PATHOGENESIS 291 



"There are, in fact, two distinct groups of phenomena 

 which must be differentiated. Firstly, there is preparation for 

 the anaphylactic state that is to say, the injection of 

 anaphylactising substances, which we will call for simplicity 

 preparatory substances ; and, in the second place, there is the 

 exciting of anaphylaxis by the second injection, with the 

 production of the leading symptoms of anaphylaxis itself ; we 

 shall call these exciting substances." 



2. "The anaphylactic state lasts many weeks"; i.e., on 

 my interpretation, the incubation or " alloy "-formation takes 

 time. 



3. " There may be some similarity between anaphylaxis 

 and immunity"; i.e., both phenomena, I believe, represent a 

 reaction to poisons, be it by neutralisation or by more or less 

 pathogenetic adaptation, both of which must be at the expense 

 of vitality. 



4. " Anaphylaxis is to a certain extent specific; that is to 

 say, the second injection should be of the same nature as the 

 first " ; i.e., the reaction of the body is definite and apparently 

 purposive to meet a definite contingency of which it has, as it 

 were, received notice.* 



5. "The symptoms of anaphylaxis are immediate and 

 intense, while the symptoms of primary intoxication are 

 mild"; i.e., in my view the body, unable to meet renewed 

 stimulation by further neutralisation of the poison and com- 

 pelled to battle for its very life, proceeds to a violent effort, a 

 violent "elan" to eject the impurities in toto. Having 

 received a primary infection it is somewhat prepared to deal 



* I do not deny, of course, that the healthy body can be made to react in a 

 particular manner by means of inoculations. What I insist upon, however, is, that 

 it remains to be seen in every case whether a genuine prophylaxis is thus to be 

 contrived or whether the result is not in reality r ' ana." i.e., "away from " phylaxis, 

 i.e., pathogenesis. I insist that a special physiological investigation would be 

 required in every case ; such investigation to determine not only the immediate 

 and expedient gains, but also the complete subsequent, latent and hereditary 

 effects of the stimulations and changes involved. Who is Who ? physiologically 

 and pathologically before and after the operation ? What is the value of the 

 inoculation in the sum total of racial vitality? These are the important matters 

 that require urgently to be determined. 



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