368 LOCAL TLSSUE REACIIVnY 



sul).si(k'(l. I'oiir (l;i)s altcT this a bloody \vatery discharge aj)j)cai'c(l 

 and the aicas on the buttocks turned l)la(k. 



One oi the authors fnst saw the case at this time. Kxaniinaiion 

 revealed gangrenous areas with discharge and sloughing in botii 

 buttocks, sides of the abdomen and thighs. There was an area 

 of pneumonia in the right lower lung and left otitis media. No 

 cervical rigidity nor sign of meningitis were observed. The Was- 

 sermann was negative; blood and urine of no special interest. No 

 pus caN'ities formed but t^vo large masses of necrotic tissue were 

 lifted out. Despite \arious treatments including three blood 

 transfusions, the child died twenty-one days after admission. 

 Case of Meleney (1930) : 



A child received a small jjrophylactic dose of scarlet fe\ er serum 

 after a contact ^vith a scarlet fever case. Foiu" days later, the patient 

 de\ eloped typical scarlet fexer during ^vhich a large dose of scarlet 

 fever antitoxin ^^'as administered (several ^veeks after the first 

 administration of scarlet fe\er antitoxin) . A severe and extensive 

 gangrene dexeloped at the site of the second injection of the 

 scarlet fever serum. 



Information is lacking as to ^vhether bacteremias \vere present 

 at any stage of the disease in the cases described. Ho\\e\'er, if 

 one considers here the fact that accompanying infections ^vere 

 incidental to the development of this peculiar type of Arthus 

 phenomenon in the human, it may be assumed that the mechan- 

 ism of this disease belongs, at least in part, to the domain of the 

 jDhenomenon described in this monograph, rather than to the 

 Arthus phenomenon in the human. The cotnse of events is readily 

 illustrated in Method 25 of Table x and may be interpreted as 

 consisting of the following phases: (1) localization of bacterial 

 reacting factors in the sites injected with the animal protein; (2) 

 subsequent elicitation of reactivity by means of these bacterial 

 factors; (3) the animal protein (serum) injected into these pa- 

 tients may interact with previously actively acquired antibodies 

 and form the necessary reacting factors for elicitation of severe 

 lesions in the reactive sites. 



TOXIC MANIFESTATIONS IN THE COURSE OF TYPHOID FEVER IN THEIR 

 RELATION TO THE PHENOMENON OF LOCAL TISSUE REACTIVITY 



Granted that the phenomenon of local tissue reactivity may 

 exemplify an underlying mechanism in the pathology of certain 

 infections, the question stiggests itself ^vhether the active prin- 



