ANAPHYLAXIS OR ALLERGY 199 



There is, however, iimch doubt as to the identity of the process of 

 anaphylatoxin formation (as it occurs when antipon, antibody and 

 complement are incubated in vitro) and the process of anaphylactic 

 intoxication. In the first place, a poisonous character, apparently 

 identical with this "anaphylatoxin" may be given to serum without 

 the use of any specific antibody whatever; merely agitating fresh 

 serum with anv finely divided foreign material that offers large total 

 surfaces, such as kaolin, agar, or starch, is suflficient, as also is treat- 

 ment with lipoid solvents, such as chloroform (Jobling). In fact, 

 merely removing the fibrin from the plasma may make the resultant 

 serum highly toxic, even for the very animal from which it came. 

 Furthermore, if anaphylactic shock were the result of anaphylatoxin 

 formation in the sensitized animal through the reaction of antigen with 

 antibody and complement, the intoxication should occur if antibody 

 and antigen are injected simultaneously into an animal; but as a mat- 

 ter of fact the animal receiving antibody in passive sensitization will 

 not react unless the antigen is injected at least three hours after the 

 sensitizing serum is injected."** This incubation period is supposed 

 to be required for the anaphylactic antibody to be fixed in the cells 

 where the reaction takes place (Otto), and perhaps, in modification 

 of the antibody so that it has a greater affinity for the antigen than 

 it has while free in the serum (Weil) ;^° also in acquiring the capacity 

 to affect the cells after union with the specific antigen. Finally, the 

 isolated nonstriated muscle tissue (uterus) of a sensitized animal gives 

 specific reactions when brought in contact with the specific antigen, no 

 matter how thoroughly the animal's blood has been removed from the 

 tissues; whereas, the uterine muscle of an animal injected with sensi- 

 tizing immune serum only one hour before killing does not react when 

 in contact with specific antigen. Weil disputes the toxic nature of ana- 

 phylaxis, even in the intracellular reaction, which he calls a "cellular 

 discharge." He holds that in the guinea-pig the cellular reaction 

 takes place chiefly in the nonstriated muscles, while in dogs the reaction 

 is essentially hepatic, resulting in a profound congestion of the liver 

 and consequent fall of blood pressure, decreased blood coagulability 

 from hepatic action, and the increase in proteolytic products in the 

 blood characteristic of all acute hepatic injuries. ^^ Even in the 

 guinea-pig, however, the liver is affected in anaphjdactic shock, and 

 Meinicke^- adds to the evidence of cellular anaphylaxis by finding that 

 the perfused liver of sensitized guinea-pigs reacts to antigen with a 

 marked inhibition of its capacity to form urea from ammonium lactate. 



Nevertheless, the formation of anaphjdatoxin is an interesting phe- 

 nomenon which may well be of importance in human intoxications, 



*^ See Weil, Jour. Med. Res., 1914 (30), S7; Jour. Immunol., 1916 (1), 109. 

 ^^ Jour. Med. Res., 1915 (32), 107. 

 " Jour. Immunol., 1917 (2), 525. 

 " Zeit. Immunitat., 1918 (27), 489. 



