THE TUBERCLE BACILLUS 607 



clinically by Sahli, 51 that of Klebs, 5 - and the tuberculin produced from 

 bovine tubercle bacilli by Speiigleiv 



Diagnostic Use of Tuberculin. Subculancous*Usc. The prepara- 

 tion usually employed for diagnostic purposes is Koch's "Old Tubercu- 

 lin" ( Alttuberculin) . This preparation is administered by hypodermic 

 injection 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 tuber- 

 culin into 9.9 c.c. of the 0.5 per cent carbolic solution. A cubic centi- 

 meter of this then contains 0.01 c.c. of tuberculin. One cubic centi- 

 meter of this solution added to 9 c.c. of 0.5 per cent carbolic acid gives a 

 solution in which each cubic centimeter contains 0.001 c.c., or 1 mm. of 

 tuberculin. 



The initial dosage in adults in Koch's 54 early work, and as used by 

 Beck 55 on a large number of patients, was 1 mgm. 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 mm. 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 

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

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

 ture there maybe nausea, a chill, rapid pulse, and general malaise. 

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

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

 there may be coughing and increased expectoration. The temper- 

 atures of persons subjected to the test should be taken regularly for 

 three or four days before tuberculin is used. 



Ophthalmo-tuberculin Reaction. Wolff-Eisner 56 and, soon after him, 

 Calmette, 57 proposed a method of using tuberculin for diagnostic 

 purposes by instillation into the conjunctival sac. In tuberculous 



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



tiKlebs, Cent. f. Bakt % 1896; Dent. med. Woch., 1907. 



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



M Koch, Deut. med. Woch., 1890. 



55 J5ecfr, Deut. med. Woch., 1899. 



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



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



