628 ANAPHYLAXIS IN RELATION TO INFECTION AND IMMUNITY 



making a tuberculin test may exhibit a fever for several days without 

 apparent cause. On the other hand, dishonest dealers may force cattle 

 to drink cold water or have given cold water irrigations just before the 

 temperature is taken, preventing the registration of a febrile reaction. 



Methods of Conducting the Tuberculin Test. The object of the 

 tuberculin test is to introduce sufficient tubercle protein to react with 

 the tubercle antibody, with the formation of the protein poison, which 

 shows its presence and effects by a general, a local, or a focal reaction or 

 by a combination of these. Various methods have been proposed, of 

 which the following are best known: 



1. The subcutaneous tuberculin test is the oldest test of its kind, having 

 been discovered by Koch 1 in 1891. It consists in the subcutaneous 

 injection of old tuberculin. A positive reaction manifests itself in a 

 constitutional disturbance, accompanied by fever, a local reaction at the 

 site of injection ("Stichreaction")? and frequently a focal reaction at the 

 site of tuberculous disease. 



2. The cutaneous tuberculin test of von Pirquet, 2 consisting in the 

 local application of old tuberculin to a superficial abrasion of the skin. 

 A positive reaction is indicated by redness, edema, and other inflamma- 

 tory phenomena. 



3. The conjunctival tuberculin test of Wolff-Eisner 3 and Calmette, 4 

 consisting in the local application to the conjunctiva of one eye of a drop 

 of 1 per cent, solution of old tuberculin or purified tuberculin. A positive 

 reaction is indicated by congestion and lacrimation. 



4. The percutaneous tuberculin test of Moro and Doganoff, 5 consisting 

 in the application of tuberculin ointment prepared by mixing equal parts 

 of old tuberculin and anhydrous lanolin and applying it to the skin over 

 the upper portion of the abdomen or about the nipple. A positive reac- 

 tion is indicated by an efflorescence of papules upon the anointed skin. 



5. The intracutaneous tuberculin test of Mendel 6 and Mantoux, 7 

 consisting in injecting into the superficial layers of the skin 0.05 c.c. of 

 diluted old tuberculin. A positive reaction is denoted by infiltration 

 and hyperemia about the site of injection, similar to the reaction to the 

 cutaneous test. 



Comparative Delicacy and Relation of the Various Tuberculin Tests. 

 In judging of the comparative delicacy of the various tuberculin 



iDeut. med. Wochenschr., 1891, xvii, 101. 



2 Berl. klin. Wochenschr., 1907. xliv, 699. 



3 Discussion, Berl. klin. Wochenschr., 1907, xliv, 70. 



4 Presse me'dicale, 1907, xv, 388. 5 Wien. klin. Wochenschr.. xx, 933. 



Med. Klin., 1908, iv, 402. 7 Munch, med. Wochenschr., 1908, No. 40. 



