RECENT WORK ON ANAPHYLAXIS 121 



this reason he advises injecting serum by the spinal 

 route. 



True anaphylaxis in man therefore consists in a 

 typical symptom-complex following a second injec- 

 tion of protein after an interval of at least ten days. 

 These symptoms are urticarial and erythematous 

 rashes, oedema of the skin and of the mucous mem- 

 branes of mouth, nose, pharynx, and upper respira- 

 tory passages, vomiting, abdominal pain and diar- 

 rhoea, dyspnoea, collapse, and occasionally death. 

 We have seen, also, that the normal serum reaction 

 consists in slight and transient symptoms of much 

 the same character. Until pathological investiga- 

 tions have carried us further, it is suggested that 

 we should refer to this latter group with sHght symp- 

 toms as serum sickness, and retain the word anaphy- 

 laxis for the more serious cases following second 

 injections. It may be that the difference is only 

 one of degree, in which case we must presuppose a 

 sensitising dose or some equivalent, but the distinc- 

 tion will at any rate serve to emphasise certain points 

 in the theory and practice of sensitisation. 



Several other conditions in man shew symptoms 

 very closely resembling true serum anaphylaxis — 

 e.g., (i) the so-called food anaphylaxis, (2) insect 

 stings, (3) the state of hypersensitiveness to certain 

 drugs, sometimes referred to as drug anaphylaxis. 



Food anaphylaxis has been dealt with in Chapter V. 

 of this work by Besredka. It is a question which 

 raises numerous difficult problems still requiring 

 elucidation. Vaughan,^ for example, states that the 

 sensitising group resulting from protein digestipn is 

 destroyed in normal digestion, and that it is only 

 under abnormal conditions that protein sensitisation 

 results through the alimentary canal. Whether or 

 not all proteins contain this sensitising group, and 

 ^ Vaughan, loc. cit. 



