166 ANAPHYLAXIS IN ITS RELATION TO DISEASE 



If now we pass on to a consideration of an infection with an 

 organism which is a pure toxin producer the interpretation of the 

 clinical picture will be different. In diphtheria, for example, we have 

 coincidently with the multiplication of the invading organisms 

 a production of toxin. This in itself is, of course, quite sufficient to 

 account for practically all the clinical symptoms that we observe. 

 These set in early, since comparatively few organisms are capable 

 of producing toxin in sufficient amount to call forth clinical evidence 

 of disease. There is hence not the usual incubation period of eight 

 days, and the initial symptoms in any event are not due to any 

 antigen-antibody reaction, but to the toxin itself. When the anti- 

 bodies then appear we may, of course, rightfully assume that pre- 

 cipitins are formed, as well as lysins and antitoxins, and theoretically 

 we might expect a clinical reaction due to anaphylatoxins. Clini- 

 cally, however, we have no clear evidence of this, which is probably 

 owing to the fact that the toxin effect by itself controls the entire 

 picture. In scarlatina, v. Pirquet concedes that the primary malady, 

 i. e., the eruptive fever per se, is similarly a pure toxin effect, but 

 that the sequelae, and notably the nephritis, are the expression of the 

 action of anaphylatoxins, which are formed, if at a time when the 

 corresponding antibodies are present, an autoreinfection (from 

 a broken-down lymph gland for example) occurs. A toxin effect, 

 of the primary type, is then not produced, since antitoxins are at 

 the time present in sufficient quantity to counteract their effect 

 (Fig. 10). 



It would, of course, lead too far to continue the analysis of the 

 different infectious diseases along these lines, but I believe to have 

 shown that the anaphylactic principle serves to explain many points 

 in clinical symptomatology for which an adequate explanation has 

 heretofore been lacking. If we consider that the absorption of alien 

 proteins (and hence of bacterial proteins) probably always gives 

 rise to the production of corresponding antibodies of the anaphyl- 

 actin type, we can also understand that there is probably not a 

 single infectious disease in which they are not formed, and in which 

 they cannot, theoretically at least, play an active part. Besides 

 the diseases already discussed this would certainly seem most likely 

 in syphilis, in typhoid fever, measles, glanders, and pneumonia, and 

 future studies of these diseases from this standpoint will, no doubt 

 lead to interesting results. All along the line a start has indeed only 



