EYPERSENSITIVEHESS, PltOTEIN INTOXICATION 203 



of the symptoms that occur during acute and chronic anaphylactic shock, 

 and it has been found on observation, indeed, that in practically all animals 

 studied, peristalsis of the small intestine is greatly increased. 



Although the liver seems to be unaffected in typical anaphylactic 

 shock in sensitized guinea-pigs, rabbits and cats, this organ plays an 

 important part in anaphylaxis of the dog. Manwaring was the first 

 to call attention to this fact and stated th.at removal of practically all 

 the viscera, except the liver, of a dog sensitized with horse serum does not 

 prevent the occurrence of a pronounced drop in the blood pressure when 

 this animal is reinjected with the protein to which it has been sensitized. 

 If, however, the liver alone is excluded from fhe general circulation, the 

 characteristic drop in blood pressure can usually be prevented. Voegtlin 

 and Bernheim corroborated Manwaring's experiments, and by employing 

 sensitized Eck-fistula dogs, showed that when the portal vein near the 

 hilus of the liver and the hepatic artery were clamped, reinjection of 

 horse serum did not produce a fall in pressure. When the clamp was 

 removed and the circulation in the liver re-established the blood pressure 

 fell rapidly. They also demonstrated that if the Eck-fistula was per- 

 formed before the first injection of foreign protein, the animal, on re- 

 injection, rarely showed the symptoms of anaphylactic shock, suggesting 

 that the Eck-fistula in some way had interfered with sensitization. 

 Denecke has confirmed these experiments, using egg-white, and concludes 

 that in the dog the liver is necessary both for sensitization and for the 

 production of anaphylactic shock. Weil, too, has pointed out the im- 

 portance of the liver in the symptomatology of anaphylactic shock in dogs 

 and has shown that during the period of shock the liver is enormously 

 engorged with blood. Simmons in "a recent note has pointed out the fact 

 that in the dog the hepatic vein has a rich musculature, and suggests that 

 during anaphylactic shock these vessels may undergo marked constriction. 



The most important alterations in the blood and blood-forming organs 

 are to be observed in changes in the coagulability of the blood and in the 

 cellular constituents. The fluidity of the blood and marked delay in coag- 

 ulation during anaphylactic shock, which Biedl and Kraus(o-) observed 

 in their early experiments upon dogs has been noted quite regularly in 

 most species of animals dying of acute shock. According to Sirensky this 

 is dependent upon the diminished fibrinogen content of the serum. Pepper 

 and Krumbhaar concluded from a study of the delayed coagulation of the 

 blood in anaphylactic dogs that the diminished coagulability was dependent 

 upon either a decrease in thromboplastin or an excess of antithrombin. 



Lee and Vincent believed that they could show in guinea-pigs that 

 anaphylactic shock caused an injury to blood platelets which are rich in 

 thromboplastic substance. In serum disease in man, a decrease in coagula- 

 tion time may occur, but that actual purpura may develop during serum 

 sickness without change in coagulation time, bleeding time, or number of 



