722 Tuberculosis 



culosis where the destroyed tissue could be readily discharged from 

 the surface of the body. 



Many, however, continued to use it, and Petruschky* has reported, 

 with careful details, 22 cases of tuberculosis which he claims have 

 been cured by it. 



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 Pirquetf 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 re- 

 actions 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 " dermotubercuUn reaction," "cutaneous tuberculin reaction" or 

 "cutaneous test." 



Detre,! desiring to kill two birds with one stone, modified the von 

 Pirquet test by applying tuberculin made from cultures of human 

 bacilli to one arm of the patient, and tuberculin made from cultures 

 of bovine bacilli to the other. Accordingly as the reaction took 

 place upon one or the other arm he divined that the infection was 

 caused by the one or the other bacillus. The method has not 

 proved to be a satisfactory means of differentiation. 



A modification of this method by Ligmeres§ is called by him the 

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

 safety razor, avoiding scarification, but removing the superficial 

 epidermal cells by scraping, and then applies 6 large drops of un- 

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

 The reaction obtained is purely local and without fever. 



Moroll has modified the von Pirquet's method by using the 

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

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

 skin without previous scarification. This method is now known as 

 the percutaneous test. 



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

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



* "Berliner klin. Wochenschrift," 1899, Dec. 18-25. 



t "Ibid., May 20, 1907. ' ' 



i "Wiener klin. Wochenschrift, 1908," No. 41. 



f § " Centralbl. f Bakt. u. Parasitenk.," Orig., xlvi, Hft. 4, March 10, 1908, p. ;■ ;■ 



373- i- i- 



II "Miinch. med. Wochenschrift," r9o6, p. 216. 



** "Text-book of Bacteriology," 1901, p. 489. 55 



