ALLERGIC REACTIONS 337 



justifiable. Eppenstein accordingly recommends successive tests 

 with solutions of increasing strength, and the use of both eyes alter- 

 nately, beginning in adults with a 1 per cent, solution of the old 

 tuberculin, and then increasing to a 2 per cent, and finally to a 

 4 per cent, solution, while in children a \ per cent, solution is used 

 as the starting dose. 



The existence of any disease of the eye would, of course, constitute 

 a contra-indication to the method in question. 



As regards the clinical value of the Calmette reaction, as com- 

 pared with the cutaneous reaction of v. Pirquet, it appears from an 

 analysis of 2974 examinations collected by Petit that 94.3 per cent, 

 of clinically tubercular cases showed the reaction, while among non- 

 tubercular individuals only 18.4 per cent, reacted. The eye reac- 

 tion would thus seem to be more useful from the diagnostic stand- 

 point, and it is to be hoped that it may yet be improved to such a 

 degree that dangerous reactions may with certainty be avoided. 



As in the case of the v. Pirquet reaction, systemic and focal symp- 

 toms do not occur. 



The Tuberculin Test According to Moro (Dermo-reaction). Moro 

 has shown that a skin reaction may be obtained in tubercular indi- 

 viduals after inunction with a salve composed of equal parts of 

 the old tuberculin of Koch and of lanolin. To this end a small 

 amount of the salve (about the size of a pea) is for a minute rubbed 

 into an area of the skin measuring not more than 5 cm. in diameter. 

 The best district for this purpose is the skin just below the sternum 

 or in the vicinity of the nipple. After drying for about ten minutes 

 the patient may dress, no special covering being required. After 

 twenty-four to forty-eight hours a dermatitis then develops which 

 is characterized by the appearance of miliary nodules of variable 

 size and number, which occur either singly or confluent. At the 

 same time there is a more or less extensive general redness of the 

 affected area, accompanied by a certain amount of itching (see 

 Plate X). 



Regarding the clinical value of the method our knowledge is as 

 yet too meager to warrant its general recommendation. V. Pirquet 

 states that he has been able to obtain positive results only in highly 

 susceptible individuals, but suggests that it may be tried, if for 

 any reason the cutaneous or the eye reaction cannot be employed. 



22 



