PAPERS ON MEDICINE AND PUBLIC HEALTH 323 



standing features being those of extreme dyspnea and 

 collapse. The dose may be small, in one instance re- 

 ported about 1 c.c. (500 units) of antitoxin having been 

 given subcutaneously. Kerley 3 reports a case of known- 

 hypersensitiveness where the dose was gradually in- 

 creased until 5 minims were given, resulting in alarming 

 shock. Persons showing this type of reaction are fre- 

 quently found to be subject to asthma or hay fever, being 

 subject to the former particularly in the vicinity of 

 horses or stables. Xearly all children dying after 

 serum-shock are cases of "status lymphaticus". 



After the intravenous injection of low-potency anti- 

 toxin even when the material is warmed to the body 

 temperature and the injections given very slowly, chills 

 more or less severe in character are observed in nearly 

 half of the cases. Park 2 suggests that this is probably 

 due to a special form of the protein possibly in the state 

 of a fine flocculent precipitate. According to his experi- 

 ence less than 1 per cent of intravenous injections pro- 

 duce a chill when the best products are employed, where- 

 as this undesired symptom occurs much more frequently 

 when less perfect serums are used. In some instances 

 the intravenous administration of antitoxin or other 

 serum several weeks or longer after an initial injection 

 which caused marked reaction, results in alarming symp- 

 toms of collapse. This effect is said to almost never fol- 

 low a second subcutaneous injection. In other instances 

 frequently repeated intravenous injections of serum de- 

 velops instead of desensitization a hypersensitiveness so 

 marked that even small amounts of serum give a sharp 

 reaction. Such conditions are, fortunately, known to be 

 relatively very infrequent. 



Scrum Sickness. — The occurrence of this type of re- 

 action according to Park 2 varies considerably in different 

 series of cases, from ten to sixty per cent or more, the 

 size of dose influencing this incidence. Concentrated 

 globulin preparations of antitoxin cause a relatively low 

 incidence. Following the first injection of antitoxin or 

 other serum there occurs an incubation period varying 

 from three hours to twenty-four days (more commonly 

 from three to twelve days). The symptoms primarily 



