468 PROTEIN POISONS 



administration of the serum, or, if not at this time, on the 

 seventh to the tenth day following the injection. In instances 

 in which effects are not noticeable until from seven to ten 

 days following the injection, the symptoms are largely 

 confined to those of peripheral irritation, as evidenced by 

 urticarial lesions accompanied by intense itching. On the 

 other hand, in cases in which a reaction follows within 

 twenty-four hours, the symptoms of poisoning are more 

 pronounced, and where occasionally a fatal result follows 

 it occurs usually within an hour after the injection. In 

 these cases, which are fortunately rare, we find that the 

 symptoms are very similar to those obtained through the 

 injection of the poison obtained by Vaughan through 

 protein cleavage. Thus, Gillette 1 reports the case of 

 an asthmatic fifty-two years old, to whom he gave 2000 

 units of antitoxin globulin, administered under the left 

 scapula. While dressing, following the injection, the 

 patient complained of a prickling sensation in the chest and 

 back of the neck. He at once sat down in the chair and 

 complained of inability to breathe. The physician felt his 

 pulse and found it full and regular. Immediately thereafter 

 the patient was seized with a tonic spasm, during which 

 death ensued, the whole interval elapsing between the 

 injection and the fatal outcome not exceeding five minutes 

 in duration. In spite of the rapidity with which death 

 occurred in this case, we can still recognize evidences of 

 the three stages characteristic of fatal protein poisoning: 

 the stage of peripheral irritation indicated by itching 

 sensations in the skin, the stage of partial paralysis or 

 weakening of the lower extremities, and the convulsive 

 stage, during which death occurred. 



In cases of sudden death following within a few minutes 

 after the injection of horse serum, it is not infrequent that 

 one of the stages is absent or ill-defined. Thus, in the 

 instance cited above, the loss of ability to move the lower 

 limbs was not specifically mentioned, although in other 



1 Jour. Amer. Med. Assoc., January 4, 1908, p. 40. 



