SERUM REACTIONS '309 



animal scrum while the cutaneous test may be positive. A positive 

 ophthalmic test suggests natural or atopic hypersensitiveness and is 

 regarded by many as a contraindication to the administration of 

 serum. 



Delayed Reactions. — 1. Serum Sickness in Man. — Besides the 

 serum reactions described in the preceding paragraphs there is 

 another phenomenon called serum sickness which may follow the 

 administration of horse, hog, rabbit and perhaps other sera. It is 

 not an immediate reaction but develops usually after several days 

 or wdthin two or three weeks. It is characterized by headache, 

 joint pains, fever and a rash. Edema of the face or other parts 

 of the body may occur. Regional enlargement of the lymph 

 nodes is noted quite commonly. The symptoms may last for 

 periods varying from one day (accelerated type), to one week or 

 longer. Relapses have been observed according to Zinsser, Enders 

 and Fothergill (1939). Coca concludes that serum sickness can be 

 produced in 100 per cent of all individuals if as much as 50 c.c. 

 of normal horse serum is given intravenously. It may appear, how- 

 ever, following the administration of much smaller doses. The 

 student should remember that diphtheria antitoxin represents the 

 pseudoglobulin fraction of horse serum that has been precipitated, 

 washed and concentrated. Serum sickness in man is more readily 

 produced with whole serum than with the pseudoglobulin fraction. 

 Harten and Walzer (1939) state that most workers report that the 

 administration of antistreptococcic and antipneumococcic sera gives 

 a higher incidence and greater severity of serum reactions than 

 diphtheria or tetanus antitoxin. 



It would appear from the reports of Bradshaw (1939) and 

 Hutchinson (1939), that the incidence of serum sickness is greatly 

 reduced if antitoxin is employed that has been subjected to a 

 special method of treatment involving peptic digestion. Several 

 of those who have perfected enzymatic methods for the treatment 

 of immune serum are Parfentjev (1936), and Coghill, Fell, 

 Creighton and Brown (1940) in America, Pope (1939) in Eng- 

 land, and Grabar (1938) and Hanson (1938) in France. 



Parfentjev (1936) developed a process of peptic digestion of 

 antitoxic sera under carefully controlled pH conditions which ac- 

 complishes 70 to 80 per cent digestion of the plasma proteins. His 



