HYPERSENSITIVENESS, PROTEIN INTOXICATION 207- 



peared in waves. It has also been amply demonstrated that the toxic sub- 

 stance formed by manipulating the serum in this manner in vitro produces 

 symptoms when injected into animals such as the guinea-pig that are 

 analogous to anaphylactic shock, but, so far, there are no convincing experi- 

 ments to show that the injection of these inert substances into the normal 

 animal react with the serum of that animal in vivo to form the toxic 

 substances so readily obtained in vitro. It is true that injection into the 

 circulation of guinea-pigs of various inert or colloidal substances such as 

 agar, kaolin, starch or inulin call forth symptoms that simulate anaphy- 

 lactic shock, but Hanzlik and Karsner after experimentation with these 

 substances and a long list of others such as arsphenamin, collargal, gelatin, 

 acacia and peptone which produce what are known as anaphylactoid symp- 

 toms, come to the conclusion that the mechanism of their toxic action is 

 different from that observed in anaphylactic shock. Death of the animal 

 in some instances and particularly after the use of agar is due to pul- 

 monary thrombosis, or, in other instances, is associated with pulmonary 

 hemorrhages, hemolysis or a direct toxic action upon the tissues of the 

 body. Further observations upon the inhibition of symptoms by atropin 

 or adrenalin, upon lung perfusion and muscle strip tests, convince them 

 that the toxic effect of these substances has no bearing on anaphylaxis 

 and should not be confused with it. 



There is, perhaps, one outstanding exception to the negative results 

 which have so far been reported, namely, those of Bordet upon anaphy- 

 laxis with erythrocytes. Bordet has shown that the simultaneous injection 

 of erythrocytes together with their specific anti-serum in the normal guinea- 

 pig will bring about a reaction which simulates the active anaphylaxis 

 caused by the injection of red cells in sensitized animals, and he there- 

 fore concludes that the toxic substance which produces these symptoms is, 

 under these circumstances, formed in the circulation. 



In reviewing the evidence so far brought forward in support of these 

 various theories, one must come to the conclusion that in anaphylactic 

 shock, the cells of the body play an important part in the process. 

 Though most of the positive experiments show that the toxic reactions take 

 place within the cells and are independent of the formation of any 

 poisonous substance in the blood of the animal, still, it is not altogether 

 possible to exclude humoral reactions as aiding in, or playing some part in, 

 the production of the intoxication. 



Whatever the origin of the toxin and wherever the point of attack 

 in the body, there is considerable evidence to show that profound changes 

 take place not only in the metabolism of the cells but in the chemistry 

 of the body fluids. Whether some of these changes are the cause or the 

 effect of anaphylactic shock can not at the present time be ascertained, 

 though it seems probable that many of them must be considered at least 

 as a part of the abnormal reaction. 



