Onset in 12 to 24 hours (may begin earlier); acme in 24 to 36 hours; duration of reaction--3 to 4 days or even longer (in severe cases).
Some reactions are of short duration. 3 grades of reaction, according to Citron:
1. Reddening of caruncle and palpebral (lid) conjunctiva.
2. More intense reddening, with involvement of ocular (eyeball) conjunctiva, and increased secretion.
3. Very intense reddening of the whole conjunctiva, with much fibrinous and purulent secretion, etc.
5. TIME OF INSPECTION:
12 and 24 hours after instillation; then once a day.
6. CAUSE OF REACTION:
Hyperaemia and exudation resulting from interaction between _instilled tuberculin_ and _antibodies in conjunctiva_ (bacteriolysin, according to Wolff-Eisner).
7. INTERPRETATION OF REACTION:
Wolff-Eisner maintains that positive conjunctival tuberculin reaction means _active_ tuberculosis, a conclusion accepted by but a few.
8. FIELD OF APPLICATION OF CONJUNCTIVAL TUBERCULIN TEST:
_Should not be used_; connected with _danger_ to the eye.
Conjunctival test used very rarely at present.
IV. PERCUTANEOUS TUBERCULIN TEST
1. SYNONYMS: Salve Test; Moro Test.
2. SALVE: Equal parts of Old Tuberculin and anhydrous lanolin.
3. APPLICATION OF TEST:
Site: abdominal wall below ensiform process, _or_ breast below nipple, _or_ inner surface of forearm.
Application: rub in with the finger (using moderate pressure) a small particle of salve about the size of a pea.
Rub it in into an area about 5 cm.; rub 1 minute.
4. REACTION:
In 24 to 48 hours--_either_ numerous small reddened spots which disappear in a few days, _or_ numerous small nodules, _or_ coalescing nodules on a red base, etc.
5. INTERPRETATION OF REACTION:
Positive reaction is a.s.sumed to indicate existing tuberculous infection somewhere in the body; does not indicate that the process is active.
6. FIELD OF APPLICATION OF PERCUTANEOUS TUBERCULIN TEST:
The percutaneous tuberculin test fails in a large proportion of tuberculosis cases.
The test is used rarely at present.
LIGNIERES TEST
A modification of the Moro Test
Instead of salve, a few drops of Old Tuberculin rubbed in.
Used rarely at present.
V. INTRACUTANEOUS TUBERCULIN TEST
1. SYNONYMS--Mantoux Test
2. APPLICATION OF TEST:
Injection into skin (needle parallel to skin) of 1/100 mg. of Old Tuberculin (according to Mantoux).
3. REACTION:
Onset in a few hours, well developed in 24 hours, acme in 48 hours.
Reaction consists of a central nodule surrounded by a halo of redness.
This is the intracutaneous test as originally suggested by Mantoux.
CONCLUSIONS
Comparing the various tuberculin tests we find that:
1 _The Subcutaneous Tuberculin Test_ has the advantage of focal reaction, disclosing in a certain percentage of cases the seat of the disease.
The subcutaneous test should, however, never be employed unless _as a last resort_, and then only after all other methods of diagnosis are exhausted and an absolute diagnosis is very essential.
In the vast majority of suspected cases of tuberculosis, thorough study of the history of the case, combined with thorough physical examination, furnishes all the necessary data for diagnosis and an efficient plan of treatment.
2 _The Cutaneous Tuberculin Test_ is a very efficient diagnostic measure in children under two years of age in whom a positive cutaneous tuberculin reaction indicates active disease.
Positive cutaneous tuberculin reaction in adults indicates existence of a tuberculous process, somewhere in the body; it does not indicate that the process is active.
Negative cutaneous tuberculin reaction is one of the corroborative evidences of absence of tuberculosis, unless reaction is prevented by very advanced disease or tolerance to tuberculin established by tuberculin treatment.
3 Thorough study of the history and thorough physical examination of each individual case are more important and should precede the application of any test.