292 ANAPHYLAXIS 



determine the cause and then to immunize against it. If 

 an individual knows that eggs, for example, are the cause, 

 the remedy would be to eat a minute amount of egg that 

 will not cause the disturbance and to continue each day to 

 increase the amount gradually until immunity is established. 



In many cases of hay fever it is difficult to determine the 

 cause, in many others it is not. The procedure in such 

 cases is to apply the "skin test," intracutaneous injection 

 of minute quantities of the materials suspected. A local 

 reaction will indicate the cause. If this is determined a 

 course of injections of solutions of the causative agent taken 

 before the time w^hen the "hay fever" usually appears will 

 in many cases give relief. Test solutions and immunizing 

 solutions of a great number of known causative agents 

 may be procured from commercial sources. Various pollens 

 are a common, but by no means the only cause. 



The author knows from his own experience that organisms 

 in the nose are frequently associated with these conditions. 

 Vaccines made from these organisms have in his hands 

 relieved many. 



The proper procedure, however, is, as above outlined, 

 to ascertain the cause and then to immunize against it. 



In medical practice the reaction is used as a means of 

 diagnosis in certain diseases, such as the tuberculin test in 

 tuberculosis, the mallein test in glanders. The individual 

 or animal with tuberculosis becomes sensitized to certain 

 proteins of the tubercle bacillus, and when these proteins in 

 the form of tuberculin are introduced into the body a reac- 

 tion results, local or general, according to the method of 

 introduction. The practical facts in connection with the 

 tuberculin test are also in harmony with the author's theory 

 of anaphylaxis as above outlined. Milder cases of tuber- 

 culosis give more vigorous reactions because the intra- 

 cellular enzymes are not used up rapidly enough since the 

 products of the bacillus are secreted slowly in such cases. 

 Hence excess of enzyme is free in the blood and the injection 

 of the tuberculin meets it there and a vigorous reaction 

 results. In old, far-advanced cases no reaction occurs, 

 because the enzymes are all used in decomposing the large 

 amount of tuberculous protein constantl}^ present in the 



