RELATION OF ANAPHYLAXIS TO INFECTIOUS DISEASES 607 



When the antibodies appear, we may rightfully assume that a ferment, 

 in the nature of a protein amboceptor or lysin, appears with the antitoxin, 

 and theoretically we may expect a clinical reaction due to the protein 

 poison or anaphylatoxin liberated from the bacilli. It may be that 

 diphtheria antitoxin is in the nature of this ferment, or antitoxin and 

 ferment may exist together and in this manner afford an explanation 

 for the local destruction of the bacilli and the cleaning up of the mem- 

 brane, the effects of the anaphylatoxin being overshadowed by the true 

 toxin, or expressing itself in the paralyses and other symptoms commonly 

 ascribed to the toxones. von Pirquet concedes that in scarlatina the 

 primary symptoms of the malady, i. e., the eruption and angina, are due 

 to a pure toxin effect, to the true scarlatinal virus, but that the sequelae, 

 and notably the nephritis, are the expression of the action of anaphyla- 

 toxins that are formed when the corresponding antibodies are produced. 

 Likewise in such infections as typhoid fever and pneumonia, I 

 cannot eliminate the action of true toxins and endotoxins, and ascribe 

 all the symptoms to a protein poison or anaphylatoxin. It is not al- 

 ways true that the incubation period is devoid of symptoms. Mild 

 and evanescent symptoms are frequently present, and it is but natural 

 to ascribe these to the effects of bacterial products themselves. After 

 a time, when the bacteria have multiplied and reached special tissues, 

 the symptoms become more intense and the typical lesions are produced. 

 These may be ascribed to the result of the combined action of toxins 

 themselves and the protein poison, rather than to the protein poison 

 itself to the entire exclusion of the metabolic products of the bacteria. 

 In the present state of our knowledge it is, of course, very difficult to 

 decide which symptoms in a given disease are due to bacterial toxins, 

 which to endotoxins, which to ptomains, which to a mechanical action 

 of the bacteria, and which to the protein poison or anaphylatoxin. 

 While it is perfectly true that we can now understand symptoms as due 

 to protein poison that cannot be ascribed entirely to toxins and endo- 

 toxins, it seems to me unwise to ascribe all lesions and symptoms to the 

 toxins, on one hand, or the protein poison, on the other. It is necessary 

 for us to know the manner in which the protein poison is produced, 

 how infection is so closely allied to what we know as anaphylaxis, and 

 that in any one disease, such as diphtheria, tetanus, and pneumonia, the 

 toxins and endotoxins are of primary and immediate importance, whereas 

 in others, such as smallpox, chickenpox, and whooping-cough the protein 

 poison itself is of primary importance and that in all disease all factors 

 may be concerned to a more or less degree. 



