ARTHRITIS 149 



Torrey first recalls the rather interesting work of Terc, who 

 treated a large number of rheumatic cases with bee stings, following 

 which the patient often reacted with a typical general reaction fever, 

 general malaise, etc. When the sting was repeated over a period of 

 time the patient became more or less refractory and during this re- 

 fractory period the symptoms of the arthritis disappeared. Langer 

 later repeated this work, using an extract of the bee poison, but his 

 clinical observations were not so extensive nor so conclusive as those 

 of Terc. More recently Bold has investigated the poison of the bee 

 and has tried to sensitize animals to the bee toxin, but without re- 

 sult. Torrey then continues: "The lack of result with sera and 

 vaccines, unless the administration is followed by a definite febrile 

 reaction, and the good result following such reaction, no matter what 

 agent is used, indicates that a nonspecific agent alters bodily condi- 

 tions materially. It is not clear whether actual infection is influ- 

 enced by allergic or anaphylactic reaction. More reason exists for the 

 view that the change affects the toxic expression of the infection, 

 and that, while the organisms are still retained in viable form, their 

 presence, or products, do not excite response by marked tissue change. 

 There is probably a prompt detoxicating action exerted in the blood 

 or tissues by the allergic response to the introduction into the blood 

 stream of a foreign protein. While a similar response may be elicited 

 to a less degree by subcutaneous or intramuscular injection of toxic 

 proteins the sudden and full effect is attained only by intravenous 

 injection where the protein is put into the blood unmodified by pas- 

 sage through other tissues and unaltered by cell or membrane selec- 

 tion. The usual typhoid prophylactic initial dose of 500 million killed 

 typhoid bacilli given subcutaneously seldom gives a severe reaction; 

 if given intramuscularly there is more apt to be a more marked 

 febrile response, while one-tenth of that dose given intravenously 

 will as a rule promptly produce a chill and a sudden rise in tempera- 

 ture to 103-105F. (39.4-40.6C.). The ultimate gain in specific 

 immunity against typhosus infection will be much greater in the for- 

 mer case but a detoxicating action and termination of acute inflamma- 

 tory processes will follow promptly after a severe reaction to the 

 small dose given intravenously but not after the gradual absorption 

 of the larger subcutaneous dose. 



Two questions suggest themselves: (a) While experience offers 

 abundant evidence that arthritis can be promptly terminated by such 

 intravenous therapy, is it a safe procedure and does it for this pur- 

 pose show any decided advantages over salicylate therapy? (b) 

 Granting that arthritis may be controlled by this means, is there any 

 indication that carditis is prevented or favorably influenced? 



(a) Regarding the safety of the procedure. Bacterial extracts or 

 emulsions vary so greatly in their toxic effects that great care must 

 be used in the selection of the strain and the estimation of the dose. 



