quinine, antipyrine and the iodides may be mentioned. While the history of these eases shows a marked resemblance to anaphylaxis, there is, for most of them, no very definite experimental basis. Friedberger has recently obtained anaphylactic symptoms in guinea-pigs sensitized with an iodine-proteid compound. It would be of theoretical importance if true anaphylaxis could be experimentally produced with these substances, because they are of a non-proteid nature.
Food Idiosyncrasies.—Probably everybody is familiar with the fact that certain foods, harmless for most people, cause marked trouble in others. Certain individuals, for example, react to the ingestion of strawberries, buckwheat, clams, eggs, etc., as if a poison had been swallowed. These cases also are probably anaphylactic, but here again the experimental test is lacking to clinch the relationship between these phenomena.
Treatment of Anaphylaxis.—The treatment is not yet in a satisfactory state, but there are a number of remedies available for some of the manifestations of this protean complex. If an injection of horse serum produces respiratory symptoms of an asthmatic type in a patient, the only rational treatment is the administration of atropin, for the investigations of Auer and Lewis have shown that this asthma is due to a tetanic contraction of the finer bronchioles which hinders or prevents the entrance and exit of air in the lungs, and atropin causes a relaxation of these muscles. In a study of the prophylactic value of atropin injections in guinea-pigs, Auer was able to save 72 per cent, of his animals, while 75 per cent, of the untreated controls promptly died. These results have been corroborated by a number of observers, especially by Biedl and Kraus. The negative results which Friedberger and Mita obtained are probably due to the inadequate dose of the atropin which they administered.
If the injection of the serum, however, causes symptoms of cardiac failure with slight symptoms of asthma, there is no treatment founded on experiment. The treatment must be symptomatic only; but one class of drugs must be avoided. Auer has shown in highly sensitized rabbits that drugs of the digitalis group should not be used, because they hasten the fatal outcome by aiding the production of the same cardiac lesion which anaphylaxis itself calls forth. Moreover, the same observer has recently described changes in the cardiac muscle produced by members of the digitalis group, especially strophanthin, which are very similar to those produced in cardiac anaphylaxis. It is, therefore, clear why these cardiac stimulants must not be given, even though the weak heart would seem to demand their exhibition.
The most rational treatment is the preventive one. The utmost precaution should be observed whenever it become necessary to inject a therapeutic serum in a patient who has been injected with serum before, who is subject to asthma, hayfever, or who shows an idiosyncrasy to
