SOME ASPECTS OF ANAPHYLAXIS 447 



quinine, antipyrine and the iodides may be mentioned. While the 

 history of these eases shows a marked resemblance to anaphylaxis, there 

 is, for most of them, no very definite experimental basis. Friedberger 

 has recently obtained anaphylactic symptoms in guinea-pigs sensitized 

 with an iodine-proteid compound. It would be of theoretical impor- 

 tance if true anaphylaxis could be experimentally produced with these 

 substances, because they are of a non-proteid nature. 



Food Idiosyncrasies. — Probably everybody is familiar with the fact 

 that certain foods, harmless for most people, cause marked trouble in 

 others. Certain individuals, for example, react to the ingestion of 

 strawberries, buckwheat, clams, eggs, etc., as if a poison had been swal- 

 lowed. These cases also are probably anaphylactic, but here again the 

 experimental test is lacking to clinch the relationship between these 

 phenomena. 



Treatment of Anaphylaxis. — The treatment is not yet in a satisfac- 

 tory state, but there are a number of remedies available for some of the 

 manifestations of this protean complex. If an injection of horse serum 

 produces respiratory symptoms of an asthmatic type in a patient, the 

 only rational treatment is the administration of atropin, for the investi- 

 gations of Auer and Lewis have shown that this asthma is due to a 

 tetanic contraction of the finer bronchioles which hinders or prevents 

 the entrance and exit of air in the lungs, and atropin causes a relaxa- 

 tion of these muscles. In a study of the prophylactic value of atropin 

 injections in guinea-pigs, Auer was able to save 72 per cent, of his 

 animals, while 75 per cent, of the untreated controls promptly died. 

 These results have been corroborated by a number of observers, espe- 

 cially by Biedl and Kraus. The negative results which Friedberger 

 and Mita obtained are probably due to the inadequate dose of the 

 atropin which they administered. 



If the injection of the serum, however, causes symptoms of cardiac 

 failure with slight symptoms of asthma, there is no treatment founded 

 on experiment. The treatment must be symptomatic only; but one 

 class of drugs must be avoided. Auer has shown in highly sensitized 

 rabbits that drugs of the digitalis group should not be used, because 

 they hasten the fatal outcome by aiding the production of the same 

 cardiac lesion which anaphylaxis itself calls forth. Moreover, the same 

 observer has recently described changes in the cardiac muscle produced 

 by members of the digitalis group, especially strophanthin, which are 

 very similar to those produced in cardiac anaplMaxis. It is, therefore, 

 clear why these cardiac stimulants must not be given, even though the 

 weak heart would seem to demand their exhibition. 



The most rational treatment is the preventive one. The utmost 

 precaution should be observed whenever it become necessary to inject a 

 therapeutic serum in a patient who has been injected with serum before, 

 who is subject to asthma, hayfever, or who shows an idiosyncrasy to 



