36 PHYSICOCHEM1CAL PROPERTIES 



It is then evident that the monosodium compounds will be 

 much more easily and rapidly transformed to bases than the 

 disodium or hyperalkaline compounds. 



But as the monosodium compounds cause crises only when 

 injected rapidly and do not produce them when -injected 

 slowly, we can draw logically this third conclusion, that, if 

 the formation of the precipitate is the primary cause, the 

 origin and the intensity of the disturbance is determined only 

 by the duration of the reaction. And to this conclusion 

 Doerr, Besredka, Mutermilch, and others, have come in 

 order to explain anaphylactic shock as caused by biologic 

 antigens. Thus we see: 



1. That intravenous injections can cause immediate dis- 

 turbance. 



2. That this disturbance arises by the transformation of a 

 soluble sodium compound to an insoluble base, that is to say, 

 to a precipitate. 



3. That the degree of the disturbance is caused by the 

 rapidity with which the reaction takes place. 



And we may therefore conclude that death or non-fatal 

 crisis which immediately follows injection is determined by 

 a reaction which is exclusively intravascular; that it does not 

 result from any toxic reaction of the product but from its 

 mechanical action on the capillary circulation. 



Moreover, this is not the only expfanation which can be 

 given to this phenomenon. The reactions of the organism, 

 however localized they may be, are never simple. The 

 arsenobenzenes can be combined with a series of other sub- 

 stances which exist in the blood plasma and especially with 

 the calcium salts and can thus form compounds which are 

 more or less insoluble. By removing these substances from 

 the blood the injection causes a rupture of equilibrium and 

 especially a modification of plasma coagulability which 

 necessarily reacts on the intracellular fluids. The purely 

 mechanical intravascular action of emboli may therefore be 

 complicated by intimate and complex intracellular reactions 

 as in the case of biologic antigens. And in this case also, it 

 is the factor "time," the rapidity of the reaction, which plays 

 the principal role in the severity of pathologic manifestations. 



