ANAPHYLAXIS 407 



lowed closely in the footsteps of experiments on transfusion, and as 

 early as 1666 a commission of the London Koyal Philosophical So- 

 ciety reported deaths following transfusion, alleging intravascular 

 coagulation as the probable cause of deatk 



The cause of death following injections of foreign whole blood, 

 blood cells, and serum has, since that time, occupied the attention of 

 many workers whose studies need not be reviewed for our present 

 purposes. Chief among them were Magnani, Brown-Sequard, Ma- 

 gendie, and, more recently, Naunyn, Landois, and Ponfick. 72 



The work of Landois is of special interest in that he worked 

 with blood serum free from cells, and attempted to correlate the 

 occurrences after the injection of animals with the action of the 

 serum upon the cellular blood elements in vitro. Landois observed 

 both the solution of hemoglobin and hemagglutination, and was 

 led to regard the action of serum upon erythrocytes as the primary 

 cause of death after transfusion. His conception of the mechanism 

 is apparently twofold. On the one hand, he believed that when 

 small quantities of blood were transfused, a formation of fibrin 

 (stroma-fibrin) was initiated in the stroma of the injured erythro- 

 cytes which led to coagulation and thrombosis in the capillaries of 

 the central nervous system and lungs. In the case of the transfusion 

 of rabbit's blood into dogs he attributed death to embolism in the 

 pulmonary vessels due to "Massenhafte Verklebung der Kaninchen- 

 zellen im Hundeblut" or, in other words, to hemagglutination. 



Ponfick and others have disputed the validity of Landois' con- 

 clusions, but the basic principles of his explanations have been up- 

 held within recent years by workers who have gone over the same 

 ground with the aid of more modern methods. Two careful re- 

 searches have appeared during the last two years in which the prob- 

 lem has been approached by different routes, but in which the gen- 

 eral conclusions show much agreement. Coca, 73 investigating the 

 cause of death following the injection of washed blood cells into ani- 

 mals of different species, concludes that in these cases death is due to 

 mechanical obstruction of the pulmonary circulation owing to ag- 

 glutination of the injected cells. It is important to note, however, 

 that he adds in his conclusions the following paragraph: "The 

 mere presence of specific agglutinins does not suffice, in the injection 

 of 'toxic 7 erythrocytes, to occlude the pulmonary circulation. The 

 cooperation of another factor must be assumed a factor probably 

 found in the capillary walls." 



Loeb, Strickler, and Tuttle, 74 investigated the cause of death fol- 

 lowing the injection of normal dog and beef sera into rabbits. They 



72 A brief historical review of this work can be found in the paper of 

 oca (1), Virchow's Arch. f. path. Anat., 1909, Vol. 196, p. 92. 



73 Coca. Virchow's Archiv, Vol. 196, 1909. 



74 Loeb, Strickler, and Tuttle. Virchow's Archiv, Vol. 201, 1910. 



