RECENT WORK ON ANAPHYLAXIS 123 



of some constituent of the serum leads to a breaking 

 down of serum proteins, with liberation of toxins. 

 Animal experiments on this subject are quoted by 

 Besredka in Chapter V. of this work. The whole 

 subject needs a great deal of investigation. It may 

 be that it will help to bridge the gap which at present 

 exists between true serum anaphylaxis as we see it 

 following serum inoculation and the state of hyper- 

 sensitiveness to a specific toxin (the so-called 

 " bacterial anaphylaxis ") found in many of the 

 infective diseases, such as tuberculosis, syphilis, and 

 others. Indeed, this analogy has been carried yet 

 a step furtlier, and " it has been argued with some 

 plausibility that a man may be sensitised by the 

 degeneration products of his own tissues, and that 

 this is an explanation afforded of some of the curious 

 outbursts which are occasionally witnessed in such 

 affections as nephritis, especially when they are 

 chronic " (Goodall).^ On the other hand, we are 

 faced with phenomena, such as those of " serum 

 fastness " and " drug fastness," which point to an 

 acquired and generally specific resistance on the part of 

 the animal body. It is clear, therefore, that we have not 

 yet by any means solved this very difficult problem. 

 Bacterial anaphylaxis, a state of hypersensitiveness 

 produced by the liberation of the foreign protein of 

 bacteria by the process of bacteriolysis, has of late 

 years been made responsible for the symptoms of 

 the acute exanthemata. The incubation period 

 {J. Mcintosh)^ and the presence and distribution of 

 secondary rashes point in this direction, but certain 

 wide differences between the clinical pictures of the 

 various exanthematous diseases have still to be 

 accounted for on this hypothesis. As the result of 

 an analysis of loo cases of secondary rash in acute 



^ Loc. cit. 



2 Quarterly Journal of Medicine, vii., p. 272, 1913-14. 



