84 Diagnosis of Tuberculosis [March, 



The serum test was that described in detail before.^ The anti- 

 gen was that of Besredka.^ The total number of cases compared 

 was 200. The results are given in Table 2. 



It was previously shown by one of us^^ that, in cases of certain 

 tuberculosis, only 90-95 percent of the cases give positive serum 

 reactions. It was also shown that, in the advanced cases, the reac- 

 tion is usually absent, so that it was even suggested that a failure 

 of the serum test in an advanced case of tuberculosis may be taken 

 as a bad prognostic sign. 



Comparing the earlier findings with those of the present series, 

 we notice the same phenomenon, namely, in 8 out of 100 cases the 

 serum reaction is negative in spite of the fact that the cases are 

 undoubtedly tuberculous. The value attributed previously to these 

 negative findings seems to be justified by the present results, in 

 spite of the fact that the urinary findings appear to contradict the 

 serological, inasmuch as out of 92 cases of positive serum results 

 the urinary findings in 42 cases, at least, were negative by both 

 methods, and in only 40 cases, or less than 50 percent, the urinary 

 findings confirmed, by both methods, the serum findings. On the 

 other hand, out of 8 cases of tuberculosis in which serum findings 

 were negative, every case gave a positive Weiss test and 6 cases 

 also gave positive diazo tests. 



Remembering that the presence of neutral sulfur, according to 

 Weiss, is due to the destruction of tissue, and that the intensity and 

 frequency of the occurrence of the reaction run parallel with the 

 progress of the disease, the findings above may be of great value 

 in confirming the opinion, stated earlier, that cases of tuberculosis 

 in which there is no circulating antibody are cases in which there is 

 considerable destruction of tissues, as indicated by the excess of 

 sulfur in the urine. 



The finding of 11 positive serum reactions among the cases 

 which do not present any Symptoms of tuberculosis clinically, 

 should not be attributed, as was explained before,^^ to non-specificity 

 of serum diagnosis, but rather to the fact that in its earlier stages, 



8 Bronfenbrenner : Zeitschr. f. Immunitätsforsch., 1914, xxiii, p. 221. 

 ö Besredka and Manouschine: Compt. rend. soc. hiol., 1914, Ixxvi, p. 180. 

 10 Bronfenbrenner : Arch. of Intern. Med., 1914, xiv, p. 786. 



