THE FOCAL REACTION 73 



action and a sharp general systemic reaction. Tuberculous foci in 

 lymph glands, in the kidney and the genito-urinary tract and else- 

 where respond in a similar manner. Closely related we find the effect 

 on leprous lesions. Josephson describes the activation of a case of 

 macular leprosy following the accidental injection of a relatively 

 large intravenous dose of vaccine. 



Among the nontuberculous inflammatory foci can be included the 

 tonsils which at times flare up after a nonspecific injection. Schmidt 

 describes such a case in which a milk injection activated a latent 

 angina with the coincident appearance of mild joint pains. Inflam- 

 matory activation can be observed following milk injections in cases 

 of furunculosis and in some instances more than the usual amount of 

 constitutional reaction. Thus the normal diabetic does not react 

 with a temperature rise to milk injections, but if suffering from 

 furuncles will frequently do so. We also note arthropathies, the nega- 

 tive phase of which, with its increased pain, swelling and limitation of 

 motion, is not an uncommon clinical observation and has been fully 

 discussed by a number of observers. Inflammatory foci in the ap- 

 pendix and the gall-bladder, erysipelas, inflammatory lesions of the 

 eye, inflammatory lesions of the respiratory tract, of the female adnexa 

 and the male genito-urinary tract, etc., are also found. Schittenhelm 

 observed that following the injection of typhoid vaccine old fistulas 

 would show an increased amount of secretion; bronchiectatic patients 

 would secrete more mucus; chronic appendiceal lesions would become 

 more painful and tender, etc. 



The activation of quiescent malarial foci has assumed diagnostic 

 importance and will be more fully discussed. Papules of syphilitic 

 origin react with an increased hyperemia just as do other inflamma- 

 tory foci. 



In a general way one can make the statement that any circum- 

 scribed inflammatory process irrespective of its bacterial etiology or 

 its location will frequently light up with a typical focal reaction after 

 a nonspecific injection and usually within 24 hours after the injection. 

 Of these various processes tuberculous lesions are perhaps more sen- 

 sitive because of a more profound sensitization of the tissue cells of 

 the host against protein in general as suggested by a recent dis- 

 cussion by Wolff-Eisner. 



II. LOCALIZED INFLAMMATORY PROCESSES ENDOGENOUS OR TRAU- 

 MATIC IN ORIGIN. In this category must be placed certain of the 

 toxic forms of arthritis, such as the Poncet type, as well as gout. In- 

 flammatory lesions of the kidney, and inflammatory lesions of the eye, 

 including iritis, albuminuric retinitis, etc., are also among the local- 

 ized processes. Healing fractures, such as Dollken has described, 

 respond with a typical focal reaction. Neuritis is to be included in 

 this group. 



