ALLERGIC REACTIONS 293 



the tubercular subject, on the other hand, marked hyperemia occurs 

 after three to six hours, (more rarely after twelve to twenty-four 

 hours); this principally affects the lower lid, the lower portion of the 

 eyeball, the caruncle and the semilunar fold (see Plate VIII). At 

 the same time there is some swelling and secretion, which in severe 

 reactions becomes mucopurulent. 



The height of the reaction is reached after ten to twelve hours, 

 after whicluthe inflammatory manifestations usually disappear and 

 there is a return to the normal. 



While in most cases no unduly severe reactions occur, such have 

 nevertheless been noted in isolated cases, and a number of observers 

 look upon the method in its original form as dangerous and not 

 justifiable. Eppenstein accordingly recommends successive tests 

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

 alternately, 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 J per cent, solution 

 is used as the starting dose. 



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

 a contraindication 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 reaction 

 would thus seem to be more useful from the diagnostic standpoint, 

 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 

 symptoms do not occur. 



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

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

 uals 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 



