368 



INFECTION AND IMMUNITY 



those of true anaphylaxis. We cannot go into the controversial 

 literature in this place, but may set down our own opinion that 

 we think that the time interval between observation of symptoms 

 and injection, on first administration, the speeding up of symptoms 

 in cases of second and third injections, the nature of the symptoms, 

 and the relationship between serum sickness and antibody formation 

 in the patient, as pointed out by C. W. Wells, 52 as well as more 

 recently by MacKensie and Longcope, 53 together with the phenomena 

 of desensitization of patients, leave little room for doubt that this 

 peculiar condition is fundamentally of an anaphylactic nature. 



It is not so easy to include in true anaphylaxis the apparently 

 inherited sensitiveness to foreign proteins most frequently observed 

 as food idiosyncrasies. Whether or not these belong into the cate- 

 gory of anaphylaxis, the future must reveal. 



SKIN REACTIONS. There are two kinds of skin reaction, s one which 

 can be obtained, for instance, in horse serum sensitive people by the 

 injection of minute quantities, 0.1 to 0.01 c.c. of horse serum intra- 

 cutaneously injected. In these cases, within a few minutes to one- 

 half hour, a growing urticarial wheal begins to appear which fades 

 again within an hour or longer. This reaction has been variously 

 used to determine whether or not patients possessed a high degree 

 of sensitiveness just before the administration of therapeutic sera. 

 We have recently experimentally studied the relationship of such 

 immediate skin reactions with generalized anaphylaxis in guinea 

 pigs, and have found that the two phenomena correspond with con- 

 siderable accuracy, namely, that guinea pigs give definite immediate 

 skin reactions during the periods at which they are highly sensitive 

 to intravenous injections, and that recovery from severe anaphylactic 

 shock desensitized them not only to general anaphylaxis but to the 

 skin reaction as well. 



There is another form of skin reaction typified by the tuberculin 

 reaction and the typhoidin reaction in which very little manifest 

 change occurs during the first two hours, but in which after twelve 

 to twenty-four hours, definite inflammatory swellings occur at the 

 point of injection with the occasional development of a little central 

 neucrosis and hemorrhage, and true cell injury. Such reactions 

 fade only after three or four days or longer, and are similar in 



62 Wells, C. W., Jour. Infec. Dis., 16, 1915. 



53 MacKensie and Longcope, Med. Sec. N. Y. Academy Med. April, 1921. 



