ANAPHYLAXIS 267 



the following way which the author has not seen presented. 

 The enzymes necessary to decompose the injected protein 

 are present in certain cells and are formed in larger amount 

 by those cells to meet the increased demand due to injection 

 of an excess of protein. They are retained in the cell for a 

 time at least. If a second dose of protein is given before the 

 enzymes are excreted from the cells as waste, this is digested 

 within the cells in the normal manner. If a third dose is 

 given, the cells adapt themselves to this increased intra- 

 cellular digestion and it thus becomes normal to them. 

 Hence the immunity is due to this increased intracellular 

 digestion. 



On the other hand, if the second injection is delayed long 

 enough, then the excess enzyme, but not all, is excreted from 

 the cells and meets the second dose of protein in the blood 

 stream and rapidly decomposes it there, so that more or less 

 intoxication from the split products results. This uses up 

 excess enzyme, hence subsequent injections are not digested 

 in the blood stream but within the cells as before. So that 

 " antianaphylaxis" is dependent on the exhaustion of the 

 excess enzyme in the blood, and the condition is funda- 

 mentally the same as protein immunity. 



As has been indicated "sertim sickness" and sudden death 

 following serum injections are probably due to a sensitization 

 of the individual to the proteins of the horse in some unknown 

 way. Possibly urticarial rashes and idiosyncrasies follow- 

 ing the ingestion of certain foods — strawberries, eggs, oysters, 

 etc., may be anaphylactic phenomena. 



In medical practice the reaction is used as a means of 

 diagnosis in certain diseases, such as the tuberculin test in 

 tuberculosis, the mallein test in glanders. The individual 

 or animal with tuberculosis becomes sensitized to certain 

 proteins of the tubercle bacillus and when these proteins in 

 the form of tuberculin are introduced into the body a reac- 

 tion results, local or general, according to the method of 

 introduction. The practical facts in connection with the 

 tuberculin test are also in harmony with the author's theory 

 of anaphylaxis as above outlined. Milder cases of tubercu- 

 losis give more vigorous reactions because the intracellular 



