200 WARFIELD T. LONGCOPE AND GEORGE M. MACKENZIE 



In man, primary injection of horse serum is followed in a certain 

 proportion of cases by the condition known as serum sickness. The fre- 

 quency of serum sickness varies to a certain extent with the dose of serum 

 employed, increasing in frequency with the size of the dose until, when 

 50 c.c. of horse serum are injected intravenously, about 90 per cent of 

 the patients develop serum sickness. The disease usually makes its ap- 

 pearance 7-10 days after the injection of serum and is characterized by 

 the appearance of urticarial, erythematous or scarlatiniform eruptions, 

 by an enlargement of the lymph nodes and, in a certain proportion of 

 cases, fever, edema of the eyelids and of the extremities, and arthralgia. 

 Rarely, there are gastro-intestinal disturbances. In children, as observed 

 by von Pirquet and Pick, there is at first a polymorphonuclear leukocytosis. 

 Later the leukocytes become normal or even decreased in number, and 

 the relative proportion of lymphocytes is increased. Von Pirquet and 

 Schick, who first studied completely this disease, described the above symp- 

 toms as occurring in the normal form of serum disease, whereas a second 

 injection, made months or years after the first, might result in the so-called 

 accelerated reaction, in which the above symptoms occurred within 36 

 days after the injection of serum; or a third variety, termed by them 

 the immediate reaction which took place within 24 hours after the in- 

 jection. Immediate reactions may rarely be fatal and are accompanied 

 by severe and generalized urticaria, engorgement of the face and neck with 

 great cyanosis, great respiratory difficulty simulating an acute and violent 

 attack of asthma, prostration and collapse. 



It may be mentioned here that the most serious symptoms which have 

 occurred in man, and the individuals who for the most part have suc- 

 cumbed, do so after the first injection of foreign protein. These individu- 

 als, as far as can be learned, have not received previous injections of the 

 specific proteins to which they react and have been termed naturally hyper- 

 sensitive individuals. 



The numerous studies which have been made upon the physiology, 

 pharmacology and chemistry of anaphylaxis have resulted in an enormous 

 amount of work, and no attempt will be made here to present a compre- 

 hensive review of this subject nor to discuss the various theories regarding 

 the mechanism of sensitization or of shock. Several reviews of the subject 

 and extensive bibliographies are readily available, and the object of this 

 chapter is to present a description particularly of the disturbances of 

 metabolism, that are precipitated or associated with anaphylaxis and 

 allied phenomena. 



It need only be pointed out that the physiological studies upon animals 

 suffering from anaphylactic shock have shown that changes take place in 

 different structures and different organs, the localization varying somewhat 

 in the several species of animals that have been investigated. 



The important studies of Auer and Lewis first showed the effect 



