80 PROTEIN THERAPY 



sorption of proteins and protein fragments insufficiently degraded in 

 the intestinal tract, i.e., a protein sensitization. He then develops the 

 more or less definite association of the exudative diathesis and spas- 

 mophilia with scrofula; while he does not regard the scrofula as the 

 cause of the diathesis, he inclines to the definition of Feer that 

 "scrofula is tuberculosis on the basis of an exudative diathesis." 

 Wolff-Eisner is inclined to the view that in tuberculosis there is evi- 

 dence of an exudative diathesis with sensitization against tuberculin 

 and also against proteins in general. This latter which is nonspecific 

 and general in character accounts, in his estimation, for many of the 

 evidences of similarity in the clinical course of tuberculosis and those 

 observed in an exudative diathesis. Not only is scrofula "tuberculosis 

 on the basis of a diathesis" but the tuberculous lesion itself, involving 

 as it does the prolonged absorption of partially split proteins from the 

 necrotic foci, may ultimately bring in its train symptoms that are 

 commonly regarded as due to a diathesis. As such he regards the 

 changes observed in the cornea, skin lesions such as the tuberculids, 

 the decided alterations in the reactivity of the sympathetic and central 

 nervous systems to which Moro, Pottenger and Ferranini have called 

 attention. While we have been familiar with the increased nervous 

 lability of the tuberculous individual for a long time, we have failed 

 to grasp the dependence of the increased irritability on the general 

 hypersensitiveness to proteins. Not only does this nervous irritability 

 indicate the close parallelism to the diathesis of the child, the tendency 

 to effusion is also evident in the tuberculous patient one has but to 

 call to mind the common appearance of pleural, peritoneal and joint 

 effusions. The alteration in the vasomotor stability also finds its 

 expression in the frequent appearance of urticarial eruptions after 

 tuberculin injections. 



It will be recalled from the previous discussion of the effects of 

 nonspecific injections on the permeability of vascular endothelium that, 

 depending on the dosage or the degree of irritation (or stimulation if 

 we wish to use that term) there may result either an increase or a 

 decrease in the permeability. We may expect that the effect of the 

 tuberculin (or the living virus) will also find some expression in 

 changes in the permeability in one direction or another. According to 

 Wolff-Eisner we find the clinical demonstration of this experimental 

 observation in the effect of the tuberculous invasion of lung tissue, 

 where in one instance we find an exudative change, in another an 

 indurative process. 



Plasmaactivation. The third factor involves the consideration of 

 the effects which any nonspecific provocative agent would have on an 

 inflammatory lesion such as the tubercle; the tubercle would react as 

 any seminecrotic focus of other etiology would react were it not for the 

 fact that the tubercle is practically avascular. Tubercles react to 

 nonspecific injections (or to nonspecific stimuli of other origin) only 



