SOME ASPECTS OF ANAPHYLAXIS 445 



one of the ways mentioned to this proteid. It is interesting that those 

 individuals which recover are in a state of anti-anaphylaxis for some 

 time afterwards, that is, they are temporarily free from attacks of 

 asthma or hayfever, from which they suffered before. 



Local Reactions of Anaphylaxis. — In 1890 Eobert Koch announced 

 that the injection of tuberculin produced a local and general reaction 

 in tuberculous guinea-pigs, which, he said, led to an arrest of the 

 tuberculous process and even to health. Everbody probably remembers 

 the sensation which this statement caused. Unhappily, however, the 

 results obtained later in clinical tests did not fulfil expectations. 

 Nevertheless, one important fact remained: the important diagnostic 

 value of the febrile reaction which follows the injection of tuberculin 

 in the tuberculous individual. This reaction occurs only in subjects 

 which are tuberculous, in other words in those who are sensitized by the 

 proteids of the tubercle bacillus ; the reaction is thus one of anaphylaxis. 



The original method of injecting tuberculin was not devoid of 

 danger, nor was it at best very agreeable to the individual with a posi- 

 tive reaction. In 1907 v. Pirquet described a cutaneous reaction in 

 tuberculosis which gives accurate results and is devoid of any danger 

 or marked discomfort to the patient, v. Pirquet noted that a very 

 small quantity of tuberculin applied to a local scarification of the skin 

 produced within forty-eight hours a well-marked inflammatory reaction 

 in tuberculous subjects, which did not appear in normal individuals. 

 This inflammatory reaction in an individual shows that he must have 

 been sensitized by the tubercle bacillus, in other words that a tubercu- 

 lous process is in existence somewhere in the organism. The value of 

 this fact is obvious, for it gives a warning, which if properly heeded 

 may prevent invalidism and death. 



A reaction similar to that just described is the ophthalmo-reaction 

 of "Wolff-Eisner and of Calmette. Instead of letting absorption take 

 place from the skin these investigators instilled the tuberculin in the 

 conjunctival sac of the eye. In tuberculous subjects a quite violent 

 reaction follows ; because of this violent response the ophthalmo-reaction 

 has fallen into disrepute. 



Phenomenon of Arthus. — The appearance of a local, massive edema 

 and even necrosis at the site of an injection of serum in a sensitized 

 rabbit was first noted by Arthus in 1903 and has been described before 

 in these pages. In was the first example of a definitely recognized, 

 experimental, local anaphylaxis. 



Hayfever. — The most annoying and widespread manifestation of 

 local anaphylaxis is hayfever. Many, thousands of people suffer from 

 it in the United States alone. In this country we have two disease 

 periods, the so-called " spring or June cold " prevailing in June and 

 July, and the " autumn catarrh " which begins at the end of July and 

 lasts to October. The majority of hayfever patients suffer during the 



