THE FOCAL REACTION 81 



when they are of the exudative type or when the connective tissue 

 delimitation of the tubercle is either incomplete or exceedingly labile. 

 It is to be recalled that as one of the results of plasmaactivation 

 proteolytic enzymes appear in the serum and in inflammatory foci and 

 that the polymorphonuclear leukocytes are increased in number and 

 in activity. The augmented digestive activity results in a loosening 

 of the connective tissue defense of the tubercle. If sufficiently intense 

 a typical focal reaction activation-absorption of necrotic material 

 and systemic reaction can result in this way, just as after stimula- 

 tion due to specific tuberculins. 



The Therapeutic Application of the Focal Reaction. Schmidt is 

 of the opinion that the local reaction, elicited by means of specific 

 or nonspecific agents (such as milk), is of definite value in tuber- 

 culosis, and together with Kraus cites some twenty-odd cases to sup- 

 port his view. While it is of course not to be denied that in a very 

 limited number of cases this may be true, we are of the opinion that 

 the tubercle offers a decided exception to the general rule that the 

 active stimulation of a chronic inflammatory focus is of therapeutic 

 value. We have pointed out that for vascularized inflammatory lesions 

 such stimulation affords a rational method of therapy. In the tubercle 

 we deal with the constant danger that the limitation of the lesions by 

 means of the connective tissue encapsulation may be sufficiently dis- 

 organized that an extension of the process and irreparable injury may 

 result. Irrespective, therefore, of the theoretical probabilities that 

 therapeutic focal activation may be beneficial, in the tuberculous lesion 

 it is a hazardous procedure (Lewin). Before leaving the subject it 

 must be pointed out that nonspecific stimulation of the tuberculous 

 patient (not involving focal reactions) has been found very useful both 

 with certain drugs (and these include the commonly accepted ones 

 such as creosote, succinates, arsenicals, etc.), as well as with serum 

 injections such as Czerny and Eliasberger have recently reported. 

 That the milder nonspecific injections seem to have a decidedly stimu- 

 lating effect on the metabolism of infants has been previously reported. 

 (Plantenga, etc.) 



The peculiar therapeutic importance that attaches to the diphasic 

 character of the focal reaction has been previously discussed. Through 

 the existence of inflammatory foci in various organs the omnicellular 

 stimulation by means of the various nonspecific agents (the ergotropie 

 of v. Groer) becomes to a certain extent an organotropie. It is in this 

 sense that we must consider the effect of the treatment of paresis by 

 means of tuberculin injections and similar therapeutic measures. A 

 combined therapy of nonspecific and etiotropic agents may be of 

 value, and experiments in this direction have been reported by Kyrle 

 and Scherber, who have used milk injections in conjunction with mer- 

 cury in the treatment of syphilis, or the use of milk injections and 

 salicylates in the treatment of arthritis, the use of milk injections and 



