CLINICAL SIGNIFICANCE OF ANAPHYLAXIS 445 



The same inference can be made from Bail's 50 experiments on 

 passive sensitization. For, although passive sensitization of guinea 

 pigs with the serum of tuberculous animals has been unsuccessful, 

 Bail succeeded in obtaining lethal anaphylactic reactions by injected 

 macerated tuberculous tissues, following these on the next day by 

 injections of tuberculin. It is plain from this, as Friedemann cor- 

 rectly argues, that we must assume that the antibodies (receptors) 

 formed against tubercle bacilli are closely bound up with the tissue 

 cells, the reaction of tuberculin being largely with "sessile receptors." 

 Indeed, it seems as though the antibodies formed against tubercle 

 "bacilli undoubtedly remain in close relation to the cells of the tis- 

 sues except in cases of active tuberculosis in which localized areas 

 of cells are under the influence of a very intense action of the poi- 

 sons, and a consequent overproduction and discharge of receptors 

 (using the Ehrlich nomenclature) may occur. This would corre- 

 spond with considerable accuracy, moreover, to the histological facts, 

 for in this infection, similar to leprosy and a number of other con- 

 ditions, but unlike most acute infections, the battle against the micro- 

 organisms is carried out chiefly by the adjacent tissue cells. 



We might assume, therefore, that, in tuberculous individuals, 

 there is indeed a reaction, at first local, then generalized to a slight 

 degree, in which antibodies are actually formed. These antibodies, 

 however, remain to a preponderant extent sessile, or incorporated in 

 the reacting cells. Upon the injection or application of tuberculin 

 the reaction takes place in or upon the cells. Whether or not the 

 further cooperation of complement or alexin is then necessary for the 

 lysis and poison production from the antigen, as in the similar reac- 

 tions taking place in the circulation, or whether the intracellular 

 ferments themselves suffice for this, cannot be decided at present. 

 It is certainly not unlikely that the circulation of tubercle-antigen 

 even in small quantities throughout the body may produce such 

 hypersusceptibility of cells (represented graphically by the concep- 

 tion of sessile receptors in many parts of the body remote from the 

 lesion a quality remaining constant for prolonged periods and ex- 

 plaining the subsequent skin and ophthalmic reactions obtained upon 

 test). Certain clinical observations cited by v. Pirquet 51 would seem 

 to support such a view. For instance, he states that, having em- 

 ployed his left forearm repeatedly for tests, he was able to obtain 

 positive reactions in this area with tuberculin diluted 1 to 1,000, 

 whereas his right forearm was negative to tuberculin ten times as 

 concentrated. Furthermore, as Kohn 52 has shown that, while the 

 first injection of tuberculin into the eye of a normal person produces 

 no reaction, this eye will not only react to a second instillation, 



50 Bail. Zeitschr. f. Immunitatsforsch., Vol. 4. 



51 V. Pirquet, "Kraus u. Levaditi Handbuch," Vol. 1, p. 1050. 



52 Kohn. Quoted from Lowenstein, Kraus and Levaditi, Vol. 1, p. 1033. 



