CONGENITAL AGAMMAGLOBULINAEMIA 



( vii) The common virus diseases, including measles, chicken- 

 pox, mumps, poliomyelitis and Jennerian vaccination, 

 run a normal course and are followed by evidence of 

 clinical immunity. In one case three attacks of mumps 

 were reported (Bruton, 1952) but one feels that the 

 possibility that two (or three) of these were subacute 

 bacterial parotitis should be seriously considered. 

 (viii) In one case a successful skin graft from an unrelated 

 donor was reported, but subsequent experience indi- 

 cates that most such grafts were rejected in normal 

 fashion. 

 (ix) Children maintained with normal gamma globulin 

 injections and antibiotics are showing a high proportion 

 with arthritis of rheumatoid type. 

 (x) One patient is on record who developed an idiopathic 

 haemolytic anaemia without autoantibodies. The con- 

 dition was cured by splenectomy (Rohn, Behnke and 

 Bond, 1954). 

 These findings lead to the simple conclusion that what is 

 lacking in these patients is the ability to develop plasma cells 

 capable of producing Type i (classical) antibody. They show 

 normally functioning immune responses of Type 3. I have 

 found nothing in the literature relevant to Type 2 responses. 

 This has the important, and to most people unexpected, 

 implication that immunity to the common virus diseases may 

 be mediated by processes not requiring the release of antibody 

 into the circulation. It is natural, therefore, to believe that 

 antiviral immunity in such persons is developed by a response 

 of Type 3 character. Whether this is also the case in normal 

 persons must await further study. Perhaps some evidence for 

 this can be seen in the fact that the immune type response 

 to Jennerian vaccination is essentially a delayed hyper- 

 sensitivity response and can also be given by non-infective 

 vaccine lymph. 



Another aspect of agammaglobulinaemia which may be 

 stressed is that the normal woagglutinins are absent and are 



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