Anaphylaxis

“ This investigator showed for the first time that anaphylaxis in rabbits is characterized by a marked drop in blood pressure. This drop in blood pressure Arthus considers the most delicate indicator of anaphylaxis. In 1910 Cesaris-Demel described the effects which were produced when the excised heart of a sensitized rabbit was perfused with a dilute solution of the same proteid which caused sensitization. ”

“ These cases often end in death. Examination of the history of such individuals often shows that they were subject to asthma, or possessed a peculiar idiosyncrasy to the odor of horses which brought on the symptoms of hayfever and asthma. Cases of this kind are probably examples of anaphylaxis in spite of the apparent absence of any sensitizing injection, for this state of sensitization could easily be attributed to inheritance or to a gradual sensitization via the lungs or the stomach. ”

“ The remarkable fact is now established that an organism may be so altered by the injection of an apparently perfectly harmless proteid, that a subsequent injection of the same proteid acts like a violent poison. Predisposition of an individual to any substance means now that this individual is sensitized to this substance. How this sensitization has been accomplished is still undecided in many instances, but the basic conceptions of anaphylaxis will be a safe guide in solving the problem. ”

“ If the anaphylaxis to the diphtheria antitoxin, horse serum, can develop arthritis, is it not probable that the most striking feature of gout, the inflammation of the joint, is also an anaphylaxis to poisons yet unknown to us but the same poisons that make the gouty urticaria and asthma? ”

“ The conditions which render a person liable to develop anaphylaxis and the mechanism by which it is established are as yet imperfectly understood.
_Vaccine Treatment._--The vaccine treatment elaborated by A. E. Wright consists in injecting, while the disease is still active, specially prepared dead cultures of the causative organisms, and is based on the fact that these "vaccines" render the bacteria in the tissues less able to resist the attacks of the phagocytes. ”

“ The rapidity with which the symptoms appear after eating is highly characteristic. Schloss [4] has reported a case of an eight-year-old boy who evinced [p.11] marked sensitiveness to eggs, almonds, and oatmeal. Experiments in this instance showed that a reaction was produced only by the proteins of these several foods, and that extracts and preparations free from protein were entirely inert. It was further found that by injection of the patient's blood serum guinea-pigs could be passively sensitized against the substances in question, thus showing the condition to be one of real anaphylaxis. ”

“ These experimental facts render it quite probable that all these cases where the first injection of horse serum produced alarming symptoms or even death, were sensitized in one of the ways mentioned to this proteid. It is interesting that those individuals which recover are in a state of anti-anaphylaxis for some time afterwards, that is, they are temporarily free from attacks of asthma or hayfever, from which they suffered before. ”

“ If the intoxication of anaphylaxis is produced by the rapid production of toxic cleavage products from the injected proteid, it is legitimate to assume that the serum of sensitized animals should possess ferments which rapidly accomplish this degradation of the proteid molecule. ”

“ Exception must be taken, moreover, to the statement that “its use is absolutely safe.” The danger of anaphylaxis from repeated injections of albuminates cannot be disregarded, and as J. F. Anderson, director of the Hygienic Laboratory, has pointed out54 we know little of the secondary or remote effects of the intravenous injection of toxic substances; some of them probably do permanent harm.
Such claims as the following require no comment:
“It builds up and increases the hemoglobin in the blood. ”

“ One thinks of the gouty patient who cannot take iron or digitalis because it aggravates the gouty pain and of the attack of gout that is brought on by a glass of champagne or a piece of beef or a few strawberries that the majority of mankind can take freely without harm. Now, if urticaria, eczema, arthritis, asthma and hay fever form a picture of anaphylaxis, and if these symptoms also form the picture of the gouty diathesis, is it not probable that one of these pictures can be explained in the terms of the other? ”

“ The reason for this is that each person has a cultivated immunity to a given toxic state of the intestinal contents, and when from pressure or the irritation caused by a calculus. there is a denudation of the mucosa the infection that takes place has not the power to arouse a systemic resistance' but can cause only a local inflammation; this inflammation may end in ulceration, or it may cause a thickening of the parts and interfere with drainage from mucous or glandular pockets ”

“ From the study of the processes by which immunity is secured against the effects of bacterial action the serum and vaccine methods of treating certain infective diseases have been evolved. The _serum treatment_ is designed to furnish the patient with a sufficiency of antibodies to neutralise the infection. The anti-diphtheritic and the anti-tetanic act by neutralising the specific toxins of the disease--_antitoxic serums_; the anti-streptcoccic and the serum for anthrax act upon the bacteria--_anti-bacterial serums_. ”

“ Such children walk late, talk late, learn late to feed themselves, to bite, and to chew effectively. Watery and fat, they carry with them into later childhood the infantile susceptibility to catarrhal infections of the lung, bowel, skin, etc., and they are apt to suffer, in consequence, from a succession of pyrexial attacks. Nasal catarrh, bronchitis, otitis media, enteritis, eczema, urticaria papulata, are apt to follow each other in turn, giving rise in many cases to a persistent enlargement Page 147 of the corresponding lymphatic glands. ”

“ In man this is the commonest form of all, and is well known under the term "wool-sorters' disease," or pulmonary anthrax. This mode of infection occurs when dried spores are inhaled in processes of skin-cleaning. It frequently commences as a local lesion affecting the mucous membrane of the trachea or bronchi, but it rapidly spreads, affecting the neighbouring glands, which become greatly enlarged, and extending to the pleura and lung itself. Such cases, as a rule, rapidly end fatally. ”

“ The more widely the limits of these problems are extended, the more probable does it become that the experimental testing of all possibilities will put us on the proper road for an explanation of the phenomena observed. Surely it would be absurd to limit the study of anaphylaxy only to a study of the behaviour of the blood; for it is more than likely that it is the cells of the body which ultimately play the chief part in the appearance of anaphylaxy. The behaviour of the blood plasma is possibly only a reflection of the defensive measures adopted by the cells of the body ”

“ Infection is present sooner or later in all the morbid animal products. The nasal mucus, bronchial exudate, saliva, tears, contents of the cutaneous vesicle, milk, contents of the bowels, and the blood have been successfully inoculated on susceptible subjects. Inoculations with blood failed with Bryce, but proved successful with Konnhauser, Krajewski, Even, Lignieres and Physalix, so that the first named cases may be explained by a prior immunity, or by a too advanced stage of the case which furnished the matter. ”

“ Clinical Aspects of Inflammation.—It must clearly be understood that inflammation is not to be looked upon as a disease in itself, but rather as an evidence of some infective process going on in the tissues in which it occurs, and of an effort on the part of these tissues to overcome the invading organisms and their products. The chief danger to the patient lies, not in the reactive changes that constitute the inflammatory process, but in the fact that he is liable to be poisoned by the toxins of the bacteria at work in the inflamed area. ”

“ All diseases of the alimentary canal, not of a traumatic origin or from the accidental or intentional swallowing of corroding chemicals or from the continuous use of drugs on the advice of physicians, come from infection or intoxication. Why not? This is the most reasonable cause, for the fecal matter in health is toxic and it only requires one step further to sufficiently intensify the putrefactive change to create irritation of the mucous membrane. Of course there is a degree of immunization taking place all the time. ”

“ The local phenomena of inflammation usually follow the introduction of living bacteria into the tissues, and general symptoms of poisoning follow later, when the bacteria, toxins, or ptomains, have entered the circulation. Some bacteria, however, excite no local reaction, but enter the circulation at once. The pyogenic variety, it should be noted, cause the production of pus.
Elimination. Bacteria can be eliminated from the blood in several ways; the kidneys, however, are the organs which carry the burden of most frequently relieving the body of them. ”

“ But just so soon as the general vitality is lowered, or there is an impairment of the normal condition of the epithelium lining the respiratory tract, a culture-medium is provided in which these germs flourish and grow. Anything which will cause an irritation or congestion of the mucous membrane of the throat and bronchial tubes furnishes the necessary conditions for the infection to take place. The germs themselves excite an acute inflammation, and the inflammation extends from the head or throat to the bronchial tubes, through the spread of the infective agent along the respiratory tract. ”

“ More recently complications such as pleurisy, pneumonia, infectious endocarditis, diarrhœic enteritis, and especially suppurative polyarthritis of young animals have been referred to omphalo-phlebitis. All these complications result from infection. The microorganisms themselves or the toxins they secrete appear to have a particularly injurious action on the serous membranes, a fact which throws light on the frequency of such complications as pleurisy, peritonitis, endocarditis and arthritis. ”

“ Contagion is communicated sometimes with the utmost ease, if the new victim be in a receptive condition, and in the presence of any disease, even the most simple, it is well to take every precaution. The mucous surfaces are peculiarly ready to absorb infection of many kinds. Measles is easily absorbed from pocket handkerchiefs, as are also scarlet fever, whooping-cough and other diseases. By inhalation through the nostrils or mouth, scarlet fever, measles, whooping-cough, mumps, diphtheria, dysentery, cholera and even pneumonia and meningitis may be communicated. ”

“ ANTHRAX. (Charbon, Wool Sorters' Disease, Splenic Fever) .—This is "an acute infectious disease of animals, transmitted to man by inoculation into the wounds, or by inhalation of, or swallowing the germs." Butchers, tanners and shepherds are most liable to it. The exciting cause is the bacillus anthracis (anthrax bacillus) . The local skin condition is a pustule containing the bacilli, which may also invade the general circulation. If the germs are inhaled, there is broncho-pneumonia; if swallowed, areas of inflammation and local death occur in the intestines. ”

“ The infective agent, which is not known, is not undoubtedly communicable from man to man, but it is carried from place to place, and it clings to ships and buildings; it thrives in hot, moist, crowded places. The priest should disinfect his hands after visiting a case.
Anthrax, called also wool-sorter's disease and splenic fever, is a very fatal disease, and the bacillus is communicable to any one through an abrasion of the skin, through the intestines by swallowing it, or through the lungs by breathing it in in dust. Disinfect the hands and the shoes after visiting a patient. ”

“ Formation of an Abscess.#--When pyogenic bacteria are introduced into the tissue there ensues an inflammatory reaction, which is characterised by dilatation of the blood vessels, exudation of large numbers of leucocytes, and proliferation of connective-tissue cells. These wandering cells soon accumulate round the focus of infection, and form a protective barrier which tends to prevent the spread of the organisms and to restrict their field of action. ”

“ Secondary toxic centres often develop in the course of this disease, notably in the glands, lungs and dependent organs, the hypostatic congestion resulting from lying in one position, causing stasis of blood, death and necrosis of tissue, both of the external and internal organs. All vessels connected with the dying tissues carry toxins to other parts of the body. Suppurating glands, and phlebitis of the femoral veins are examples of this secondary infection, and are accountable for the heart failure and collapse so often fatal during the second, third and fourth weeks of typhoid, fever. ”

“ A young vigorous body possessing a large degree of vital force will almost always route surplus toxins through skin tissues and skin-like mucus membranes, producing repeated bouts of sinusitis, or asthma, or colds, or a combination of all these. Each acute manifestation will "cure" itself by itself eventually. But eventually the body's vital force can no longer create these aggressive cleansing phenomena and the toxemia begins to go deeper. When the allopathic doctor gets a patient complaining of sinusitis, they know they will eventually get a cure. ”