IMMUNITY AND AXAPHYLAXIS 213 



obviously suggested, and experiments on animals proved 

 the truth of the inference. These symptoms differed 

 from those of serum disease in that they came on immedi- 

 ately or within an hour after the injection, were very 

 severe, and in some cases ended fatally. The earliest 

 recorded case is that of the son of Professor Langerhans, 

 who was given a prophylactic dose of serum, took ill at 

 once, and died shortly afterwards. The next recorded 

 cases were three communicated by Goodall to the Anti- 

 toxin Committee of the Clinical Society (of which 

 Committee -he was a member). The first of these was 

 that of a girl, aged 4 years, admitted to hospital suffering 

 from diphtheria. She was given 4000 units on October 

 24th, 1897, and the same amount on October 25th and 

 26th. On Nov. 3rd there was a slight urticarial rash. On 

 Nov. 30th she had a well-marked relapse of diphtheria, and 

 was injected with 4000 units of antitoxin. " Within twenty 

 minutes of the injection, she was seized with shiverings, 

 quickly followed by two convulsions. Seen a few minutes 

 later by the assistant medical officer, the convulsions had 

 ceased, but the child was in a drowsy state, and the 

 temperature had risen to 105 F. . . . There was no 

 rash. . . . During the night the child vomited several 

 times ; about 6 a.m. on Dec. ist a rash was noticed; and 

 was a multiform erythema. It persisted till Dec. 5th, and 

 while it was present the temperature remained up and 

 the pulse was very rapid. On Dec. 5th and loth there 

 were twitchings of the mouth, and throughout the child was 

 drowsy and apathetic, and had a bad colour. She slowly 

 recovered and left the hospital well on Feb. 3rd." Similar 

 cases could be multiplied, and some given in which the 

 immediate reaction is limited to a local or general rash. 



Such cases giving an immediate reaction fall into two 

 groups : (i) Where the serum has not previously been 

 injected ; and (2) Where a dose of horse serum has been 

 administered on a previous occasion (excluding doses 

 given within the incubation period of the serum disease). 



i. In the first group numerous fatalities have been 

 recorded. In most of these, a history of asthma, or some 

 similar condition, has been noted, and this is very 

 important, since the subcutaneous injection of diphtheria 



