TUBERCULIN DIAGNOSIS. 



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, indurated 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 fully develop until the third or fourth day 

 and then it begins to fade. Frequently a small pigmented spot remains. 

 General and focal reactions are practically absent. 



Moro's Ointment Reaction. 



Moro and Doganoff 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 na- 

 ture of Lichen Scrophulosorum. 

 Therefore, in accordance with the 

 number and size of these nodules 

 as well as the time of their appear- 

 ance, three grades of reaction are 

 described. 



In carrying out the reaction the 

 ointment is heated to 25 C. and a 

 quantity about the size of a pea is 

 thoroughly rubbed into the skin of 

 the abdomen or the region of the 

 mamilla, for almost a minute. The 

 diagnostic value of the reaction is 

 variously interpreted. 



An almost analogous reaction, 

 described independently of Moro, 

 by Lignieres and Berger is to be 

 found in thoroughly rubbing in con- 

 centrated old tuberculin into the 

 shaved skin of tuberculous cattle. 



FIG. 13. Inoculation with tuberculin for the 

 Pirquet reaction. 



Historical. 



The Ophthalmo Reaction. 



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

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

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



