one of the ways mentioned to this proteid. It is interesting that those individuals which recover are in a state of anti-anaphylaxis for some time afterwards, that is, they are temporarily free from attacks of asthma or hayfever, from which they suffered before.
Local Reactions of Anaphylaxis.—In 1890 Robert Koch announced that the injection of tuberculin produced a local and general reaction in tuberculous guinea-pigs, which, he said, led to an arrest of the tuberculous process and even to health. Everbody probably remembers the sensation which this statement caused. Unhappily, however, the results obtained later in clinical tests did not fulfil expectations. Nevertheless, one important fact remained: the important diagnostic value of the febrile reaction which follows the injection of tuberculin in the tuberculous individual. This reaction occurs only in subjects which are tuberculous, in other words in those who are sensitized by the proteids of the tubercle bacillus; the reaction is thus one of anaphylaxis.
The original method of injecting tuberculin was not devoid of danger, nor was it at best very agreeable to the individual with a positive reaction. In 1907 v. Pirquet described a cutaneous reaction in tuberculosis which gives accurate results and is devoid of any danger or marked discomfort to the patient, v. Pirquet noted that a very small quantity of tuberculin applied to a local scarification of the skin produced within forty-eight hours a well-marked inflammatory reaction in tuberculous subjects, which did not appear in normal individuals. This inflammatory reaction in an individual shows that he must have been sensitized by the tubercle bacillus, in other words that a tuberculous process is in existence somewhere in the organism. The value of this fact is obvious, for it gives a warning, which if properly heeded may prevent invalidism and death.
A reaction similar to that just described is the ophthalmo-reaction of "Wolff-Eisner and of Calmette. Instead of letting absorption take place from the skin these investigators instilled the tuberculin in the conjunctival sac of the eye. In tuberculous subjects a quite violent reaction follows; because of this violent response the ophthalmo-reaction has fallen into disrepute.
Phenomenon of Arthus.—The appearance of a local, massive edema and even necrosis at the site of an injection of serum in a sensitized rabbit was first noted by Arthus in 1903 and has been described before in these pages. In was the first example of a definitely recognized, experimental, local anaphylaxis.
Hayfever.—The most annoying and widespread manifestation of local anaphylaxis is hayfever. Many thousands of people suffer from it in the United States alone. In this country we have two disease periods, the so-called "spring or June cold" prevailing in June and July, and the "autumn catarrh" which begins at the end of July and lasts to October. The majority of hayfever patients suffer during the
