

HYPERSENSITIVENESS, PROTEIN INTOXICATION 210 



not so far been reproduced in the animal. One can add little to the 

 excellent original description by von Pirquet and Schick and that more 

 recently published by Jochmann. 



Serum disease may be defined as an abnormal condition produced in 

 man by single or repeated injections of heterologous sera and character- 

 ized by the appearance of various types of eruptions, fever, arthralgia, 

 adenopathy, edema and occasionally nausea and vomiting. The incuba- 

 tion period of the disease following the introduction of serum varies some- 

 what in different individuals and according to whether the individual 

 has had previous injections of the same foreign serum. Depending upon 

 these factors, von Pirquet originally recognized three types of reaction, 

 namely, the normal reaction which occurred from 6-10 days after the 

 first injection of serum, the accelerated reaction appearing 35 days after 

 the injection of serum and the immediate reaction appearing within the' 

 first 2448 hours after the injection of serum. 



In the normal serum reaction, 610 days elapse as a rule between the 

 injection of serum and the first appearance of the outspoken signs of the 

 disease. In most instances, serum sickness starts with swelling of the 

 lymph nodes, and very frequently those nodes which drain the area 

 of the body into which the serum has been injected are the first to enlarge. 

 Within 2448 hours, the adenopathy becomes general. By this time 

 characteristic rashes occur which appear as urticarial wheals of various 

 sizes, affecting the skin of all parts of the body or as diffuse erythematous 

 and scarlatiniform itching eruptions. Accompanying, or following, the 

 eruption there is very frequently edema of the eyelids, face and ankles, 

 and, in severe cases, actual anasarca. Fever varying from 100 to 102 

 Fahr. is common. In a small number of cases arthralgia appears, first 

 manifesting itself frequently in the tempo romaxillary joint, and, though 

 the joints are not red or swollen except in the rarest instances, they 

 are exquisitely painful, ami motion may produce excruciating pain. 

 Some patients complain of pains extending down their arms or down 

 their legs, and in such instances the muscles of the arms and 

 legs may be distinctly tender. In severe cases practically every 

 joint in the body is involved, though the large joints are the ones that 

 are most frequently affected. Usually there is some headache with pros- 

 tration and malaise during the height of the disease, though this is not 

 often a striking feature. 'In rare cases nausea and vomiting occur. The 

 spleen is occasionally enlarged and may be palpable. The urine in most 

 cases shows no albumin, even during the period of edema. The blood, 

 during the early stages of the disease, presents a polymorphonuclear leu- 

 kocytosis, but later it is common to observe a leukopenia with an increase 

 in the lymphocytes. The disease may last only 24 hours or may be pro- 

 tracted over 2-3 weeks. In severe cases there may be relapses at from 

 7-day to 2-week intervals. According to some observers the relapses 



