SERUM DISEASE 613 



shows the urticaria-like lesion that develops on the arm of one of my col- 

 leagues following scarification and the thorough application of a drop of 

 horse serum. This man is also susceptible, to a lesser extent,. to guinea- 

 pig and rabbit serum, and is seized with sneezing and distressing dyspnea 

 after .entering a house where these animals are kept. Thayer has re- 

 ported a case of buckwheat hypersensitiveness where vaccination with 

 the flour resulted in a local reaction. It would be well for physicians 

 to make this simple test whenever they suspect a patient of being hyper- 

 sensitive to horse serum. All that is necessary is to cleanse the arm with 

 alcohol, scarify, as when vaccinating with cowpox virus, and rub in a 

 drop of the diphtheria antitoxin with a tooth-pick or some suitable 

 instrument. The reaction usually appears within fifteen minutes, and 

 there are usually no, or but very slight, general symptoms. 



Various means have been tried and advocated to bring about a state 

 of anti-anaphylaxis or desensitization of the patient : 



1. A preliminary injection of 0.5 c.c. of serum as antitoxin may be 

 given, followed in three or four hours by the regular injection. While 

 it is difficult to produce anti-anaphylaxis (see Chapter XXIX), this 

 method is in common use. 



2. According to Auer and Lewis, 1 Auer, 2 Anderson and Schultz, 3 

 Biedl and Kraus, 4 and Karsner, 5 atropin sulphate has a distinct protective 

 action against the asphyxia of acute anaphylaxis in the guinea-pig. It 

 may be well to administer from yiir to YQIT grain of the drug hypoder- 

 mically before injecting the serum, and once or twice subsequently, 

 at intervals of twelve hours, in those cases in which hypersensitiveness is 

 suspected, especially when serum has been injected within a year's 

 time. 



3. Rectal injections of serum have been advised by Besredka, who 

 bases his recommendations upon the fact that by this route absorption 

 takes place slowly and desensitization is gradual. While in the chapter 

 on Serum Therapy I have frequently advised the intravenous injection 

 of serum, it is to be understood that this applies to first doses. It is 

 far more dangerous to give serum intravenously to those injected on a former 

 occasion; in these instances the physician will do well to give his injections 

 intramuscularly or subcutaneously, when, if symptoms develop, they will 

 not be explosive nor so dangerous. Since rectal injections are usually 

 refused, the serum may be administered very slowly subcutaneously. 



1 Jour. Amer. Med. Assoc., 1909, liii, 458; Jour. Exper. Med., 1910, xii, 151. 



2 Amer. Jour. Physiol., 1910, xxvi, 439. 



3 Proc. Soc. Exper. Biol. and Med., 1910, vii, 32. 



4 Wien. klin. Wochenschr., 1910, xxiii, 385. 

 6 Jour. Amer. M.ed. Assoc., 1911, Ivii, 1023. 



