TUBERCULOSIS OF THE EYE 351 



DIAGNOSIS AND TREATMENT WITH TUBERCULIN. 



Since Zimmermann, A. von Hippel, and Schiek showed the value 

 of the application of tuberculin in tuberculosis of the eye, its use, 

 which had been considered as ineffectual, has been increasing in 

 diagnosis and treatment. For the typical tubercles of the iris, 

 about which there is no doubt, the treatment is freely applied. It is 

 also gradually being more freely applied to those chronic affections of 

 the globe which, though they are not certainly known to be tubercular, 

 from their whole course appear to belong to that group which, from 

 clinical analogy (von Michel, Manz, etc.), and from Stock's experi- 

 ments, can well be tubercular. 



The following points should be noted in the diagnostic injection of 

 tuberculin : 



1. Is there any local reaction in the affected organ ? 



2. Does any characteristic general reaction occur ? 



Local reaction, recognizable by increased injection, pain, and an exudation, is 

 definite proof of the tubercular nature of the affection. Unfortunately, this is not 

 constant even in undoubted cases of tuberculosis. In many of nay own cases only 

 a transient injection occurred. After the injection a renewal of the precipitates, 

 with exacerbation of the iritic symptoms, may occur. This has been observed by 

 Michel, Haab, Manz, Uhthoff, Hess, and Stock. My own experience, which agrees 

 with numerous other authors, is that this is exceptional. 1 



The absence of a local reaction in the cases of tubercular iritis may be due to the 

 fact that the necessary conditions were not present, or were so to only a slight 

 extent. Wassermann and Bruck were able to prove that antituberculin is formed 

 in the tubercular eyes, and that its action on the tuberculin injected causes the 

 reaction. When there is no antituberculin present, according to their theory the 

 reaction would fail. By others the local reaction is attributed to the injected 

 tuberculin increasing the reaction of the tuberculin already present. Others, again, 

 hold that the tuberculous organs are especially susceptible to the action of the 

 tuberculin. 



When the reaction fails, it cannot be concluded that the process is non-tubercular. 



Under these circumstances the occurrence or the failure of the general reaction 

 can often be turned to account. The conclusion is, however, very uncertain, and 

 the following points crop up : 



1. Can a general tuberculin reaction always be expected from a tubercular lesion 

 in the eye '? Is the failure of a febrile reaction to be taken as meaning that there is 

 no tuberculosis in the eye '? 



No definite conclusion on this point can be formed at present, especially as the 



1 Of. the collected literature to 1905 inclusive, by G. Weiss, in the Zentralblatt f. 

 Grenzgebiete der Med. 11. Chir., 1906, p. 401. For the ophthalmological literature, see 

 Zinunemiann, Bull, du Congr. de la Soc. Fran<;. d'Ophth., 1898, p. 70; Schiek, A. f. 0.. 

 1900, 1. 2; also Groeuomv, II. Aufl., Graefe-Saemisch, 1904: Hess, 'Tuberculose des 

 Auges, ' Leipzig, 1904 ; A. von Hippel, A. f. 0., 1904, lix. 1 ; Gamble and Brown, Jour. 

 Amer. Med. Assoc. , October, 1905; Kayser, ' Sammelreferat, ' K. M. f. A.. 1905, i. 119; 

 also in Stock, 'Exper. u. Klin. Studien iiber die Tub. des Auges,' A. f. 0., 1907, xlvi. ; 

 also Enslin, Deutsche Med. Woch., 1903, Xos. 8 and 9. 



