118 ANAPHYLAXIS AND ANTI-ANAPHYLAXIS 



defined and most constant in their occurrence in the 

 guinea-pig. They are accompanied by fall of blood- 

 pressure, diminished coagulability of the blood, dis- 

 appearance of polymorphonuclear cells from the 

 blood-stream, and spasmodic contraction of the 

 muscles of the bronchioles. With regard to this last 

 sign, Manwaring and Crowe^ have recently carried 

 the matter a step farther by means of perfusion 

 experiments with isolated anaphylactic lungs. They 

 note three types of pulmonary anaphylactic reaction — 

 (i) bronchial anaphylaxis or spasmodic contracture 

 of the muscles of the bronchioles; (2) vascular ana- 

 phylaxis or spasmodic contracture of pulmonary 

 bloodvessels, usually accompanied by oedema; (3) 

 pseudo-anaphylaxis or the plugging of the pulmonary 

 bloodvessels with thrombi and agglutinate masses of 

 corpuscles. 



It appears to be a general rule that the symptoms 

 and signs of anaphylaxis vary with the animal 

 inoculated rather than with the protein used. In 

 man these symptoms have been observed chiefly after 

 injections of antitoxic horse serum in the treatment 

 of diphtheria, tetanus, etc. Here we immediately 

 encounter the question. Is the normal reaction of 

 man to a primary injection of foreign serum an 

 example of anaphylaxis ? Or, in other words, is 

 there any difference between the so-called serum 

 sickness and anaphylaxis ? Goodall,^ who has 

 recently published observations on 3,502 consecutive 

 cases of serum sickness following injections of diph- 

 theria antitoxin, considers that for the present at any 

 rate it is advisable to keep the two conditions dis- 

 tinctly separate. He therefore divides his cases into 

 three classes — ( i ) persons who exhibit ordinary serum 

 sickness after a primary infection — the normal reac- 



1 Proc. Soc. Exper. Biol, and Med,, xiv., p. 173, 1917. 



2 Lancet, i., p. 323, 1918. 



