52 TUBERCULIN DIAGNOSIS 



The Ophthalmo Reaction. 



At the discussion which followed v. Pirquet's presentation of his cuta- 

 Historical. neous reaction, Wolff-Eisner remarked, "that by instilling some 10 

 per cent, tuberculin into the conjunctival sac, a local conjunctivitis was 

 obtained and occasionally, also a general reaction. The marked severity of the reac- 

 tion, however, and its apparent lack of specificity, made its diagnostic value improb- 

 able." Calmette, who believed that Wolff-Eisner's failure in obtaining accurate 

 results lay in the fact that glycerin was contained in the old tuberculin employed by 

 him, obtained by alcohol precipitation a glycerin-free dry product, which he used in 

 a i per cent, solution equivalent to 10 per cent, old tuberculin. It was he, therefore, 

 who first established the clinical diagnostic value of the reaction. But his hypothesis 

 was erroneous, as the mild reactions which he obtained were not due to the absence of 

 glycerin, but because the Lille tuberculin is much weaker than the German prepara- 

 tion. The author was able to show that the old tuberculin could very well be used for 

 the Ophthalmo reaction if, instead of the 10 per cent., a i per cent, dilution was made. 

 Thus employed, the reaction is exceedingly mild and specific. Eppenstein later advised 

 a 2 and 4 per cent, dilution in cases where the i per cent, solution gave no reaction. 



Technique of Reaction. 



It is of extreme importance to have freshly prepared sterile dilutions of 

 the old tuberculin (Hochst Farbwerke). All the ready-for-use preparations 



on the market should be discarded. This 

 applies also to the "Tuberculin Test" 

 Calmette' s sold by Poulenc Freres. 



The mishaps and low grade of specifi- 

 city often ascribed in literature to the 

 ophthalmo reaction can in a great major- 

 ity of cases be explained by the employ- 

 ment of preparations other than the i to 

 2 per cent, fresh dilutions of the old 

 tuberculin advocated by the author, and 

 in still another number of cases to its em- 

 ployment in conditions where it was dis- 

 tinctly contraindicated. The prepara- 



FIG. 14. Ophthalmodiagnosticum for J F ^ 



tuberculosis. (After Citron.) tion of fresh tuberculin dilutions is very 



much simplified by the "Ophthalmodiag- 

 nosticum for Tuberculosis ," of the firm P. Altmann, Berlin N. W. 6 (Fig. 14). 

 This outfit consists of twelve sealed glass tubes each containing o.i 

 c.cm. old tuberculin, a cylinder for the dilution graduated in percentages, 

 and a pipette measuring o.i c.cm. fitted with a rubber bulb. One of 

 the sealed ampoules is shaken so that the tuberculin is collected into its 

 broader part and then broken at the designated point near the narrow end. 

 The tuberculin is drawn up to the mark into the pipette and then trans- 



