152 PROTEIN THERAPY 



ment of acute articular rheumatism, or of chronic arthritis, nonspe- 

 cific therapy naturally has nothing to offer. To those of us who 

 are not so satisfied I believe it adds a definitely useful agent and at 

 times a very powerful one. Indeed to those who are interested in 

 nonspecific therapy or the mechanism involved, the arthritic cases 

 offer a particularly valuable field for research. There is practically 

 no risk to the patient as there might be in more or less experi- 

 mental work on the more acutely ill the signs of improvement or 

 retrogression are objectively under the control of the physician and 

 the interesting focal reaction elicited by the nonspecific agents at 

 the inflammatory site can be carefully observed, especially in the 

 more chronic type of arthritis. 



The mechanism that is involved in the recovery of the patient is 

 still quite obscure. It is to be taken for granted that we must first 

 of all seek to remove any apparent focus of infection. Whether 

 the joint pathology always represents actual bacterial invasion or 

 at times merely a focal reaction of hypersensitive tissues is by no 

 means a settled question. We do know that the nonspecific injection 

 brings about a focal reaction and that the mechanism of recovery 

 Linges on this reaction. Whether, as a result of the reaction the 

 local tissues become immune to the toxic effect of bacteria still alive 

 in the focus, whether it means merely an increased tolerance to toxic 

 split products set free at a distance and to which the local tissues had 

 heretofore been sensitive, or whether we deal with the actual de- 

 struction of bacteria which had become localized in the joint is not 

 determined. We can simply point to the analogy that exists between 

 the skin and the joint tissues in their property of distinct local sensi- 

 tization, and to the fact that the reaction, being a focal one (a Herd 

 reaktion), can be brought about by a great variety of agents and 

 metabolic alterations (the recent paper of Gaisbeck on acute arthritis 

 and hemiplegia is of interest in this connection) ; and as such is typical 

 in its manifestations both in the negative phase (increased inflamma- 

 tion) and the positive phase (decreased inflammation). For the 

 therapist it is the latter that is of greatest interest. 



