-cond/tb/TB.htmlbiography, and institutions transmogrify the pure progress of natural science and myth.Freeze Frames: Snapshots of a Disease in ProgressThroughout the history of tuberculosis classification, one of the key problems has been how to convert a progressive, protean disease to a single mark on a sheet of paper. Many categories have been experimented with. One suggested hallmark was whether or not one tested positive to the tuberculin test. But it was decided that those who tested positive did not have the disease, they were: ''considered to have tuberculous infection but not disease'' (Diagnosis 1955, 25). Only thosePage 177who could bring other evidence of disease to the table would be considered worthy of the classification of pulmonary or nonpulmonary tuberculosis. This other evidence, examined below, is inextricably intertwined with classification and standardization.Those who did have the disease could be lumped into the categories inactive, active, or activity undetermined. If a "provisional estimate of the probable clinical status is necessary for public health purposes, however, the terms 'probably active' or 'probably inactive' should be used. Every effort should be made to classify cases and to avoid this category" (Diagnostic Standards 1955, 28). By 1961, it was agreed that a classification somewhere between active and inactive was needed: this would be the "open negative syndrome" and would, as we have just seen, have the word "quiescent" attached to it. "Inactive" would be redefined to include "constant and definite healing." Ironically, and to underscore the attempt to separate disease from biography, "dead" was also recognized in this classification (41), presumably to stand as a cross between highly active and completely inactive! A supplement to the ICD was developed to serve epidemiological purposes, one that assigned a fourth code number to the given three for any disease. Tuberculosis classifiers took the chance to add categories for "cured or arrested pulmonary tuberculosis" (Y03.0) and tuberculin sensitivity without clinical or roentgenographic symptoms (Y01).Leaking out of the freeze frame, comes the insertion of biography, negotiation, and struggles with a shifting infrastructure of classification and treatment. Turning now to other presentations and classifications of tuberculosis by a novelist and a sociologist, we will see the complex dialectic of irrevocably local biography and of standard classification.Moving Through Tuberculosis and Its ClassificationThe next sections rely on detailed readings of two classic studies of tuberculosis sanatoria and hospitals. The first is Thomas Mann's The Magic Mountain (1929) chronicling a Swiss hospital and the seven-year sojourn of a young German engineer there, Hans Castorp. The account was based on Mann's experience as a visitor to a similar institution, when his wife was incarcerated for lung disease. The second is Julius Roth's (1963) Timetables, a comparative ethnographic analysis of several American tuberculosis hospitals in the late 1950s. This volume, too, has a strong experiential base in Roth's own hospitalization as aPage 178tuberculosis patient while he was collecting data for his doctoral dissertation.The Texture of Time: Lost to the WorldWhen Hans Castorp, the hero of Mann's novel, arrives in the Alps as a visitor to his tubercular cousin, one of his first lessons in local culture is the way that values about time change for those "up here." Everything normal appears to change for him, and the whole place seems macabre and oddly humorous. Later in the novel he will explain to another newcomer, "I have no contact with the flatland, it has fallen away. We have a folk-song that says: 'I am lost to the world'so it is with me" (Mann 1929, 614). This lost-ness first takes on the form of time passing very slowly, but in chunks that appear unimaginable to the newcomer. An old-timer says: "We up here are not acquainted with such a unit of time as the weekif I may be permitted to instruct you, my dear sir. Our smallest unit is the month. We reckon in the grand stylethat is a privilege we shadows have" (Mann 1929, 59).Roth compares the commitment to a tuberculosis sanatorium with having an "indeterminate sentence" for one's years in jail. One does not know how long one will be incarcerated. There are no milestones or turning points that make sense. Time thus also seems endless and distorted with respect to known landscapes, both inner and outer. "Where uniformity rules; and where motion is no more motion, time is no longer time" (Mann 1929, 566).The patients in both Mann's and Roth's hospitals begin to speculate on the meaning of this lost time, this time out. Is time real, objective, something that can be measured externallyor subjective, illusory? Hans originally opts for a relativist explanation: "After all, time isn't 'actual.' When it seems long to you, then it is long; when it seems short, why, then it is short. But how long, or how short, it actually is, that nobody knows" (Mann 1929, 66). His cousin Joachim, a rather hard-nosed soldier who wants only to get off of the mountain and back to his regiment, disagrees. Joachim says "We have watches and calendars for the purpose; and when a month is up, why then up it is, for you, and for me, and for all of us" (Mann 1929, 66). Hans proceeds to demonstrate how slowly seven minutes can go by while taking one's temperature. We indeed feel the seconds creep by in Mann's precise language. What is "the same?" he asks. "The schoolmen of the Middle Ages would have it that time is an illusion; that its flow in sequencePage 179and causality is only the result of a sensory device, and their real existence of things in an abiding present" (Mann 1929, 566).As time goes on, up on the magic mountain, and in each of the hospitals studied by Roth, people inside begin to develop a sense of how to fragment, break up this unbroken monolith. "We are aware that the intercalation of periods of change and novelty is the only means by which we can refresh our sense of time, strengthen, retard, and rejuvenate it, and therewith renew our perception of life itself" (Mann 1929, 107). In one of his many meditations on the nature of time, Mann argues that time and action and space are not separablenothing fills up time in a platonic-container sense, but these facets are only knowable with respect to each other:What is time? A mystery, a figmentand all powerful. It conditions the exterior world, it is motion married to and mingled with the existence of bodies in space and with the motion of these. Would there then be no time if there were no motion? No motion if no time? We fondly ask. Is time a function of space? Or space of time? Or are they identical? Echo answers. Time is functional, it can be referred to as action; we say a thing is 'brought about' by time. What sort of thing? Change? (Mann 1929, 356)At the core of this theory of action is the development of what Roth calls timetables, which are alluded to in more symbolic terms by Mann. Timetables are breaks in space-time that give meaning to action. When will I get out? What will become of me? How will I survive the boredom and the uncertainty of incarceration? Such questions are asked against the specter of unbroken time or eternity, or as Roth's patients and doctors put it for the hopeless cases, "a rather horrifying tubercular Siberiaa seemingly endless waster (of time) without any signposts along the way" (Roth 1963, 21). Or in Mann's words, "Only in time was there progress; in eternity there was none, nor any politics or eloquence either" (Mann 1929, 479).Gradually a sense that there is in fact no such thing as unbroken time comes about for the patients: "Can one tellthat is to say, narratetime, time itself, as such, for its own sake? That would surely be an absurd undertaking. A story which read: 'time passed, it ran on, the time flowed onward' and so forthno one in his senses could consider that a narrative. . . . For narration resembles music in this, that it fills up the time. It 'fills it in' and 'breaks it up,' so that 'there's something to it,' 'something going on'" (Mann 1929, 560). The patients begin to fill their days with measurement. On the magic mountain, people walk around with thermometers in their mouths, measuringPage 180their temperatures several times a day. In both books, patients are conversant with the details of diagnosis and measurement, the myriad of ways in which the monolithic diagnosis may be broken up and measured. Roth says, "Everyone is frantically trying to find out how long he is in for. The new patient questions the doctors, nurses, and other hospital personnel in an effort to discover how may years, months, and days it will take him to be cured" (1963, xvi).MetrologyOne woman has been a patient on the magic mountain for the better part of her life. Eventually she is cured of the disease, but knowing no other life, panics at the thought of leaving.
25 She sabotages her release: runs out in the snow, jumps in the lake, and sticks her thermometer into her tea to make herself appear feverish. When discovered, she is given a thermometer without any marks on it, which can only be read by a doctor with a measuring stick, thus she cannot calibrate her faking. The patients come to call this device the "silent sister."26 The silent sister becomes the symbol for the ways in which the world of the asylum acquires its own bizarre culture of metrification.Roth notes that patients are quite systematic in creating measurements for the blocks of time they will spend in the asylum. They begin to construct timetables for themselves (I will get out in six months; I will have surgery in two weeks, and so forth). "After they have been in the hospital for some time, they find that 'mild' and 'bad' are not very meaningful categories." Much more detailed matching categories develop (Roth 1963, 19).Patients begin observing how other patients are treated. There is a complex edifice of privileges in tuberculosis hospitals based ostensibly on how well the person is perceived to be. If one is making good progress, for example, one is allowed out on brief shopping trips, and so forth. "He divides the patient group into categories, according to his predictions about the course of their treatment. He can then attach himself to one of these categories and thus have a more precise notion of what is likely to happen to him than he could from simply following the more general norms" (Roth 1963, 1617).Roth goes on to describe an elaborate system of observations and comparisons made by all the patients about their own bodies, the length of time served, the predilections of the individual doctors, and the technical diagnostic material such as x-rays. Not surprisingly, muchPage 181of the information available is partial or misleading. Reference points may be more or less clear-cut and stable. If they are prescribed in detail and rigidly adhered to, as they tend to be in the career of pupils in a school system (at least ideally), one's movement through the timetable is fairly predictable. As the reference points become less rigid and less clear-cut, they must be discovered and interpreted through observation and through interaction with others of one's career group. The more unclear the reference points, the harder it is for members of a career group to know where they stand in relation to others and the more likely it is that they will attend to inappropriate clues and thus make grossly inaccurate predictions concerning future progress. The degree of stability is related in part to historical changes in institutional timetables through time (Roth 1963, 99100).Managing this instability increases the intensity of comparison and a sense, often, of bewilderment, unfairness, or even madness. Hans Castorp says to his cousin, "I cannot comprehend why, with a harmless feverassuming for the moment, that there is such a thingone must keep one's bed, while with one that is not harmless you needn't. And secondly, I tell you the fever has not made me hotter than I was before. My position is that 99.6° is 99.6°. If you can run about with it, so can I" (Mann 1929, 176). "Give me a standard, give me something to hold on to, something clear"; in the face of uncertainty, patients become positivists. Mann describes the rebellion of Hans' cousin again the system of metrification in the hospital, the "Gaffky score" which is a composite score for each patient's progress based on a number of measures:Yes, the good, the patient, the upright Joachim, so affected to discipline and the service, had been attacked by fits of rebellion, he even questioned the authority of the "Gaffky scale": the method employed in the laboratorythe lab, as one called itto ascertain the degree of a patient's infection. Whether only a few isolated bacilli, or a whole host of them, were found in the sputum analyzed, determined his "Gaffky number," upon which everything depended. It infallibly reflected the chances of recovery with which the patient had to reckon; the number of months or years he must still remain could with ease be deduced from it. . . . Joachim, then inveighed against the Gaffky scale, openly giving notice that he questioned its authorityor perhaps not quite openly. . . . (Mann 1929, 357)This questioning of authority appears inevitable in a landscape so filled with uncertainty. One character attempts a triage reminiscent of recent attempts on the part of American hospital administrators to quantify health care costs and tradeoff. "Even in the matter of the operationPage 182he took a business view, for, so long as he lived, that would be his angle of approach. The expense, he whispered, was fixed at a thousand francs, including the anesthesia of the spinal cord; practically the whole thoracic cavity was involved, six or eight ribs, and the question was whether it would pay. . . . he was not at all clear that he would not do better just to die in peace, with his ribs intact" (Mann 1929, 315).In the absence of metrics, however, the relationships between doctors and patients come under considerable strain. Patients strive to assign themselves to the proper categories, and then to see whether the doctors agree with them. In The Magic Mountain, Settembrini, a slightly satanic character, whispers constantly to Hans about how subjective the reading of the objective measures such as X-rays really is. "You know too that those spots and shadows there are very largely of physiological origin. I have seen a hundred such pictures, looking very like this of yours; the decision as to whether they offered definite proof or not was left more or less to the discretion of the person looking at them" (Mann 1929, 250).Both physicians and patients struggle to find a standard and to localize it, in the face of a constantly shifting interpretive frame:The physician finds it difficult to carry out the medical ideal of an individual prescription for each case when at the same time he recognizes the fact that his timing of a given treatment event for a given patient is to a large extent a highly uncertain judgment on his part. If you are going to guess, you might as well make the process more efficient by guessing about the same way each time, especially if you are in a situation where your clients are likely to think that you do not know what you are doing if you change your guess from one time to another. (Roth 1963, 24)This uncertainty leads to the struggles and negotiations that are at the heart of Roth's analysis. Whose timetable will prevail?Classification Struggles"The TB patient conceives of his treatment largely in terms of putting in time rather than in terms of the changes that occur in his lungs" (Roth 1963, xv).The length of time one has been inside, combined with patients' observations about where they belong in the general scheme of things, acquires a moral character:A classification system contains within it a series of restrictions and privileges. When no rigid classification system exists, these privileges themselves becomePage 183part of the timetable. . . . How long is it before he is allowed two hours a day 'up time' [out of bed]? . . . these privileges are desired not only in themselves, but for their symbolic value. They are signs that the treatment is progressing, that the patient is getting closer to discharge. (Roth 1963, 4)Timetable norms differ from hospital to hospital and from patient to patient. Trust, often in the form of moral condemnation or approval, may play a big part in structuring the timetable negotiations between doctor and patient. For example, alcoholic patients are often refused outside passes, or sometimes a patient with a recalcitrant attitude is refused a pass simply to convince him or her that they are very ill. These moralizing attitudes, well documented within medical sociology, add another texture to the landscape we are examining here, twisting it a little away from a simple formal-situated or realist-relativist axis.Doctors as well as patients may hold the deserving attitude toward those who have "served their time." Roth notes that in treatment conferences, how long the patient has been in is always taken into account in deciding the timetable, "this in itself is given considerable weight entirely aside from the bacteriological and x-ray data" (1963, 27). Even those who appear to be getting better much faster, according to these tests, are kept in longer because "TB just isn't cured that fast" (1963, 27).Patients know almost to the day when which privileges will arrive. "This relative precision of the timetable results from the emphasis placed upon the classification system by the staff, the consistency in the decisions of the physician in charge, and the physician's explicitness in telling the patients what they can expect in the future" (Roth 1963, 7).There can be a failure to be promoted in severe cases, and the reaction to this differs among patients. "The subjective reaction to failure varies greatly among TB patients, just as among engineers some of the failures are emotionally disorganized when they do not make the grade while others accept their inferior position with relative equanimity. Some patients regard a few days' delay as a tragedy" (Roth 1963, 15). Bargains are made. "Patients are sometimes given regular and frequent passes to induce them to remain in the hospital" (Roth 1963, 53).Uncertainty plays an important role in negotiations about classification in the hospital. When a patient tries to estimate what classification he or she belongs to, and the physician disagrees, "In effect, the physician tries to get Jones to change his criteria for grouping patientsPage 184so that his categories will be closer to those of the physician" (Roth 1963, 39). The doctor will provide the patient with examples of others like him or her and relates details about other similar cases. But the physician too is caught in a double bind: ethically he or she is not allowed to give too many details about others' cases. The doctor is thus ultimately reduced to vague generalizations like "no two cases are alike" (Roth 1963, 39). For the patient, this contributes to a house-of-mirrors effect:Most physicians . . . vary their approach from one patient to another according to their own judgment of what the patient can take. These judgments, which are usually based on extremely limited information about the patient, are often wrong. . . . the physicians do not know with any precision how long it will take the patient to reach a given level of control over his disease. To allow themselves a freer hand in deciding what the best time is for the patient to leave the hospital, the doctors try to avoid being pinned down to any precise estimates by the patients. (Roth 1963, 45).The twisting effect of these silences is especially clear where the norms about timetables are also shifting, either due to changes in medical practice, technology, staff, or organizational change. One patient in these circumstances said, "You never seem to get anywhere because people here don't pay too much attention to the classifications. I've been here now since November and I'm still in Group 1. My husband comes to visit me and looks at this tag and thinks I'm never going to get promoted. He wonders what's going on. Then when you do get promoted to Group 2, you don't know what it means, anyway. You have no idea what additional privileges you have. . . . It's like an ungraded school room" (Roth 1963, 10).The ungraded schoolroom, combined with uncertainties, shifts in bureaucracy, and changes in the person's biography, begin to form the substance of a kind of monstrous existence.Borderlands and Monsters: Time's Torquing of Standards and Experience"There were those who wanted to make him 'healthy,' to make him 'go back to nature,' when, the truth was, he had never been 'natural'" (Mann 1929, 482).On the magic mountain, or in any of the hospitals analyzed by Roth, the sense of unreality, of being outside of normal time, and of making up an idiosyncratic timing is very strong. Furthermore, the very insidesPage 185 |
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The Romance of Tuberculosis |
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Greta Garbo as Camille drifts across the screen in a cloud of white organza.27 She is alternately cruel and flirtatious, vulnerable and powerful. She plays with the affections of her lovers, a baron and a struggling young diplomat, from her position as a farm girl who came to Paris. Early in the movie, we understand that she has been ill; from time to time she discreetly covers her mouth with a handkerchief, or seems to swoon (always artistically). At times she recovers, and in a rhythm complexly played out against her wardrobe, she moves from white to black in dress, from sick to well, from powerful to powerless, from country to city. As the movie progresses she becomes more and more ill, and more and more purethinner, whiter, more in love with the worthy poor man and less with the nefarious rich Baron. During the whole course of the movie, no one speaks the name of her illness, any prognosis or diagnosis, nor do we see any blood, sputum, feces, or other despoiling of the purified background. Of course, she has tuberculosisand she is the ideal type, the shadow puppet against which both the medical story and the rich cultural criticisms of tuberculosis have been played out. |
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and outsides of people become mixed up in an almost monstrous way; Hans carries around his love Clavdia's x-ray in his breast pocket so that he may really know her. External time drops away as does one's biography: |
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(The inhabitants) accorded to the anniversary of arrival no other attention than that of a profound silence. . . . They set store by a proper articulation of the time, they gave heed to the calendar, observed the turning-points of the year, its recurrent limits. But to measure one's own private time, that time which for the individual in these parts was so closely bound up with spacethat was held to be an occupation only fit for new arrivals and short-termers. The settled citizens preferred the unmeasured, the eternal, the day that was for ever the same. (Mann 1929, 427) |
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This sense of time begins to blur important distinctions between life and death, time and space. "But is not this affirmation of the eternal and the infinite the logical-mathematical destruction of every and any limit in time or space, and the reduction of them, more or less, to zero? Is it possible, in eternity, to conceive of a sequences of events, or in the infinite of a succession of space-occupying bodies?" (Mann 1929, 356). As we approach the zero point in the story, Mann notes in an afterword that time-space relations are shifted so that "the story practices a hermetical magic, a temporal distortion of perspective reminding one |
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