472 PROTEIN POISONS 



fractioning the total amount of serum, and, instead of 

 using a single dose, give several doses at frequent intervals 

 over a considerable period of time. In this way it may be 

 possible to exhaust the ferment present in the body for 

 the time being, after which further amounts may be given 

 with impunity. A temporary exhaustion of the special 

 ferment would explain cases of diphtheria such as are 

 reported, in which, although alarming symptoms followed 

 the first injection, on account of the condition of the patient, 

 a second injection seemed advisable, and was given within 

 a few hours without any untoward effects whatever. Experi- 

 ences such as this find their analogy in experimental work 

 in the fact that sensitized animals which have recovered 

 from the poisoning following a second injection are not 

 again susceptible to that particular protein until after the 

 lapse of several days. 



The idiosyncrasies which certain individuals possess 

 with regard to certain protein articles of diet would appear 

 to be explainable on the ground that, through some abnor- 

 mal condition of the intestinal mucosa, certain protein 

 substances are allowed to enter the body in an unchanged 

 state. The symptoms which develop are certainly strikingly 

 suggestive of those described as appearing in connection 

 with sensitization. The symptom most constant in appear- 

 ance is an urticaria, more or less generalized in extent and 

 accompanied by intense itching. Thus, Bruick reported 

 the case of a man who reacted with urticaria every time 

 after eating pork. Smith reports the case of an individual 

 who developed a severe urticaria within a short time after 

 partaking of any article of diet which contained buckwheat. 

 Numerous cases of severe urticaria accompanied by dyspnea, 

 and occasionally incoordination of the lower extremities, 

 have been reported as occurring in susceptible individuals 

 after partaking of any food containing egg albumen, and 

 one of us has recently had opportunity to observe an indi- 

 vidual who developed a generalized urticaria accompanied 

 by marked edema and intense itching within half an hour 

 after partaking of peas as an article of diet. 



