644 ANAPHYLAXIS IN RELATION TO INFECTION AND IMMUNITY 



associates and I, 1 normal and non-syphilitic persons taking iodids or 

 bromids at the time the skin test is made or while these drugs are still 

 in the body fluids may yield well-marked non-specific reactions which 

 the physician may readily interpret as a positive luetin reaction. 



After cleansing the skin with alcohol it is drawn taut or pinched up 

 between forefinger and thumb and the needle introduced, with the 

 aperture directed toward the outer surface of the skin. If the point 

 of the needle is in the skin, a white elevation occurs immediately upon 

 injecting the solution; if it is in the subcutaneous tissue, no filtration 

 is apparent. (See Figs. 68 and 69.) 



A special tuberculin syringe may be used, and the luetin drawn 

 directly into the barrel from the stock bottle and diluted with sterile 

 normal salt solution. To obviate waste and the likelihood of contamina- 

 tion, I dilute a portion of luetin (1 c.c.) with an equal amount of sterile 

 salt solution (1 c.c.) in a sterile vessel, and then add 6 c.c. more of sterile 

 salt solution, shaking thoroughly and placing 0.2 c.c. in each of 30 small 

 sterile ampules, which are then sealed. Before using, the ampule is 

 shaken thoroughly, opened, and the contents aspirated into the syringe; 

 0.1 c.c. is allowed for waste in loading the syringe and displacing air; 

 0.1 c.c. is injected, and this is practically equivalent to 0.035 c.c. of the 

 undiluted luetin, the dose recommended. When so prepared, the dilu- 

 tion keeps well, is especially adapted for dispensary use, and the phenol 

 is so diluted as to exclude any traumatic reaction. 



Reactions. Normal or Negative Reactions. In the majority of 

 normal persons the injection of luetin is followed by a very slight trau- 

 matic reaction, or a small erythematous area appears, after twenty-four 

 hours, at and around the point of injection. No pain or itching sensa- 

 tion is experienced; the reaction recedes in forty-eight hours and leaves 

 no induration. In certain individuals the reaction may reach a stage 

 of small papule formation after from twenty-four to forty-eight hours, 

 which subsides within seventy-two hours, leaving no induration. 



Positive reactions have been classified by Noguchi into three main 

 varieties : 



(a) Papular Form. "A large, raised, reddish, indurated papule, 

 usually five to ten millimeters in diameter, makes its appearance in 

 twenty-four to forty-eight hours. The papule may be surrounded 

 by a diffuse zone of redness and show marked telangiectasis. The 

 dimensions and the degree of induration slowly increase during the fol- 

 lowing three or four days, after which the inflammatory processes begin 

 to recede. The color of the papule gradually becomes dark bluish red. 

 1 Jour. Amer. Med. Assoc., 1916, Ixvii, 718; Jour. Lab. and Clin. Med., 1917, xi, 401. 



