

AGGLUTINATION IMMUNE BODIES 337 



40). The method therefore is not available for the agglutination reaction 

 in tuberculosis. 



(iv) For the agglutination-reaction German authors prefer an emulsion of 

 tubercle bacilli ground up in a mortar. Von Behring uses an emulsion of 

 bacilli triturated in an agate mortar and afterwards desiccated. Koch 

 recommends the use of the powdered bodies of bacilli obtained in the pre- 

 paration of tuberculin TK, dried and emulsified in a 1 per cent, solution of 

 sodium chloride. In bacillary extracts, obtained by triturating tubercle 

 bacilli as described in the preparation of tuberculin TK, and freed from 

 bacilli by centrifugation, agglutinating serums produce agglutination in dilu- 

 tions of 1 in 10 to 1 in 50. This method is recommended by Koch and 

 Romberg. 



Kceppen uses an emulsion obtained by saponification which has the 

 advantage of keeping well and of being of such a degree of concentration 

 that, after agglutination, the fluid becomes quite clear. 



To prepare the emulsion described by Kceppen filter a glycerin-broth culture 

 through filter paper : wash the bacilli with normal saline solution and dry, in vacuo, 

 at the ordinary temperature. To 1 gram of dried bacilli add 3 c.c. of a warm aqueous 

 solution of potash (33 per cent.) : leave to stand for a few hours, then rub up the 

 mixture and place the emulsion in the warm incubator (37 C.) for several hours ; 

 finally heat in a water bath for 15 minutes at 100 C. The emulsion is now of a 

 thick consistency and is again heated, the water which evaporates being replaced 

 by alcohol drop by drop. Soaps are formed which are dissolved in 100 c.c. of warm 

 distilled water. For the purposes of the agglutination reaction 1*5 c.c. of the milky 

 emulsion is mixed with 50-100 c.c. of normal saline solution. 



(v) Wright and Douglas heat a glycerin-broth culture of the tubercle 

 bacillus to 60 C. for 1 hour, filter it through paper, grind it up in a mortar, 

 and emulsify in water containing 0*1 per cent, of sodium chloride and 0'5 

 per cent, carbolic acid. They then centrifuge the emulsion to remove any 

 bacterial masses which have not been resolved into their elements. This 

 liquid is only agglutinated by normal human serum in dilutions of 1 in 2 to 

 1 in 4 while tuberculous serums agglutinate it in dilutions of 1 in 10 to 1 in 50. 



6. Immune bodies (Sensibilisatrices). 



The presence of immune bodies is very inconstant in the serum of persons 

 suffering from tuberculosis. The method of complement fixation is, there- 

 fore, not applicable to the diagnosis of tuberculosis (Widal and Le Sourd, 

 Camus and Pagniez, Wassermann and others). 



SECTION IV. THE DETECTION OF THE TUBERCLE BACILLUS. 



The methods employed for detecting the tubercle bacillus vary in detail 

 according to the nature of the material to be examined but in every case 

 three methods of investigation are available. 



1. Microscopical examination. Fluids, tissues or other material suspected 

 to contain the bacillus must be stained by Ziehl's or Ehrlich's method. The 

 tubercle bacillus is the only organism which will resist the decolourization 

 used in these methods. As a matter of fact two other [parasitic human] 

 organisms might be mistaken for the tubercle bacillus, namely, the bacillus 

 of leprosy and the smegma bacillus. 1 



1 The bacillus of verruga can be left out of account. The disease has so far been very 

 little studied and is unknown in these climates. 



