DIAGNOSIS OF TUBERCULOSIS 447 



4. Technic of tuberculin reaction. 



(a) Subcutaneous test (Koch). 

 (6) Cutaneous test (von Pirquet). 



(c) Percutaneous test (Moro). 



(d) Detre test (human and bovine tuberculin to detect 



the type of infection). 



(e) Ophthalmo reaction (Calmette and Wolff-Eisner). 



5. Specificity of the tuberculin reaction. 



B. Serological. 



1. Opsonic index. 



2. Agglutination. 



3. Complement fixation. 



C. Bacteriological. 



1. Principle involved. 



(a) Microscopical. 



(6) Cultural. 



(c) Animal inoculation. 



2. Technic. 



A. Clinical Diagnosis. 1. Action of Tuberculin on Healthy Animals 

 and Man. In healthy laboratory animals, as guinea-pigs and rabbits, 

 as much as 1 c.c. of old tuberculin may be injected with no apparent 

 harm other than a somewhat transient rise in temperature. In normal 

 man even as small an amount as 0.01 c.c. of old tuberculin may cause 

 violent symptoms: chill, temperature, vomiting, malaise, and even 

 diarrhea. These effects, however, are usually transient. Man appears 

 to be far more sensitive to tuberculin than the guinea-pig. 



2. Action of Tuberculin on Tuberculous Animals and Man. In tuber- 

 culous animals very small amounts of tuberculin injected subcutan- 

 eously may cause marked symptoms; 0.2 to 0.5 c.c. will almost 

 invariably kill a guinea-pig which has been injected with tubercle 

 bacilli from four to five weeks before by the subcutaneous route. 

 Intracerebral inoculation of tuberculin will kill tuberculous guinea- 

 pigs in much smaller amounts. Postmortem there is intense conges- 

 tion around the tuberculous foci and ecchymotic hemorrhages in the 

 viscera. Twenty-five hundredths (0.25) of a cubic centimeter of 

 old tuberculin would be extremely dangerous to inject into a tuber- 

 culous man. It would probably result fatally. 1 



3. The Principle Involved. The reaction obtained in tuberculous 

 man or animals by the injection of tuberculin or other products of 



1 Deist, Beitr. z. Klinik d. Tuberkulose, 1912, xxii, 547, has observed albumoses in the 

 urine of tuberculous patients following the injection of tuberculin. 



