NOTES ON 121 CASES TESTED WITH CALMETTE'S TUBERCULIN
Authors: J. S. Webster, J. A. Kilpatrick
Journal: BMJ (1907)

becomes a practical question, might not Echool children who exhibited suspicious s5 mptoms and who gave a positive ophthalmo-reaction be eegregated and kept under observation?Some rather interesting points suggeat themselves from a study of my resaLts.In a few cases not suepected to be tuberculous, but whose.family history was bad, I have obtained pronouneed reactions.Is it possible that this reaction not only reveals the presence of an actual lesion, but also a condition of tissue whicth is ausceptible to the development of tuberculosis?What is the meaning of this reaction?Clearly to the conjanctiva of the tuber- Mnlons it is an irritant.To the eye of the healthy it is bland.I have been rather surprised to get a posltive reaction in some cases of lupus that bad been treated by the subcutancous injections of the " old" tuberaulin, fiom the smallest to the largest doses, till all local and general reactions had ceased.In such cases one would have expected that the tissues would have acquired an immunity to tuberculin.Are we to assume from this test, when positive, that there is always present an actual tuberculous leslon, or may we get it in the absence of a lesion in those susceptible to the disease?This point can only be settled by prolonged observation and by following the fature history of those cases in which the ophthalmo-reaction has been positive.Parallel results are obtained by the cuto-reaction of von Pirquet.Here, again, the introduction of tuberculin into the skin causes in the tuberculous a characteristic lesion.The tuber-.calin proves Itself an irrltant to the skin in the same way as to theconjanctivA.Both-in the case of the eye and tbe skin the action Is an evidence of tiqsue resistance to tuberculin in the tubercalous.Is the tuberculin elaborated in the 1iving tissue the same as that manu- factured irs vitro?One would expect that tuberculin instilled into the eye, scratched into the skin, or injected hypodermic'lly, would " react " only in the healtby, for i8 not the reaction a sign of tiseue resistance that we would expect to find better developed in the healthy than in the unhealthy ?It seems apparent that tuberculin, or some other toxin developed in the tuberculous, imparts to the tissues a resistance to tuberculin, as expressed by the inflammation in the eye or skin, that is absent in the healthy.Von Pirquet holds that the reaction is due to the presence of an antibody.Obantemesse, in a p3per read at the Acad6mie de M4ddecine (July, 1907), described an analogous reaction in enteric fever to a strong solation of typhoid toxin.The toxin was precipitated by absolute alcohol, and the powder obtained dissolved in distilled water(.,lmg. in iij).In non-typhoid cases in from two to three hours there occurred a slight redness and lacrymation, a reaction which was quite evane3cent, all trace of hyperaemla disappearing in from four to five houre.Bat in enteric cases the reaction was much more pronounced, and at its maximum in from six to twelve hours, and remained till the following day.When very severe it even lasted for two.to, three days.There was hyperaemia, lacrymation, and, a sero-fibrinous exudation-in all respects very similar to the ophthalmo-reaction of Calmette.No con- stitutional disturbance was obaerved.ChantemeEse cou'd not affirm whether this reaction is, or is not an early sign of enteric, but the reaction has been got in the eye of rabbits injected forty-elght hours previously with enteric bacilli.I hawve to ackaowledge with thanks my indebtednees to Dr. J. Montgomery Anderson, lote House-Physician in the wards of Sir Thomas McCall Anderson, without whose assistance It