554 IMMUNOLOGY 



Summary and Conclusions. — 



1. Evidence is offered which seems to show that tuberculin 

 allergy and immunity are not identical and that the former may 

 be detrimental to tlie host. 



2. A summary of Theobald Smith's excellent discussion of ex- 

 perimental tuljerculosis is given. 



3. Primary tul)erculosls confers a relative immunity and also 

 allergy upon the individual. There is a difference of opinion as 

 to whether the detrimental effects of the latter outweigh the bene- 

 ficial effects of the former. In any event the primary lesion rep- 

 resents a focus of virulent organisms that may ultimately lead to 

 endogenous reinfection. 



4. Relative immunity and allergy are apparently produced by 

 immunizing with suspensions of either killed or living attenuated 

 tubercle bacilli. The route of immunization may determine the 

 degree of allergy that occurs. 



5. The work of Park, Kereszturi and Mishulow on the effect of 

 vaccination with B.C.G. on children from tuberculous families is 

 presented. From these studies and those of Lurie it is evident 

 that natural resistance is an important factor in prevention of 

 tuberculosis. They conclude that B.C.G. is safe but confers rela- 

 tively little immunity and considerable allergy when administered 

 to children. Park regards the results as inconclusive. 



6. In our opinion, the problem is still in the experimental stage 

 and should be so regarded until more carefully controlled work 

 similar to that of Park et al. is completed. 



7. Allergy to streptococcus nucleo-proteins is observed not in- 

 frequently in man. Ando et al. have shown that this is a possible 

 source of error in interpreting the Dick test unless a purified toxin 

 is employed as the indicator antigen. 



The clinical symptoms and cutaneous manifestations of scarlet 

 fever are regarded by Dochez and Sherman as manifestations of 

 bacterial allergy. There are also a number of investigators who 

 regard rheumatic fever as a manifestation of streptococcus allergy. 

 At the present time the prevailing opinion as to the etiology of 

 scarlet and rheumatic fevers, respectively, is that the former 

 is a toxemic and infectious disease caused by certain hemolytic 

 streptococci, while the etiology of the latter, rheumatic fever, is as 

 yet either undetermined or not generally agreed upon. 



