SOME ASPECTS OF ANAPHYLAXIS 443 



the name of anaphylatoxins legitimately, for there is no cloud regarding 

 their origin. Such substances, with such a pedigree, have not been 

 isolated so far. With these properly identified anaphylatoxins no con- 

 fusion will be produced, for they will cause a true anaphylaxis, and the 

 usual conception of this process will not be obscured, but, on the contrary, 

 clarified. 



This question of the causal relationship between proteid cleavage 

 products obtained in vitro, and the symptoms and signs of true ana- 

 phylaxis has been discussed at some length because this view-point of 

 the problem enjoys great favor; because it was necessary to point out 

 that this view as formulated at present leads to confusion, to the useless 

 sacrifice of a well-defined symptom complex and its characteristic 

 anatomical and functional signs, and finally because this view is not 

 the necessary and inevitable consequence of the experimental data 

 at hand. 



Other Manifestations of Anaphylaxis. Serum Disease. — The de- 

 scription given so far has dealt exclusively with the experimental 

 analysis of the more important anaphylactic phenomena in lower ani- 

 mals. But similar phenomena occur in man and these have been 

 extensively studied. Opportunity for this study was afforded shortly 

 after therapeutic sera were generally employed to combat disease, espe- 

 cially diphtheria. 2 To v. Pirquet, associated in his earlier work with 

 Schick, we owe the most thorough study of some of the reactions which 

 the human organism may show when injected with various kinds of 

 therapeutic sera. These reactions v. Pirquet and Schick called serum- 

 disease. The development and course of this serum disease is as fol- 

 lows. The first injection of a therapeutic serum, usually obtained 

 from an immunized horse, is tolerated by most individuals without any 

 reaction. In those that do react, the symptoms do not develop at once, 

 but after the lapse of eight to ten days. The chief disturbances which 

 now occur are fever, skin eruptions, swelling of the lymph glands near 

 the site of injection, pains in the joints and muscles and edema of the 

 face and dependent portions of the body. In spite of this apparently 

 formidable list of ailments the general condition of the patient is excel- 

 lent, as a rule, and there is but slight danger. 



When the same patient is reinjected after an interval of more than 

 ten days, the picture is somewhat different. The period of incubation 

 is practically absent or at least considerably shortened, and the symp- 



2 It must be stated at once that these undesirable accessory reactions which 

 sera sometimes show in the human being form no contraindication to their 

 employment in proper cases. In severe diphtheria, for example, the anti- 

 diphtheritic serum is the only remedy which can save the patient from death; 

 to hesitate in its employment because it may produce more or less severe symp- 

 toms itself, would be criminal, as this action might be equivalent to throwing 

 away the only chance of recovery the patient has. 



