640 ANAPHYLAXIS IN RELATION TO INFECTION AND IMMUNITY 



curred is not great enough to warrant the abandonment of a procedure 

 that has proved itself of such great value in diagnosis. Nevertheless, 

 they emphasize the necessity for observing proper precautions, and 

 give the following rules to be adopted: 



1. The conjunctival test should never be repeated in the same eye. 



2. A solution stronger than 1 per cent, original tuberculin should 

 never be used for making the first instillation. 



3. Any existing inflammatory disease of the eye is an absolute con- 

 traindication to the test. 



4. The test should not be given to manifestly scrofulous children. 



5. Skin diseases in which the lesions are situated upon the face, near 

 the eye, especially when these are suspected of being tuberculous, pre- 

 clude the application of the test. 



6. It is safest not to give the test to elderly persons, and particularly 

 to arteriosclerotics, as they are unduly prone to develop corneal ul- 

 ceration. 



THE PERCUTANEOUS TUBERCULIN REACTION (MoRO) 

 Variety of Tuberculin Used. This consists of 5 c.c. of old tuberculin 

 and 5 grams of anhydrous lanolin thoroughly mixed. The ointment 

 retains its potency for many months when preserved in a cold dark 

 place. Manufacturers market the preparation in small collapsible 

 tubes containing sufficient for at least one or two tests. 



Method of Conducting the Test. A piece of ointment about the 

 size of a pea is thoroughly rubbed for at least a minute into an area of 

 skin about two inches in diameter over the upper abdomen or near a 

 nipple. The patient may be instructed how to apply this ointment, or 

 the physician may do it himself, protecting the finger with a rubber cot. 

 The Reaction. This may appear within twenty-four hours, or be 

 delayed for as long as from four to six days. It consists of an eruption 

 of slightly elevated papules situated upon a hyperemic base, which 

 vary in size from a pinhead to large areas of infiltration (Fig. 129). It 

 subsides in from three to ten days. Moro described these grades of 

 reaction as follows: 



1. Mild reactions: From 1 to 10 scattered papules. 



2. Moderate reactions: About 50 or more papules, partly discrete, 

 partly confluent, and with a general reddening of the skin. There may 

 be well-marked itching. 



3. Severe reactions: Numerous large, extremely red papules or 

 vesicles up to 8 mm. in diameter, having an intensely reddened base. 



