INTERNAL SECRETION AND DISORDERS OF LIVER 679 



ciency may impair the normal emergency reproduction of blood proteins. 

 Additional experiments of Whipple, Smith and Belt (1920) indicate that 

 the blood serum proteins are stabilizing or protective factors. These 

 observers state that such proteins are essential environmental factors of 

 the circulating blood in its relation to the body cells and that this may be 

 the most important function of these plasma colloids. Other experiments 

 by the authors indicate that the liver cells are particularly concerned in 

 the shock reaction which follows plasmapharesis. A fatal shock reaction 

 is almost constant following even moderate plasma depletion preceded by 

 liver injury. This would indicate that the liver cells are particularly con- 

 cerned in the shock reaction which may follow plasmapharesis and lower- 

 ing of the blood plasma protein values. It may be that this type of shock is 

 not unlike the common surgical shock. The evidence in their experiments 

 also gives strong support to the theory that in shock there is a primary cell 

 injury which precedes the familiar clinical reaction. 



Substances Involved in Anaphylaxis as Hepatic 

 Internal Secretions 



Anaphylaxis and Antithrombin. Manwaring (a) (&) (1910), in ex- 

 periments on the mechanism of anaphylactic shock in dogs, demonstrated 

 that in the absence of some of the abdominal organs, especially the liver 

 and the intestine, shock cannot be produced. It was pointed out that the 

 pronounced fall of blood pressure, which is the essential feature of the acute 

 anaphylactic reaction in dogs, is not due to the direct action of a foreign 

 protein on the sensitized blood vessels, but is an indirect phenomenon, due 

 to the explosive formation or liberation of depressor substances by the 

 liver. Voegtlin and Bernheim (&) (1911), working with Eck fistula dogs, 

 conclusively demonstrated that the liver is essential for the development 

 of anaphylactic shock. This fact has been confirmed by Denecke (1914) 

 and renders certain that the liver is essential for the vasomotor depression, 

 inasmuch as the latter fails to supervene if the liver is excluded from the 

 circulation. 



In the guinea pig the vasomotor disturbance plays a small part in the 

 acute shock of anaphylaxis, but in its stead there occurs a spasmotic closure 

 of the bronchioles by their circular musculature, with inspiratory fixation 

 of the lungs and asphyxia. Manwaring and Crowe (1917) and Rumpf 

 (1918) submit experimental evidence which tends to show that the liver 

 may also be concerned in the development of anaphylaxis in guinea pigs. 



Weil (b) (1917) has shown that peptone affects the liver in exactly the 

 same fashion as anaphylaxis. The isolated organ, when perfused thereby, 

 renders the blood incoagulable. Injection into one branch of the portal 

 vein induces a localized area of hepatic congestion. It is also emphasized 



