Toxic Products 723 



Calmette* 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 having been superseded by the dermal methods.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 precipitate 

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

 may be used. Ordinary tuberculin must be avoided, as the glycerin 

 it contains causes too much irritation and masks the reaction. 



Priority in regard to the theoretic aspects of these reactions 

 seems to belong to Wolff-Eisner,t who was the first to point out 

 that the injection of all albuminous substances resulted in hyper- 

 sensitivity instead of immunity unless certain precautions were 

 observed. Upon this ground Levy J gives him credit as the founder of 

 the method. The reaction is undoubtedly an allergic phenomenon. 



Klebs§ made strong claims for his own modifications of tuber- 

 culin, known as antiphthisin and tuber culocidin, but according 

 to the experimental studies of Trudeau and Baldwin, antiphthisin 

 is only much diluted tuberculin, and exerts no demonstrable in- 

 fluence upon the tubercle bacillus in vitro, does not cure tuberculosis 

 in guinea-pigs, and probably inhibits the growth of the tubercle 

 bacillus upon culture-media to which it has been added only by its 

 acid reaction. 



The "bouillon-filtrate" (bouillon filtre), of Denys|| is a porcelain 

 filtrate of bouillon culture of the tubercle baciUus and corresponds 

 to Koch's original tuberculin before concentration, except in that 

 it has not been subjected to heat. 



Tuberculin-R. — TR or tuberculin-R appears to be an important 

 addition to the immunology of tuberculosis, made by Koch.** 



TR signifies " tuberkelbacillen resten" or bacillary fragments. 



Pursuing the idea of fragmenting the bacilli, or treating them chemically to 

 mcrease their solubility, Koch found that a 10 per cent, sodium hydrate solution 

 yielded an alkaline extract of the badllus, which, when injected into animals, 

 produced effects similar to those following the administration of tuberculin, 



* "La Presse Medicale," June 19, 1907. 

 t "Centralbl. f. Bakt. u. Parasitenk.," 1904, Orig., xxxvu. 

 X "Verein fiir innere Medizin zu Berlin," Dec. 16, 1907. 

 § "Die Behandlung der Tuberculose mit Tuberculocidin," 1892. 

 I "Acad, royale de med. de Belgique," Feb. 22, 1902; abst. " Centralbl. f. Bakt. 

 u. Parasitenk.," Ref., 1902, xxxi, p. 563. 

 ** "Deutsche med. Wochenschrift," 1897, No. 14. 



