SYMPTOMS OF SERUM SICKNESS 227 



The associated skin eruptions are usually of the type of an urticaria; 

 although Hartung describes rashes simulating scarlet fever and measles. 



V. Pirquet and Schick consider the following as the most positive 

 symptoms of serum sickness: 



1. The occurrence of the exanthema seven to fourteen days after 

 injection. 



2. First appearance of the rash around the point of injection. 



3. Regional enlargement of the lymph glands. 



4. Complete absence of any changes in the mucous membrane. 

 Measles is excluded by the absence of Koplik spots, coryza, and con- 

 junctivitis. 



In scarlet fever the following symptoms help to exclude serum sickness: 



1. Initial vomiting. 



2. Occurrence of angina before or at the same time as the exanthema. 



3. High fever. 



4. The simultaneous existence of the infection among others in the 

 hospital or neighborhood. 



If the serum disease does not arise after the first, but after a later in- 

 jection, it is characterized by the absence of, or very marked diminution in, 

 the length of the period of incubation, and in addition by increased severity 

 of the symptoms. 



In the dog these phenomena have been carefully observed by 



Anaphylaxis Biedl and Kraus and Arthus: 3 to 5 c.cm. of horse serum is 



in the Dog. administered for the first injection and after three weeks 10 



c.cm. are given intravenously. In about one-half a minute the 



dog becomes restless, begins to vomit, and has involuntary evacuation of 



urine and feces. This is followed by a period of excessive prostration during 



which the dog lies with his limbs outstretched and almost motionless as if 



paralyzed. After several hours the animal either begins to recover or dies. 



Biedle and Kraus noticed that about 15 to 30 seconds after the intra- 

 venous reinjection, the arterial blood pressure begins to sink rapidly. This 

 has been ascribed to the wide dilatation of the peripheral blood vessels due 

 to a paralysis of the peripheral vasomotor system. In addition there is a. 

 leucopenia and a diminution in the coagulation power of the blood r 

 symptoms which have been observed also in man. The animal par ex- 

 cellence for anaphylaxis experiments is the guinea-pig. The rabbit is 

 the next choice. 



If guinea-pigs receive as their second inoculation a large dose of serum in- 

 Anaphylaxis travenously, they die acutely (Th. Smith) ; (animals that have not been 

 in the sensitized bear this same quantity of serum without any disturbance- 

 Guinea-pig whatsoever). The blood pressure first rises, then sinks rapidly. At 

 and Rabbit, postmortem the lungs are firmly inflated (Gay and Southardt)> 

 Death is probably caused by respiratory paralysis, Auer and Lewis 

 having described a tetanic spasm of the bronchial muscles. 



