584 Tuberculosis. 



and reactions were brought out in different forms, but all are 

 based upon the hypersensitiveness of the cutaneous tissue of 

 tuberculous patients. In all of these methods the reactions 

 are due to the same underlying principles and the results are 

 Tather uniform especially in the fact that distinct positive 

 reactions have a considerably greater diagnostic value than 

 negative results. Cutaneous reactions differ from the con- 

 junctival reaction in that simultaneous subcutaneous injections 

 of tuberculin, or injections made a short time before, may pre- 

 vent the development of the former. 



The cutaneors reactions vary according to the method of application 

 of the tuberculin. In all cases, however, there is local inflammation 

 and serous infiltration of the tissues, the symptoms usually becoming 

 pronounced on the second or third day, and they may persist until 

 the fifth day. When the first test gives a doul)tful result it is advisable 

 to repeat it Avith equal or double doses of tuberculin. This frequently 

 brings out a decisive reaction. 



(a) Cutaneous Reaction. According to Vallee an area about the 

 ^ize of a silver dollar, on the shoulder or chest wall is shaved perfectly 

 smooth and the cutis scarified with a sharp scalpel (incisions may be 

 parallel or intersect each other) whereupon a 50% or concentrated 

 tuberculin is applied with a brush to the slightly bleeding surface. 



If the reaction is positive there will be a distinctly visible and 

 palpable infiltration of the border of the wound and an edematous 

 infiltration of the area surrounding the field of operation. This per- 

 sists from one to three days and may occasionally result in a separation 

 of the epidermis. In negative cases the borders of the wounds made 

 by the scalpel show only a slight swelling (mainly traumatic reaction) 

 which rapidly disappears. As a control or check it is advisable to 

 prepare a similar scarified area to be left untreated with tuberculin. 



Vallee, Moussu and Lignieres, as well as Pirqnet and Schnuerer obtained 

 results of definite diagnostic value with this method while Vanderheyden, Garth, 

 Kranich and Grunert as well as Eeinecke express themselves unfavorably in regard 

 to results obtained. Klimnier and Kiessig who applied this method on the udder 

 report 42.9% of failures in diagnosis. 



(b) Dermoreaction. Lignieres applies the tuberculin to the 

 cleansed, and shaved surface of the skin, without previous scarification. 

 In case of a positive reaction the area in question becomes reddened, 

 painful and edematous after about twenty-four hours. Occasionally 

 there are small pustules. 



According to Lignieres from 15 to 20%' of tuberculous cattle fail 

 to react to this test. Yallee succeeded in ol)taining a reaction in 13 

 out of 18 tuberculous animals while Klimmer and Kiessig record 31% 

 of negative results in known tuberculous cattle. 



(c) Intradermal (intracutaneous) Reaction. This consists of a 

 circumscribed edematous swelling of the skin following the injection 

 of 0.1 cc. of 50% tuberculin into the tissue of the cutis. According to 

 Moussu and Mantoux the folds of the skin between the base of the tail 

 and the anus, stretched tense by elevating the tail are best adapted for 

 this test. In positive reactions the fold which received the injection 

 of tuberculin swells up to the size of a hulled Avalnut or more in the 

 course of twenty-four hours and forms a sharp contrast with the 



