CHAPTER XVI 



ANAPHYLAXIS (CW.) 



FURTHER DEVELOPMENT AND THEORETICAL 

 CONSIDERATIONS 



WE have now briefly considered some of the fundamental facts 

 which the earlier investigations upon anaphylaxis have revealed and, 

 although there are still many important observations to record, the 

 material so far outlined will serve as a basis for a brief consideration 

 of the views that have been formulated concerning the mechanism 

 of anaphylactic phenomena. 



It is clear that the chapter of anaphylaxis is hardly more than 

 well begun. In the earlier stages of the investigations into this prob- 

 lem many opinions were advanced which served the valuable func- 

 tions of working hypotheses, but were quickly altered, trimmed, or 

 expanded as new and incompatible facts were revealed in astonish- 

 ingly rapid succession. The final solution is probably still far be- 

 yond our present horizon, but the recent knowledge of the toxic 

 derivatives of proteins, "the anaphylatoxins," foreshadowed by the 

 work of Vaughan and his associates, more definitely determined by 

 Friedemann and especially by Friedberger, has furnished hope that 

 we are not only on the right path toward understanding anaphylaxis, 

 but has given us a new clue to the correlation of this condition with 

 immunity. 



It will greatly facilitate exposition of the various theories which 

 have been advanced if we bear in mind that, although there have 

 been many discrepancies on minor phases, the differences of opinion 

 have centered upon the cardinal points. 



These are: 1. Is the anaphylactic phenomenon a true antigen- 

 antibody reaction in which the sensitizing injection gives rise to the 

 formation of a specific antibody with which it reacts on second injec- 

 tion ? 2. Is sensitization the result of effects exerted upon the tissue 

 cells, which participate directly in the reaction, or may the reaction 

 take place entirely in the circulation, the tissue cells being affected 

 secondarily only? 



Upon these two questions we can logically classify theories of 

 anaphylaxis. 



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