ANAPHYLAXIS IN MAN 139 



viduals who exhibit an "idiosyncrasy" to one or another of these 

 substances. This idiosyncrasy to foreign protein may be either 

 congenital or post-natal; the protein is supposed to have passed 

 unchanged through the intestinal tract in the latter case. The pheno- 

 mena in these instances are explained on the basis of sensitization 

 with specific protein; a mild anaphylactic reaction occurs when 

 the specific dust reaches the nasal mucous membrane or the specific 

 protein enters the digestive tract. 



The tendency at the present time is to regard certain clinical and 

 pathological symptoms of bacterial infections particularly fever 

 and the production of specific pathological lesions as manifestations 

 of anaphylaxis as outlined by Vaughan. 1 The body is sensitized to 

 the alien protein, be it organic dust, protein of the food, or invasive 

 bacteria; the anaphylactic reaction takes place when the homologous 

 protein is brought into contact with the sensitized individuals through 

 the proper channels. It will be remembered that the incubation period 

 in many bacterial infections was explained as the time elapsing between 

 the arrival of the alien protein (bacterial cells) in the tissues of the 

 host and the maturing of a specific proteolytic enzyme that would 

 effect their disintegration. The symptomatology of bacterial infec- 

 tions, according to Vaughan, is largely due to the liberation of the 

 anaphylatoxin incidental to the lysis of the residual organisms. 



Artificial or Acquired Hypersensitiveness. The phenomena 

 grouped for convenience as acquired hypersensitiveness are met with 

 chiefly in connection with the administration of the sera of animals 

 immunized for therapeutic purposes. Three types of anaphylactic 

 reaction may be recognized: 



1. Sudden Death. A very few cases are on record in which the 

 administration of antitoxin for therapeutic purposes, either for 

 immunization or curatively, has been followed within a few minutes 

 or hours by death. Already, in 1896, Gottstein 2 had collected 12 

 which followed the injection of diphtheria antitoxin, 8 of whom were 

 diphtheritic, 4 healthy individuals. About 1 in every 50,000 appears 

 to be the proportion of deaths due to an injection of therapeutic sera. 

 The symptoms are essentially those observed in sensitized experi- 

 mental animals which die shortly after the injection of the homologous 

 protein. Behring, Kitasato and other observers had noticed many 

 years ago, when antitoxin was first prepared on a large scale, that 

 animals immunized with large amounts of tetanus or diphtheria toxin 



1 Loc. cit. 



2 Therap. Monatschr., 1896, Heft 5. 



