Vol. 60, 1909 - University of North Carolina at Chapel Hill

90 THE CHARLOTTE MEDICAL JOURNAL
upon the circulatory system but through its
sedative action on the central nervous system
it prevents the heart from being over
stimulated and in this way is of distinct
value in some of the acute infectious diseases.
5. Arterial degeneration may be produced
in the lower animals by alcohol.
6. The degenerative vascular changes are
likely not entirely due, primarily to the
alcohol acting as such, but to the absorption
of products from the intestine which the
alcohol has indirectly caused to be formed.
Anapliylaxis and Its Relation to Practical
Medicine.*
By Dr. R. N. Duffy, New Bern, N. C.
Modern medicine is the result of a combination
of empiricism, genius and painstaking
endeavor. A great many of our
ideas and methods today were preconceived
in master minds; others there are which
were stumbled on. In the whole domain
of modern medicine there are no more interesting
subjects than infection, immunity
and serum therapy and there is no better
illustration of what genius and untiring effort,
preceded often by empiricism, have
done for scientific medicine than the history
of these subjects. The greatest advances
in the last half centur>^ of medicine
have been made along these lines and the
same will perhaps be true of the next half.
There are such infinite possibilities and
such alluring paths of study to the scientific
investigator in these new fields, and so
many yet unsolved problems that the vast
number of experiments and the results here
are not to be wondered at. "V'accination,
the Widal reaction, diphtheria and tetanus
antitoxin, tuberculin and mallein are the
conspicuous but only a few of the insults
of this work.
Serum therapy is in fact, however, not
new. Mithridates bj' taking gradually increasing
doses of poisons established in
himself resistance. It is stated also that he
fed ducks with poisons and then proposed
to use their blood as an antidote. Empiricism,
here as elsewhere preceded rationalism.
Vaccination was practiced and put
on its present basis by Jenner long before
the scientific explanation was given by
Pasteur's work on fermentation, vaccination
against anthrax, chicken cholora,
swine plague and rabies A little later also
the work of Koch and Metchnikoff, Nissen,
*The above paper was written at the request of
Dr. Watson .S. Rankin, Secretary of State Board
of Health of North Carolina, to be presented before
the State Society. It is intended as a resume of
Anaphylaxis from its inception to the present date,
and no claim for originality on the part of the
author is made for the data presented,
V. Behring and Bouchard served to open up
the portals of this vast new field.
Since the discovery of tetanus toxin by
Brieger and Frankel and of diphtheria toxin
by Roux and Yersin and the production
of their specific antitoxins by Behring and
Kitasato in 1890, the possibilities of this
new method of treatment seemed indeed
great and alluring, and much experimental
work has been done towards producing
specific sera in the treatment of the various
infectious diseases.
There is scarcely a useful method of
treatment in medicine which does not occasionally
have its compensating disadvantages
depending upon the many and variable
factors which go to make up the sum
total of results in the human organism. It
has long been known that the blood of animals
may be toxic to other animals when
injected into their circulations. Horse serum
has been used almost exclusively in
the various inoculations that have been
made in man on account of its comparative
lack of such to:;ic qualities. Untoward results
have been frequently noted, however,
after these injections and sudden death
even has occasionally been observed.
These phenomena were at first not understood.
\'on Pirquet and Schick collected
a number of cases in which the injection of
horse serum into man was followed by urticarial
eruptions, joint pains, fever, swelling
of the lymph nodes, oedema and albuminuria.
These symptoms appeared from
eight to thirteen days after the injection of
the serum. This reaction was termed by
Von Pirquet and Schick "Die Serumkrankheit"
or the "serum disease." It has been
known almost since the discovery of diphtheria
antitoxin that guinea pigs which have
been used for the testing of the antitoxin
die frequently when given a subsequent
dose, but no importance was attached to
the fact until 1905. However, when Ehrlich
was visiting this country in 1904 Theobald
Smith spoke to him about the phenomenon
in guinea pigs and Ehrlich gave the
problem to Otto to work out. His work
on the subject was published late in 1905
just before that of Rosenau and Anderson,
of the Ilygenic Laboratory, who had been
working on the subject at the same time.
When Rosenau and Anderson first encountered
the phenomenon they conceived the
idea that there might be some relation between
it and sudden death following injections
of antitoxin in man. They also
foresaw that the problem might have a
close relation to immunity. Both of these
hypotheses have been pretty clearly established.
Many observers before Rosenau, Anderson
and Otto had noted the phenomenon,