204 WARFIELD T. LONGCOPE AND GEORGE M. MACKENZIE 



platelets is evident from a case reported by Meleney. There has been as 

 little uniformity in the technique employed as in the results obtained so 

 that a definite statement as to how the delay in coagulation is brought 

 about must await further investigation. In a paper by Shattuck will be 

 found reference to the more important studies on this problem. 



The cellular reaction observed by v. Pirquet and Shick in serum dis- 

 ease in children consists in a preliminary leukocytosis, with increase in 

 polymorphonuclear leukocytes and, later, a leukopenia with well-marked 

 relative increase in the lymphocytes. In animals, apparently the charac- 

 teristic reaction of acute shock consists in a marked leukopenia, followed, 

 when recovery ensues, by a moderate polymorphonuclear leukocytosis and 

 a return to normal within 24 to 48 hours. In acute shock, an increase in 

 the eosinophile cells of the blood is not observed, but after repeated local 

 injections of a foreign serum, Schlecht and Schwenke have observed 

 local collections of eosinophilic leukocytes, and Rackamann has noted 

 variations in the cellular reaction of the peritoneal fluid of the guinea-pig. 



It will be seen from what has already been said that the action of the 

 poison producing anaphylactic shock is directed towards the smooth 

 muscle of various portions and organs of the body and that many of the 

 symptoms, though they vary in different species, are dependent upon the 

 contractions or dilatations of the smooth muscles of the bronchi, of the 

 walls of the intestines, and of the blood vessels in such organs as the lung 

 and the liver. Definite proof of this action was first brought forward 

 by Schulz and later by Dale and his co-workers. They have shown that 

 the cornu of the uterus of a virgin guinea-pig sensitized to a. specific 

 protein reacts specifically by characteristic contractions, when it is brought 

 in contact outside of the body with the protein to which the guinea-pig 

 has been sensitized. This reaction has been found to be highly delicate 

 and sensitive and occurs when the smooth muscle has been washed free of 

 all blood and body fluids. Under the conditions of the experiment the 

 reaction, moreover, is highly specific, and the characteristic contraction 

 cannot be obtained, either by the addition of the guinea-pig's own serum 

 or by proteins other than that to which the guinea-pig has been sensitized. 

 The same principles, moreover, hold for the reactions of the muscle 

 strip as obtain for the anaphylactic reactions in the guinea-pig, for it is 

 possible to desensitize the smooth muscle by the additions of protein up 

 to the normal limit of contraction. After the muscle strip has been treated 

 in this manner it no longer reacts when bathed in the specific serum. Not 

 only is this specific reaction obtained with the smooth muscle of the uterus 

 from actively sensitized guinea-pigs, but it may likewise be demonstrated 

 after the passive sensitization of a guinea-pig when the strip of washed 

 smooth muscle will react characteristically if suspended in fluid to 

 which the specific protein has been added. The sensitiveness of the 

 smooth muscle, after active sensitization, appears on the 6th to the 8th 



