In view of the evidence which has been presented that hyaluronidase is not inhibited by salicylates in therapeutic concentrations, it would seem that Guerra's explanation of the anti-rheumatic action of these drugs in terms of hyaluronidase inhibition must be abandoned. The question naturally arises as to whether or no their apparent anti-histamine action can be invoked in this connexion, as well as whether the effect of hyaluronidase on the skin of rheumatic fever patients described by Guerra and its diminution after administration of salicylate can be explained by the same mechanism. A voluminous literature exists regarding the effects of salicylates on immunological reactions, but the evidence, though some is suggestive, seems to be scarcely sufficient to provide a complete answer to these questions. The response to hyaluronidase described by Guerra in rheumatic fever, however, appears to be of the nature of a hypersensitivity reaction, such as was described by Jones & Mote (1934) as occurring in rheumatic fever patients following repeated in- jections ofvery small amounts,of rabbit serum. It is true that only a single injection of hyaluronidase appeared to have been given (in Guerra's paper no details are provided, nor is any mention made of control tests in normal subjects), but since strepto- cocci of the type believed to be responsible for pre- disposing to rheumatic fever are hyaluronidase producers, sensitivity to hyaluronidase might well be of general occurrence in rheumatic fever. If such be the case, inhibition ofhistamine, which is believed to play a part in such hypersensitivity reactions, would account for the reduced response to intradermal injections of hyaluronidase after treatment with salicylate. SUMMARY 1. Investigation of the effects of sodium salicylate and acetylsalicylic acid on the viscosity-reducing activity of hyaluronidase has shown that they are inhibitory only in relatively enormous concen- trations (more than 3 % for sodium salicylate and 0-33 % for acetylsalicylic acid).
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Verzár et al. (1948) studied this question.