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

ORIGINAL COMMUNICATIONS. 93
ena similar to the precipitating and absorb- death. In the most severe forms there deing
actions which govern the relation of velop paresis or paralysis and convulsive
colloids among themselves. movements, as in the guinea pig, and death
Otto believes that, according to the side rapidly follows. Wiley and Gillette each
chain theory, the first injection results in a have recorded a fatal case during the past
weakening or disappearance of the portions year. Landishas reported a series of seven
of the antigens which are in the body, and cases of untoward symtoms following the
thus ;ni apparent hyper-susceptibity re- use of Maragliano's anti-tuberculous sesults.
rum. Waterhouse records a personal ex-
Richet thinks that anaphylaxis is due to perience of sensitization following the use
is due to the presence of a toxicogenic sub- of antistreptococcic serum. Schmitt restance,
non-toxic itself, but producing a ports a personal experience in which he had
a poison by reaction with a second inject- moderately severe symptoms following a
ion of the extract. He supports his view prophlactic injection of diphtheria antitoxby
experiments with a mixture of the se- in. A curious instance about this case is
rum of a sensitized dog and the extract in that he is always subject to asthmatic atvitro.
He claims that this mixture is more tacks when exposed to the odor of horses,
toxic than the extract alone. Boone has had a similar experience; Wiley's
So much for a review of the phenomenon fatal case was affected in like manner manitself.
We are now lead inevitably, as in ner when about horses, and this has been
all subjects pertaining to medicine, to the true of many of the reported cases. Gilquestion
of its practical nature and we im- lette's fatal case had been subject to asthmediately
enter an alluring field of surmise ma for years. During the past year, F. L.
and speculation. How much is true and Taylor, Quigley, Drefoos and Thomas have
how much is false it remains for further in- each reported cases of collapse following
vestigation to thrash out. the injection of antitoxin, but none of their
There are certain differences as well as cases were fatal,
similarities in the reaction in man and the V. Pirquet and Schick, as stated preguinea
pig. In five or ten minutes after viously, have collected a number of cases
an injection in the pig there are symptoms in which the symptoms following the antiiudicative
of respiratory embarrassment; toxin were very mild and developed only
scratching at the mouth, coughing and after an interval of from eight to thirteen
sometimes spasmodic, rajiid or irregular days. The symptom-complex in these
breathing; the pig becomes restless and cases they designated as the Serumkrankagitated.
This stage of exhilaration is heit. As mentioned before, these cases
soon followed by one of paresis or com- usually exhibit urticarial eruptions, joint
plete paralysis. Spasmodic, jerky and con- pains, fever, swelling of the lymph nodes,
vulsive movements now supervene. Pigs oedema and albuminuria. The urticaria
in this stage may recover but usually con- may persist for months, as in a case reportvulsions
appear and are almost invariably ed by Blain. V. Pirciuet and Schich have
a forerunner of death. The symptoms do shown that the first injection renders the
not always follow in the order given. Death individual sensitive to future injections, so
usually occurs within an hour and fre- that, if a second injection is given in from
quently in less than thirty minutes. fourteen days to four months after the first,
A single initial dose in man may be fol- a reaction occurs almost at once or at least
lowed by a reaction, but never is this so in within twenty-four hours. They call this
a guinea pig. Both, however, react to a the "immediate reaction." If the second
second injection. In man. the symptoms injection is given after a period of four
very greatly in kind and intensity. As a months, the reaction, while delayed from
rule, the major syiniHoms come on a few fiye to eight days, occurs earlier than the
minutes after the injection but in a less se- first reaction, and this they term the "acvere
form the onset may be delayed for an celerated reaction."
hour or two. In the milder form' there is a Royer has collected thirty cases illustrafeeling
of faintness, substernal pain, some ting the effects of a second injection of
difficulty in breathing, paroxysmal cough, diphtheria antitoxin in man. He thinks
sneezing and itchiness, particularly of the there is little doubt that second injections
scalp. An annoying urticaria, oedma of of serum, after considerable intervals of
the face and swelling of the tongue may time, cause immedate disturbance several
occur, also nausea and vomiting in some days earlier than that met with as a normal
cases. In addition to an increase in in- reaction.
tensity of the above symptoms, in the se- The "immediate reaction" of V. Pirquet
verer type the patient becomes cyanotic; and Schich, according to accumulated stashows
signs of collapse; may froth at the tistics, occurs in from 18-27 % of cases remouth
aud there is a feeling of impending ceiving injections of antitoxin; the "accel-