HOWARD T. KARSNER 969 



reactions" or phenomena but this does not indicate necessarily that in their essential 

 nature they are directly related to anaphylaxis. 



The original observation of anaphylaxis was with a substance, the poison of the 

 tentacles of actinia, which in itself has toxic effects. Richet and Portier' in studying 

 this substance found that if a sublethal dose had been injected into a dog and three 

 weeks allowed to supervene a very small second dose proved to be fatal. Eel serum, 

 ox serum, and dog serum are toxic for the guinea pig. Venoms of certain snakes are 

 toxic for a variety of animals, as is true of certain of the substances which produce 

 anaphylactoid symptoms. The substances of protein character usually produce 

 hyperemia, hemorrhage, and edema. They have been grouped by Arthus under the 

 term "congestins." Being of protein character, they may be capable of producing 

 anaphylaxis. As pointed out by Arthus,^ and by Karsner^ independently, the patho- 

 logical findings following fatal shock have the special characters of anaphylaxis plus 

 those of the congestins — a congestive type of anaphylaxis, thus a combination of 

 anaphylactic and anaphylactoid phenomena. 



ANAPHYLAXIS 



The basic statement of the nature of anaphylaxis is given simply by the dis- 

 coverer Richef in the words: "Une substance insufhsante a tuer ou meme a rendre 

 malade un animal normal, determine des accidents foudroyants et mortels chez un 

 animal qui, longtemps auparavant, avait regue cette meme substance." The term 

 "anaphylaxis" (ana, "against"; phylax, "guard"), coined as a result of physiological 

 experiments, came into general use when the more strictly immunological work of 

 Arthus, Otto,s and Rosenau and Anderson'' gave the key to the mysterious ill effects 

 that sometimes follow the use of horse serum in the treatment of diphtheria. The 

 general reaction is sometimes referred to as the "Theobald Smith phenomenon," the 

 local reaction as the "Arthus phenomenon." The local reaction is practically the 

 same in all animals, but the general reaction varies in different species, and in man 

 shows differences within the species. The special problems deal with sensitization, 

 incubation, intoxication, and the reaction. 



ACTIVE SENSITIZATION 



Under this heading must be considered the nature of the sensitizing substance, 

 the mode of introduction into the body, and the size of the dose. Wells,^ in his admi- 

 rable reviews, points out that "anaphylaxis represents an antigen-antibody reaction." 



'Richet, C: L' Anaphylaxie. Paris: Alcan, 1923; Compt. rend. Soc. de hiol., 66, 1005. 1909; 

 Portier, P., and Richet, C: ibid., 54, 170. 1902. 



2 Arthus, M.: DeVAnaphyla.xie a rimmunUe. Paris: Masson, 1921. 



3 Karsner, H. T.: Ztschr.f. Immiinitdtsforsch. ii. exper. Therap., 14, 81. 1912. 

 4 Richet, C: L' Anaphylaxie. Paris: Alcan, 1923. ' 



5 Otto, R.: Leuthold Gedenkschrift. Berlin, 1906. 



^ Rosenau, M. J., and Anderson, J. F.: Hyg. Lab., U.S. Pub. Health b" Marine Hosp. Serv., Bull. 

 2Q. Washington, D.C., 1906; /. Med. Research, 21, i. 1909; Anderson, J. F., and Rosenau, M. J.: 

 Arch. Int. Med., 3, 519. 1909; Harvey Lectures, p. 117. Philadelphia: Lippincott, 1908-9. 



7 Wells, H. G. : Physiol. Rev., i, 44. 1921 ; see also The Chemical Aspects of Lmmunity. New York: 

 Chemical Catalogue Co., 1925. 



