Hemorrhagic Reactions in Tuberculous Lesions and Skin Tests During Protracted Anaphylactic Shock

Abstract

The method which gives the best result for reproducing the observations which we will describe is as follows: Guinea pigs are injected intraperitoneally with a large dose (10-20 mgm.) of the slightly virulent tubercle bacillus strain R.1, or with killed tubercle bacilli. The infection is followed 3 to 8 days later by the intraperitoneal injection of 0.1 to 1.0 mgm. egg white (dry weight). After this treatment the guinea pigs usually develop a strong skin sensitiveness to egg white, 1 often giving large necrotic skin reactions with 0.01 mgm. egg white.

When the guinea pigs, 9 to 14 days after the treatment, are injected with somewhat larger doses of egg white intraperitoneally (10-30 mgm. dry weight) they die in 4-12 hours, the symptoms showing great similarity to the tuberculin shock. The most striking finding at the autopsy—beside an abundant exudate in the peritoneal cavity—is that in the peritoneum and the tuberculous lesions (in the omentum, mesenterium, and peritoneal walls) large hemorrhagic areas are present. Sometimes the hemorrhages extend almost over the entire peritoneum. When the reaction is slight it corresponds entirely to the usual reaction of tuberculous animals killed by the injection of tuberculin around the tuberculous lesions. From 93 tuberculous guinea pigs sensitized with egg white, tested with intraperitoneal injections during the last year, 30 died with the above described symptoms. In these guinea pigs the method of treatment and sensitization and also the interval between the treatment and the testing was variable. Of the guinea pigs which were infected and treated intraperitoneally, with few exceptions all died with the characteristic symptoms when tested in the third week after the treatment.

If the guinea pigs live somewhat longer or survive a severe shock we often observe that the formerly made skin tests with egg white and tuberculin show a bluish purple discoloration, and also extensive hemorrhages often occur in them.