CHAPTER XVI 



SERUIM RP]ACTIONS 



When one administers an animal serum to a patient there is 

 always the possibility that some form of "serum reaction" will 

 result. The kind, amount, and condition of the serum, the method 

 of its administrations, as well as the medical history, present con- 

 dition, and inherent capacity of the patient to react, are all fac- 

 tors to be taken into consideration by the physician. 



Serum reactions may be divided into (1) immediate reactions 

 which occur within a few minutes or within a few hours after 

 the serum is injected, and (2) delayed reactions (serum disease) 

 which manifests itself only after an incubation period of several 

 day.s or even weeks. 



Immediate Reactions. — Individuals who develop immediate re- 

 actions may be classified into several groups as follows : 



1. The asthenic child who presents a picture of status 

 lymphaticus. Such individuals cannot withstand even mild shocks 

 from almost any cause and may die following the injection of anti- 

 toxin. They are even poorer risks if tliey present a history of 

 asthma. Park and Williams (1933) state that practically all 

 deaths from antitoxin administrations have fallen in this group. 

 Fortunately the general practitioner rarely encounters cases of 

 this type. 



2. Nonspecific and anaphylactoid reaction : Lord and Heffron 

 (1938) report that, in a series of 1,755 cases receiving intra- 

 venous injections of scrum, 7 per cent developed symptoms of dififi- 

 cult breathing, flushing of tlic face, cyanosis, abdominal or lumbar 

 ]5ain, rapid and weak pulse and a few other symptoms. The same 

 authors report 17.8 per cent of the series as developing thermal 

 reactions. Not only febrile reactions but also severe chills occur 

 quite frequently following the injection of antipneumococcie rabbit 

 serum. 



In regard to the chill-producing factors present in serum. Good- 

 lier, Horsfall and Dubos (1937) report that they can be removed 

 for the most part by heating the rabbit serum to 58° C, for thirty 



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