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Here is found an explanation of the phenomena of shock, whether the shock be the result of toxins, of infection, of foreign proteins, of anaphylaxis, of psychic stimuli, or of a surgical operation with its combination of both psychic and traumatic elements. This conception of the kinetic system has stood a crucial test by making possible the shockless operation.
We have recorded 66 clear-cut experiments on dogs, which show that after fear and rage, after anaphylaxis, after injections of indol and skatol, of leucin and creatin, of the toxins of diphtheria and colon bacilli, of streptococci and staphylococci, of foreign proteins, and of strychnin, the Cannon test for adrenalin was positive.
These symptoms, to which the name serum disease is applied, usually disappear in the course of a few days. The term anaphylaxis is applied to an allied condition of supersensitiveness which appears to be induced by the injection of certain substances, including toxins and sera, that are capable of acting as antigens.
When a second injection is given after an interval of some days, if anaphylaxis has been established by the first dose, the patient suddenly manifests toxic symptoms of the nature of profound shock which may even prove fatal. The conditions which render a person liable to develop anaphylaxis and the mechanism by which it is established are as yet imperfectly understood.
May not the phenomena of anaphylaxis be studied on associational lines? Then, too, there may be chemical noci-associations with enemies now extinct, which, like the ticklish points, may still be active on adequate stimulation.
In our extensive study of the brain in its relation to the production of energy and the consequent exhaustion caused by fear and rage; by the injection of foreign proteins, of bacterial toxins, and of strychnin; by anaphylaxis; by the injection of thyroid extract, of adrenalin, and of morphin, we found that, with the exception of morphin, each of these agents produced identical changes in the brain-cells.
"Serum Disease" and Anaphylaxis. It is to be borne in mind that some patients exhibit a supersensitiveness with regard to protective sera, an injection being followed in a few days by the appearance of an urticarial or erythematous rash, pain and swelling of the joints, and a variable degree of fever.
When the kinetic system is driven at an overwhelming rate of speed, as by severe physical injury, by intense emotional excitation, by perforation of the intestines, by the pointing of an abscess into new territory, by the sudden onset of an infectious disease, by an overdose of strychnin, by a Marathon race, by a grilling fight, by foreign proteins, by anaphylaxis, the result of these acute overwhelming activations of the kinetic system is clinically designated shock, and according to the cause is called traumatic shock, toxic shock, anaphylactic shock, drug shock, etc.
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