logS NON-SPECIFIC PROTEIN THERAPY 



involved, and all must be considered when we are dealing with the so-called specific 

 bactericidal eflfects of the various chemotherapeutic agents which have been pre- 

 pared in recent years. 



THE FOCAL REACTION 



Of greater importance for the bacteriologist is the efifect of protein therapy on foci 

 of chronic infection. Whenever an area of chronic irritation exists in the body (chronic 

 bacterial infection, mechanical or chemical irritation, etc.) it is found to be more 

 susceptible to irritation than normal tissue. These irritants may be exogenous or 

 endogenous in character; the effects may become manifest in the pain of an arthritic 

 joint with a change in the barometric pressure, in the activation of a tubercle after 

 remote trauma, in the onset of a psychosis following labor or an alcoholic debauch. 



Our knowledge concerning focal reactions has been derived largely from experi- 

 ence with tuberculosis, and because of this, the term "focal reaction" has implied a 

 highly specific tuberculin reaction, although no satisfactory antigen-antibody ex- 

 planation has ever been presented." A most important factor, namely, that the 

 tissue making up the focus reacts differently to normal as well as to abnormal stimuli 

 because of the previous experience (the patho-biosis of Heubner) has been largely 

 ignored.^ 



The foreign agent injected into the circulation may rapidly pass the capillaries of most 

 tissues without bringing about an alteration and will finally be taken up by the reticulo- 

 endothelium. But the endothelium of the capillaries in and about a chronic focus is altered. 

 It is more permeable and responds to stimulation more readily than the unaltered endo- 

 thelium. As a result, the chronic focus of infection will be subject to diffusion phenomena, 

 increased metabolic activity, with greater penetration of enzymes and antibodies, while at 

 the same time accumulated toxic material may be liberated. The reaction may take several 

 forms. If very severe, the cells may become fatigued, the reversal delayed, and severe injury 

 result to the patient either through digestion and softening (as in a tuberculous focus), 

 through the absorption of toxic material, or through the dissemination of the virus. If only 

 moderate, the reversal of the status of the tissues will initiate a relatively long period of 

 quiescence and ultimate improvement after primary augmentation of the symptomology. If 

 subminimal, the stimulus may bring about general inhibition (rest) of the metabolic processes 

 at the focus without apparent primary injury. This latter would be in agreement with 

 Verworn's theory. Chronic infections have been treated very successfully when these funda- 

 mental reactions have been kept in mind. 



PARESIS 



One of the most interesting and useful fields of application of protein therapy has 

 been in general paralysis. The method took origin in the work of Wagner von 

 Jauregg,^ who has persistently developed the method to the present treatment by 

 malaria and recurrent fever inoculation. 



During the course of recent years the factors that modify the course of syphilis 



' Cf. chap. Ixxv in this volume. 



* Petersen, W. F., Amer. Rev. of Tiiherc, 5, 318. 1921; and 15, 681. 1927. 



3 Wagner von Jauregg, J.: Jahrb.f. Psych., 7, 94. 1887. 



