IDIOSYNCRASIES 617 



strychnin, morphin, etc., appear to develop a state of hypersensitive-- 

 ness. My colleague, Dr. Fred Boerner, who is hypersusceptible to 

 quinin and who suffers acutely following the swallowing of small 

 amounts, has recently shown a reaction in his skin following the appli- 

 cation of quinin to an abrasion. 1 Klausner was able passively to sensitize 

 guinea-pigs against iodoform by injecting the serum of a person sensitive 

 to this drug. Examples of drug anaphylaxis or idiosyncrasy are more 

 difficult to explain unless such drugs contain a protein substance. On 

 the other hand, a drug may alter a body protein, rendering it really a 

 foreign protein, and this may sensitize body-cells in the same manner 

 as in the "indirect anaphylaxis" of Richet, referred to in the preceding 

 chapter, following the second chloroforming of a dog. 



As was previously stated, anaphylaxis, or rather the anaphylactic 

 mechanism on the basis of the humoral theory, may be considered one of 

 the essential steps in affording resistance to disease or the state of im- 

 munity. Broadly speaking, the lesions and symptoms of infection may be 

 ascribed to the effects of soluble toxins, endotoxins, and a protein poison. 

 According to our present knowledge the endotoxins are mainly liberated 

 with lysis or disrupture of the bacterial cell. Similarly, the protein poison 

 is produced by cleavage of the bacterial protein substance. Whether the 

 endotoxins and protein poison are identical it is impossible to state. 

 For the present it may be well to consider them as separate entities. 

 In certain infections, such as tetanus and diphtheria, the soluble toxins 

 are chiefly concerned, and these are neutralized by specific antibodies, 

 the antitoxins. The antitoxins are not similar to the " ferment" that 

 splits protein, because they are able to neutralize their toxins without 

 the aid of complement. In other infections, such as typhoid fever, 

 cholera, and pneumonia, the endotoxins and protein poison may be con- 

 sidered the main etiologic factors. The chief antibodies are a cytolysin 

 (bacteriolysin), which disrupts or kills the bacterial cells, and bacterio- 

 tropin, which brings about the same result by favoring phagocytosis. 

 Apparently the cytolysins and the so-called "ferments" responsible for 

 cleaving the protein substance are quite similar in their mechanism. 

 The former are amboceptors, thermostabile and inactive without the 

 presence of a complement. There is no doubt but that heating a serum 

 containing a bacteriolysin and a complement will render the serum in- 

 active through destruction of the complement. While the ferment con- 

 cerned in splitting protein is regarded by many as an amboceptor and 

 complement, there is no general agreement on this point. Some in- 

 vestigators, for example, believe that the ferment concerned in splitting 

 1 Jour. Amer. Med. Assoc., 1917, Ixviii, 907. 



