84 THE PROTEOMORPHIC THEORY AND THE NEW MEDICINE 



volvement of the brain or, at all events, of the central nervous 

 system. 



In the laboratory experiments this condition of so-called ana- 

 phylactic shock may occur after a single inoculation with a large 

 dose of a foreign proteid ; but in that case it is somewhat delayed. 



The condition is usually induced by following a small initial 

 dose of protein (which has no apparent effect) with a larger 

 one at an interval of a week or ten days. A strictly comparable 

 condition is sometimes produced in the human subject through 

 the use of antitoxic serums, anaphylaxis being due not to the 

 antitoxin itself, but to the foreign blood serums (usually that of 

 the horse) in which it is suspended. In the case of the animal 

 in the laboratory, the condition is often fatal, sometimes very 

 rapidly so. In the case of the human subject, it may constitute 

 a serious "serum disease." 



My personal observation of the phenomena of anaphylaxis in 

 the human subject has been chiefly associated with the thera- 

 peutic administration of sheep serum (antithyroid) and various 

 vegetable proteins (proteals). A mild anaphy lactic reaction may 

 manifest itself locally, a few hours after the hypodermic injec- 

 tion is given, by a condition of erythema at the point of injec- 

 tion, involving only a small locus, or in some cases extending to 

 the entire arm. There may be marked ecchymosis of the tissues, 

 with attendant swelling lasting for twenty-four or forty-eight 

 hours. 



Whether or not there is pronounced local reaction, there may 

 be a general reaction two or three hours after the protein is 

 injected, manifested by rise in temperature, accelerated pulse, 

 feeling of malaise, and a more or less pronounced chill. These 

 symptoms disappear presently, without calling for treatment. 



Very different are the manifestations of acute anaphylactic 

 shock that may occur when a patient who for some time has been 

 under protein treatment receives by accident a full dose of the 

 protein into a vein. The anaphylactic reaction supervenes in the 

 course of fifteen or twenty seconds. The patient's face flushes 

 violently, more or less severe pains are located in the head and 

 back, and the pronounced dyspnoea simulates an acute attack 

 of asthma. In extreme cases the patient may lose conscious- 

 ness. The violent symptoms usually subside rather quickly, al- 

 though the backache may persist for fifteen or twenty minutes. 

 Aromatic spirits of ammonia may be administered, and the back- 

 ache may be controlled by a few whiffs of chloroform. Caffeine 

 may be given to stimulate the heart. But all these measures 

 are more or less of the nature of placeboid palliatives. The pa- 

 tient rallies quickly even without treatment, and, except perhaps 

 for the persistence of a frontal headache, soon feels as well as 



