﻿348 MARSHALL. 



remain sessile for a longer or shorter time, especially in human beings, 

 it results that if a tuberculous patient receives an inoculation of tuber- 

 culin, nearly all of the substance becomes attached in the diseased focus, 

 the tuberculin being concentrated from the plasma by the fixed anti- 

 tuberculin, instead of being allowed to diffuse itself throughout the body 

 fluids. The result of this concentration is that even a minute trace of 

 tuberculin will produce the well-known tuberculin reaction. 



A person inoculated with tuberculin will produce anti-tuberculin 

 and eventually set it free, and possibly patients having had localized 

 tuberculosis for a long time may also liberate anti-tuberculin into the 

 circulation, although thirteen cases were negative. This circulating anti- 

 tuberculin prevents the action of a subsequently inoculated dose of 

 tuberculin. This fact accounts for the uncertainty of the tuberculin 

 reaction in the more chronic cases of tuberculosis. 



The amount of circulating tuberculin varies in individuals and in 

 species. It was easiest to obtain an anti-tuberculin serum from cattle, 

 next from guinea pigs, and mo^t difficult to obtain it from human beings. 

 Wassermann and* Bruck claim that tuberculous cattle intended for 

 importation into Germany are previously inoculated with tuberculin so 

 that they will not react to the official tuberculin test. 



Bruck(6) was able to demonstrate the tuberculin in the circulation 

 five days after the onset of severe symptoms, during the course of acute 

 general miliary tuberculosis, and again on the eighth day. On the 

 twelfth the eircidating tuberculin had disappeared and the serum con- 

 tained anti-tuberculin, the patient's condition at the same time being 

 improved. Finally, shortly before death, the anti-tuberculin disappeared 

 and tuberculin was again demonstrable. 



Bruck found the deflection test equally satisfactory in the diagnosis 

 of pleural exudates, of the spinal fluid in meningococus infection, of 

 serum from typhoid fever patients, and in gonococcus infections (7). 

 He states that Bockenheimer and Lexer could diagnose streptococcus 

 sepsis and erysipelas by this method. A further study of meningococ- 

 cus infection and immunity was made along these lines by Kolle and 

 Wassermann (18). Miiller and Oppenheim(21) also applied this test 

 successfully in gonorrhoea! arthritis, Koch and Bruck in meningitis, and 

 Eitner(9) in diagnosing leprosy. 3 Finally, Wassermann, A. Neisser. 

 and Bruck (36) obtained a serum from monkeys immunized with syphi- 

 litic material and were able to obtain the specific deflection reaction with 

 fresh extracts from syphilitic tissue, whereas the reaction was absent 

 when fresh extracts of normal organs were employed. This result was 



'Salomon, Wien. med. Wchnsclx. (1907), 75, 121. found the method of no value 

 in the diagnosis of cancer. 



