460 PROTEIN POISONS 



the products of the digestion of tuberculoproteins. It is a 

 well-established fact that the accumulation of fermentation 

 products retards and finally arrests the fermentative process. 

 The instance in point is a perfect illustration of this law of 

 fermentation. It must be evident from this how unscientific 

 it is to treat advanced tuberculosis with tuberculin. It 

 has been argued that the tuberculin reaction is not an 

 example of sensitization, because as the treatment proceeds, 

 larger and larger doses of tuberculin are necessary in order 

 to induce the reaction, as shown by the development of 

 fever. To anyone who has followed the evidence that we 

 have given so far, the explanation must be plain. It lies 

 in two facts, of each of which we think that we have given 

 abundant proof. In the first place we have shown that a 

 certain degree of tolerance for the protein poison is easily 

 and quickly established. In the second place, the accumu- 

 lation of fermentation products retards fermentation. 

 Tuberculosis, in most instances at least, begins as a strictly 

 local infection. This is true even when the first recognition 

 of it has been in the acute miliary form. There has been 

 a previous focal infection. Only those body cells in the 

 immediate vicinity of the infection are sensitized, and only 

 these supply a ferment capable of digesting the tuberculo- 

 protein. It may well be that in this stage benefit may be 

 secured by the proper use of tuberculin, which may act as 

 a sensitizer, and develop more of the ferment to split up and 

 destroy the tubercle bacilli. It should be always borne in 

 mind that tuberculin contains a poison and should be used 

 with caution. 



There is another line of evidence that in tuberculosis there 

 is a condition of specific protein sensitization. This is to be 

 found in the fact that this disease is much more deadly in 

 lands and among people who have recently come under its 

 influence than it is where it has prevailed for many genera- 

 tions. In other words, the widespread and long-continued 

 existence of the disease, slowly, and at the cost of much 

 sickness, and many deaths, brings a certain degree of 

 immunitv. The readiness with which the North American 



