Toxic Products 679 



Recently there has been a return to the use of tuberculin for the 

 diagnosis of tuberculosis, it being claimed that by the use of minute 

 doses, several times repeated, the characteristic reaction and a 

 positive diagnosis can be obtained without danger. 



von Pirquet* found that if a drop or two of Koch's (old) tuberculin 

 is placed upon the skin of a tuberculous child, and a small scarifica- 

 tion made through the drop with a sterile lancet, a small papule 

 develops at the point of inoculation that is not unlike a vaccine 

 papule. It is at first bright, later on dark red, and remains for a 

 week. Out of 500 tests made, the results were positive in nearly 

 every case of clinical tuberculosis. The most characteristic 

 reactions were obtained in tuberculosis of the bones and glands, and 

 the method is recommended chiefly for the diagnosis of tuberculosis 

 during the first year of life. This method of testing is called the 

 "dermotuberculin reaction." 



A modification of this method by Lignieresf is called by him the 

 "cuiiluberculin reaction." Lignieres soaps and shaves the skin with a 

 safety razor, avoiding scarification, but removing the superficial 

 epidermal cells by scraping, and then applies 5 large drops of un- 

 diluted tuberculin, rubbing the reagent in with a pledget of cotton. 

 The reaction obtained is purely local and without fever. 



Moro % has improved upon von Pirquet's method by using the 

 tuberculin in the form of a 50 per cent, ointment made by mixing 

 equal parts of "old tubercuUn" and lanolin, which is rubbed into the 

 skin without previous scarification. 



Hiss§ says that "it is more simple and equally efficient to massage 

 into the skin a drop of undiluted 'old tuberculin.' " 



Calmettejl suggested the ' ophthalmo-tuberculin reaction" which 

 consists of instilling i drop of a solution of prepared tuberculin into 

 the eye of the suspect. If no tuberculosis exists, no reaction follows, 

 but if the patient be infected with tuberculosis, the eye becomes red- 

 dened in a few hours and soon shows all of the appearances of a more 

 or less pronounced acute mucopurulent inflammation of the con- 

 junctiva. This attains its maximum in six or seven hours, and en- 

 tirely recovers in three days. It usually causes the patient very 

 little discomfort, but a number of patients have been unfortunate 

 enough to suffer from supervening corneal ulceration and other de- 

 structive lesions of the eye, so that the test is now rarely used, 

 having been superseded by the dermal methods. 



The method of preparing the solution employed by Calmette 

 is to precipitate the tuberculin with alcohol, dry the precipi- 

 tate and dissolve it in 100 parts of distilled water. One or two 



* "Ibid., May 20, 1907. 



t " Centralbl. f . Bakt. u. Parasitenk.," orig., XLVI, Hft. 4, March 10, 1908, p. 

 373- 

 t "Munch, med. Wochenschrift," 1906, p. 216. 

 1 "Text-book of Bacteriology," 1901, p. 489. 

 ' "La Presse M^dicale," June 19, 1907. 



