The cutaneous and the ophthalmic reactions in the diagnosis of tuberculosis with notes on 100 cases

Abstract

Von Pirquet’s cutaneous reaction to tuberculin and Calmette’s ophthalmoreaction have of late been attracting a considerable degree of attention, and numerous articles have appeared in the various medical journals giving the experiences of different writers. I have collected a number of these articles and have noted the results and opinions of the various authors.By the kindness of Dr. Philip, whose resident physician I then was, I have been able to perform one or both tests on 100 of his patients in the Royal Infirmary, Edinburgh.For Von Pirquet’s cutaneous test I have used either Koch’s pure Old Tuberculin or the solution advised by Von Pirquet, viz:-Koch’s Old Tuberculin: 1 Part; Carbolic Glycerine (5%): 1 part; Solution of Sodium Chloride: (85%) 2 Parts.With either the procedure has been the same. First the skin was purified with Sulphuric Ether and then scarified just as for vaccination, drawing no blood if possible; then a small piece of cotton-wool, soaked in the solution, was laid on the scarification and left on for five minutes, after which it was removed and the part covered with dry cotton-wool.The upper arm was the part selected and at the end of twenty-four hours the cotton wool was removed and the scarified area examined. If a reaction was present there was redness of the area with more or less marked infiltration, best appreciated by gently running the finger over the part and so feeling for any slight raising as compared with the surrounding skin.For Calmette’s ophthalmic test, I have used Tuberculin prepared by the “Institut Pasteur” of Lille according to Calmette’s formula. It is issued in a liquid form (0*5%) or as a dry powder, to 5 milligrammes of which distilled water is added - 20 drops making the 0.5# solution and 10 drops the 1%. Calmette prepares his tuberculin solution by precipitating tuberculin with 95# alcohol and then dissolving the dry powder as above. The directions accompanying the tuberculin supplied are as follows: -"Let one or two drops fall on the conjunctiva of one eye of the patient to be tested, by preference towards the inner angle, and keep the eyelids apart for a moment. The person so treated will feel no pain or inconvenience. If he is a tuberculous subject no reaction will be produced.”“If he is afflicted with tuberculosis, no matter how slightly, the lower conjunctiva palpebrarum and the caruncula of the eye treated will commence to redden from the third hour. The injection of the vessels is slowly aocentuated and accompanied by epiphora. After six hours the caruncula begins to swell and the eye becomes covered by a slight fibrous exudation, which gathers in filaments in the inferior conjunctival sac.”“The maximum reaction is observed between the 6th and 13th hour. “It is nob accompanied by any elevation of temperature. Ho chemosis is produced nor any pain felt; the only unpleasantness is the epiphora which disappears, and all is again in its usual order after two or three days. The intensity of the reaction will be realized by a comparative examination of the eye which has not received the Tuberculin.”On the 19th of June, 1907 Calmette published his first paper on the ophthalmic reaction, but previously (on the 3rd June) Wolff-Bisner of Vienna had announced to the Society of Medicine of Berlin that a drop of diluted tuberculin put into the eye produced an inflammatory reaction. At the same time, however, he was not able to state anything as to its diagnostic value, and so Calmette’s name is the one which is now usually associated with the reaction.Before giving my own results with the tests I think it well to give some extracts from recent literature on the subject.