THE TUBERCLE BACILLUS 493 



Other tuberculins are those of Beraneck, 1 highly recommended 

 clinically by Sahli, 2 that of Klebs, 3 and the tuberculin produced from 

 bovine tubercle bacilli by Spengler. 4 



Diagnostic Use of Tuberculin. Subcutaneous Use. The preparation 

 usually employed for diagnostic purposes is Koch's "Old Tuberculin" 

 (Alttuberculin). This preparation is administered by hypodermic injec- 

 tion of small quantities obtained by means of dilutions. The dilutions 

 are best made with a 0.5 per cent aqueous carbolic acid solution. In 

 practice a 1 per cent solution is made by pipetting 0.1 c.c. of tuberculin 

 into 9.9 c.c. of the 0.5 per cent carbolic solution. A cubic centimeter 

 of this then contains 0.01 c.c. of tuberculin. One c.c. of this solution 

 added to 9 c.c. of 0.5 per cent carbolic acid gives a solution in whieh 

 each cubic centimeter contains 0.001 c.c., or 1 milligram of tuberculin. 



The initial dosage in adults in Koch's 5 early work, and as used by 

 Beck 6 on a large number of patients, was 1 milligram. This, according 

 to present opinions, is too high, and most clinicians to-day prefer 0.1 

 to 0.2 of a milligram. If after three or four days no reaction has occurred, 

 a second dose of 1 milligram is given. 



The reaction itself is recognized chiefly by the changes in tem- 

 perature. In a positive reaction the patient's temperature will begin 

 to increase within six to eight hours after injection, rising sharply 

 within a few hours to 0.5 or 1.5 higher than the temperature before in- 

 jection. It then sinks more gradually than it rose, the reaction usually 

 being complete within thirty to thirty-six hours. With the temperature 

 there may be nausea, a chill, rapid pulse; and general malaise. Locally 

 visible tuberculous processes, such as lupus, lymph nodes, etc., may 

 become more tender or swollen, and if the tuberculosis is pulmonary, 

 there may be coughing and increased expectoration. The temperatures 

 of persons subjected to the test should be taken regularly for three or 

 four days before tuberculin is used. 



Ophthalmo-Tuberculin Reaction. "Wolff-Eisner 7 and, soon after 

 him, Calmette, 8 proposed a method of using tuberculin for diagnostic 



1 Beraneck, Compt. rend, de Tacad. des sci., 1903. 



2 Sahli, Corrbl. d. Schw. Aerzte, 1906. 



3 Klebs, Cent. f. Bakt., 1896; Deut. med. Woch., 1907. 



4 Spengler, Deut. med. Woch., xxxi, 1904; xxxi and xxxiv, 1905. 

 6 Koch, Deut. med. Woch., 1890. 



6 Beck, Deut. med. Woch., 1899. 



. . * Wolff-Eisner, Berl. med. Gesell., May 15, 1907. 

 8 Calmette, Acad. des sci., June 17, 1907. 



