212 REVIEW — TROPICAL MEDICINE, ETC. 



Tuberculosis It is essential in employing tliis tost that the eye to be tested should be healthy and 



—contiwied free from abrasion. A 1 per cent, solution in sterile distilled water of a dried precipitate 

 prepared by the addition of 95 per cent, alcohol to tuberculin is employed, but in some cases 

 this was found to produce too violent a reaction, and now a 0-5 per cent, solution is in general 

 use. If the patient be tuberculous, a reaction takes place which may begin in three to twenty 

 hours after the application of the test. The ma.Kimum reaction may be reached in from 

 eight to sixteen hours, the duration of the reaction may be from two to ten days. The 

 inflammation may vary from a mild lachrymation with conjunctivitis and an almost 

 imperceptible enlargement of the caruncle to a severe purulent conjunctivitis which may 

 last for several days. There is, as a rule, no rise of temperature and no general malaise. 

 Fortunately, no case has as yet been recorded in which the eye has been permanently 

 damaged. The several reports show that the reaction bears no relation to the degree of 

 activity of the tuberculous lesion nor to the extent of the lesion. 



From the various results recorded, as regards the Calmette Ophthalmo-reaction, it 

 cannot be regarded as an infallible index of the presence or absence of tubercle, although 

 it must be considered as a valuable aid to diagnosis. Cases have been recorded in which a 

 severe reaction has been obtained in apparently healthy men, and the reaction has failed 

 in undoubtedly tuberculous individuals. In connection with this latter point, it is of 

 interest to note that persons with healed tuberculous lesions fail to give this reaction, so 

 that this test can, to a certain extent, be used as a criterion for determining when a 

 tuberculous lesion is cured. Eyre, Wedd and Hertz, i in 138 cases tested, obtained a positive 

 reaction in sixty-three cases and in the remainder no reaction occurred. The majority of 

 the positive results were undoubtedly tuberculous. Lecky has published further statistics 

 on the Tuberculin Ophthalmo-reaction, and his results show that in cases known to be 

 tuberculous, 94-3 per cent, gave positive reaction ; in cases probably tuberculous, 66-2 per 

 cent, gave positive results, and in cases considered to be healthy or non-tuberculous, 

 only 7-4 per cent, gave a positive reaction. These figures are of interest in showing, to a 

 certain extent, what reliability can be placed on Calmette's Ophthalmo-reaction as an aid in 

 the diagnosis of tubercle. 



Harrison Butler^ found this reaction of use in diagnosing whether tubercle was the 

 cause of cerebral compression in two of his cases. Continental observers have found that 

 the reaction cannot be obtained even in undoubtedly tuberculous cases during the last week 

 of life, and this view was confirmed by Eyre and his co-workers in a case of tuberculous 

 meningitis that died thirty hours after the test was applied. It only remains for time to 

 show what an important part the Calmette Ophthalmo-reaction will play in the social struggle 

 against tuberculosis. 



Calmette's test shows that newly-born children of tuberculous mothers do not give the 

 reaction, but in such children of 1 to 2 years of age, 3 per cent, give a positive result and the 

 percentage increases rapidly with age. These observations are in accordance with those of 

 Bang and Nocard, who state that tuberculosis in cattle is scarcely ever congenital. By repeat- 

 ing the test sufficiently often, Calmette suggests that the exact time at which tuberculosis 

 attacks a child may be ascertained. The part played by family contagion and by the milk of 

 tuberculous cows may be determined by studying the condition of the family and the food 

 supply. If the test be applied periodically to the members of a family in whom tuberculosis 

 is feared, the infection may be detected at an early period even before clinical signs develop 

 themselves, and the necessary precautions as regards isolation and treatment may be begun 

 at an early period of the disease. Further, Calmette's reaction would be of use in the 

 examination of pupils seeking admission to schools and who are suspected of being 

 tuberculous. In the Army and in the Navy the test could be put to a similar use. 



Slatineance^ made an interesting observation in connection with the appearance of the 

 Calmette eye reaction after a subcutaneous inoculation with tuberculin. He states that a 

 subcutaneous inoculation of tuberculin, after application of the Calmette test, produced a 

 new specific reaction on a level with the Calmette test. This reaction was produced as 

 well in the tuberculous as in healthy individuals. Its intensity was greater if the 

 interval between the two operations was a short one. In tuberculous cases he obtained a 



' Eyre, J. W., Wedd, B. H., Hertz, A. F. (December 21st, 1907), " The Tuberculin Ophthalmo-reaction 

 of Calmette." Lancet. 



■ Harrison Butler, T. (April 18th, 1908), " Calmette Ophthalmo-reaction." British Medical Journal. 



' Slatineance, A. (August 30th, 1907), " Le verial de I'ooulo-r^actiou de Calmette par I'injection souscutanee 

 de Tubcrculine." Bull, de Vliistitul Pasteur. 



