ANAPHYLAXIS 397 



that in all probability at least as far as experimental ingenuity 

 has permitted us to penetrate into this very difficult problem up to 

 the present time the phenomenon of anaphylaxis must be regarded 

 as an acute intoxication, the poison which calls it forth being the re- 

 sult of the union of an antigen and its antibody, the complex being 

 subsequently subjected to proteolysis by the action of alexin or com- 

 plement. The experimental extension of this conception to the phe- 

 nomena of bacterial anaphylaxis has promised to exert such an im- 

 portant influence upon our conceptions of infectious disease that we 

 will take up these investigations in a separate section. Although it 

 seems proved with reasonable certainty, however, that the above 

 mechanism accounts for anaphylactic shock as produced in the ordi- 

 nary experiment, there are still a number of important questions 

 which await further solution. Among these is primarily the question 

 as to whether or not we are justified in excluding finally the possible 

 primary participation of the body cell in all cases of anaphylaxis and 

 the problem of the identification of the anaphylactic reaction body 

 with any of the known antibodies. 



Many of the arguments we have cited notably those of Friede- 

 mann and Friedberger seem to exclude the participation of the 

 cells and tissues in the anaphylactic reaction as experimentally pro- 

 duced, or, rather, seem to show that shock can be explained without 

 resort to cellular participation. However, there are certain experi- 

 mental data which cannot be ignored which point toward the 

 participation of cell-changes in the condition of sensitiveness ; and 

 while it is probable that anaphylactic poisons may be suf- 

 ficiently formed in the circulation to cause shock in the rough 

 procedures which must mark even our most delicate experiments, 

 there is in addition to this much evidence of an alteration of cellular 

 susceptibility which influences the anaphylactic phenomena. The 

 question is not absolutely settled to-day and it is a problem in which 

 it is useless to speculate. We must attempt to approach it, there- 

 fore, by citing the evidence which has been advanced on both sides. 

 Some of these data we have already discussed, in connection with 

 passive sensitization, on page 383. 



JQ, The opinion of v. Pirquet was originally that there must be a 

 change in susceptibility in the cells to account for the various skin 

 reactions, assuming these analogous to anaphylaxis. Experiments 

 which seem to bear this out are those of Schultz 41 upon the increased 

 sensitiveness to serum of the excised smooth muscle of anaphylactic 

 animals. It had been shown that smooth muscle contracts when 

 brought in contact with serum. That of sensitized guinea pigs 

 showed a markedly greater susceptibility in this respect. Of great 

 importance in pointing to primary cell participation also it seems to 



41 Schultz. Jour, of Pharm. and Exp. Therap., 1, 1910. 



