76 PROTEIN THERAPY 



tion (focal) one can also determine that nontuberculous processes 

 respond with a focal reaction to tuberculin. Schmidt illustrates this 

 with two convalescent cases of polyarthritis which had been free from 

 fever and local symptoms, pain, etc., for over two weeks. Both 

 cases on receiving 0.001 gm. O.T. subcutaneously, responded with 

 severe pain in the joints previously involved, slight periarticular swell- 

 ing and some limitation of motion; the duration of the reaction was 

 of course transient. I have had occasion to repeat these observations 

 of Schmidt's and in a considerable percentage of the cases studied 

 I have found that the observation holds true. In processes that can 

 be observed at the exterior surfaces of the body, particularly in the 

 violent activation of chronic inflammatory lesions, one can observe 

 the dualistic nature of the reaction and this is of paramount im- 

 portance in the therapeutic application of the reaction a negative 

 phase in the sense that the tissue is altered more from the normal than 

 heretofore, i.e., the evidences of inflammation are increased pain and 

 swelling augmented, function impaired, etc.; then a positive phase 

 during which there is a progressive diminution of the inflammation 

 until the preinjection status is again reached or passed, the balance 

 swinging in this direction until practically normal conditions are re- 

 stored. Augmentation of the inflammation is followed by a diminu- 

 tion until healing is accomplished the pendulum swings from one 

 side to the other in the wave-like curve that we find expressed so 

 commonly in many biological processes in the opsonin curve, the 

 antiferment curve, in the leukocytic response, in the coagulation 

 mechanism, in cell permeability, all indicative of the exquisite lability 

 of the balance that exists in living protoplasm. 



The focal reaction has its counterpart in the general reaction of 

 the patient that usually accompanies the reaction, occasionally in 

 the tuberculous, more often in acute infections and corresponds 

 obviously with Weichardt's period of "plasmaactivation." This dual- 

 ity observed in both the focal reaction and the general reaction is 

 of utmost therapeutic interest. 



It is reasonable that we would seek to make the negative phase, 

 representing an augmentation of the inflammatory process as short 

 as possible and the positive phase relatively intense and protracted. 

 But the possibility arises, based on clinical observation, that the de- 

 gree and extent of the positive phase (curative) is closely dependent 

 upon and correlated with the negative phase, i.e., that their relative 

 intensity is proportional. We may conceive the negative phase, which 

 in point of time always precedes the positive one, as an exogenously 

 produced irritative process, the positive one, on the other hand, as an 

 endogenous!^ prepared, more or less physiological process of vital 

 repair. Clinically, as far as focal reactions are concerned (as for 

 instance in tuberculosis) , it is chiefly the negative phase that comes 

 to our attention in the form of the activation phenomena with whioh 



