50 TUBERCULIN DIAGNOSIS 



children would develop a distinct papule at this point, while in non-tuber- 

 culous conditions such a reaction would be absent. 



The Technique of the Cutaneous Reaction. 



"The patient's forearm on the inner side is cleansed with ether; two 

 drops of the pure undiluted old tuberculin are placed upon the skin about 

 10 cm. apart, and then the skin is scarified first between the two drops, for 

 the purposes of a control, and next within each of these drops. [A boring 

 scarifier, devised for this, works very easily.] 1 Finally a piece of cotton is 

 placed upon each of these drops and allowed to remain there for ten minutes 

 after which the cotton is removed. A dressing is not necessary." 



Interpretations of the Reaction. 



Scarification of itself produces the so-called "traumatic reaction" i.e., 

 a small wheel with a rose-colored margin appears around each of the three 

 points of scarification. This reaction passes away after several hours and 

 only a small scab remains surrounded by a red rim. 



This "traumatic reaction" is to be sharply differentiated from the 

 "specific reaction." The latter is noticed only upon the upper and lower 

 points where the tuberculin has been applied and consists of a red, indu- 

 rated papule which rapidly extends in size and elevation, measuring 10 to 30 

 mm. in diameter. (Fig. i, Plate I.) The papule may be round or have 

 irregular margins. Scrofulous children show small, irregularly raised 

 follicular infiltrations around the specific reaction. This is known as the 

 "scrofulous reaction" It may appear as early as within three hours, but 

 usually occurs within twenty-four hours. It arrives at its maximum 

 within forty-eight hours; occasionally it is delayed and may not develop 

 fully until the third or fourth day and then it begins to fade. Fre- 

 quently a small pigmented spot remains. General and focal reactions are 

 practically absent. 



Moro-Doganoffs Ointment Reaction. 



Moro and DoganofT found that a 50 per cent, ointment of tuberculin in 

 lanolin rubbed into the skin without scarification, would give a reaction 

 which consisted of small nodular or papular efflorescences after the nature 

 of Lichen Scrophulosorum. In accordance with the number and size of 

 these nodules as well as the time of their appearance, three grades of reaction 

 are described. 



In employing the ointment it should be heated to 25 C. and a 

 quantity about the size of a pea is thoroughly rubbed into the skin of the 



1 The flat end (2 mm. wide) of sterile wooden toothpicks can serve the same purpose. 



