484 THE TUBERCLE BACILLUS GROUP 
DIAGNOSIS OF TUBERCULOSIS. 
A. Clinical, by tuberculin reaction. 
1. Action of tuberculin on healthy animals and man, 
2. Action of tuberculin on tuberculous animals and man. 
3. Principle of tuberculin reaction. 
4. Technique of tuberculin reaction. 
(a) Subcutaneous test (Koch). 
[h] Cutaneous test (von Pirquet). 
(c) Percutaneous test (Moro). 
{d) Detre test (human and bovine tuberculin to detect the 
type of infection). 
{e) Ophthalmo reaction (Calmette and Wolff-Eisner). 
5. Specificity of the tuberculin reaction. 
B. Serological. 
1. Opsonic index. 
2. Agglutination. 
3. Complement-fixation. 
C. Bacteriological. 
1. Principle involved. 
(a) Microscopic. 
{h) Cultural. 
(c) Animal inoculation. 
2. Technic. 
A. Clinical Diagnosis. — 1 . Action of Tuberculin on Healthy Animals 
and Man. In healthy laboratory animals, as guinea-pigs and rabbits, 
as much as 1 cc. of old tuberculin may be injected with no apparent 
harm other than a somewhat transient rise in temperature. In normal 
man even as small an amount as 0.01 cc. of old tuberculin may cause 
violent symptoms: chill, temperature, vomiting, malaise, and even 
diarrhea. These effects, however, are usually transient. ]\Ian appears 
to be far more sensitive to tuberculin than the guinea-pig. Hamburger^ 
states that a tuberculosis-free individual fails to give a tuberculin 
reaction, irrespective of the size of the dose of tuberculin, and that the 
statement of Koch,'- who claims that a normal individual will react to 
250 mg. of tuberculin, is incorrect. In such cases, says Hamburger, the 
patient must have latent tuberculosis. ^ on Pirquet"* claims that the 
reaction is only elicited by antibodies; normal individuals and advanced 
cases fail to react. 
2. Action of Tuberculin on Tuberculous Animals and Man.^ — In tuber- 
culous animals very small amounts of tuberculin injected siibcu- 
taneously may cause marked symptoms; 0.2 to 0.5 cc. will almost 
invariably kill a guinea-pig which has been injected with tubercle 
1 Wien. klin. Wchnschr., 1908, 21, 1043. 
2 Deutsch. med. Wchnschr., 1890, 16, 1029. 
3 Wien. klin. Wchnschr., 1905, 18, 431. 
^ An excellent summary of the facts about the action of tuberculin will be found in 
Jour. Outdoor Life, by Allen Krause, 1920, 17, 170. 
