STREPTOCOCCAL INFECTIONS 



large numbers of cells carrying forbidden patterns capable of 

 reacting with mildly traumatized tissue. The experimental 

 approach then would be to excise a swollen cervical lymph 

 node, prepare a living cell suspension and inject this intra- 

 dermally in a series of normal children, preferably over one 

 of the sites of election for rheumatic nodules. If it could be 

 shown that lymph-node cells taken very early in a rheumatic 

 fever episode produced an inflamed nodule when injected 

 into the skin of a normal child while cells from a non- 

 rheumatic streptococcal pharyngitis patient did not, a very 

 strong prima facie case for the present interpretation would 

 have been established. In the case of glomerulonephritis the 

 equivalent approach would be to give the corresponding 

 cervical lymph-node cells intravenously to a normal child 

 and examine the urine for evidence of transient damage to 

 the glomeruli. Again, adequate control could theoretically 

 allow a positive finding to be established. Whether such 

 experiments are justifiable must be left to the judgment of 

 paediatricians. 



If such an approach gave rise to positive reproducible 

 findings a wide field for further research would be opened 

 up. Obviously what must be found is the nature of the 

 antigenic determinants with which the forbidden clones 

 react. If, to a series of patches infiltrated with lymphoid cells, 

 solutions containing determinants XT on suitable carriers 

 were injected, one would expect the intensity of the reaction 

 to be increased beyond that of controls. In principle this 

 might allow the identification of X and T. The possibility 

 might, of course, also have to be considered that X and T in 

 the absence of macromolecular carrier might specifically 

 inhibit the reaction — and in so doing offer a possible lead to 

 a chemotherapeutic approach. 



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