RECENT WORK ON ANAPHYLAXIS 119 



tion to serum; (2) persons who have been reinjected 

 after a lapse of at least ten days, and may shew a 

 true anaphylactic reaction; (3) persons who have 

 never been previously inoculated, but who neverthe- 

 less shew excessive severity of symptoms without any 

 latent period — almost certainly a true anaphylaxis. 



In the first group the signs noted by Goodall were 

 rashes — usually urticaria or erythema marginatum — 

 pyrexia, and joint pains. These are the usual symp- 

 toms of a normal serum reaction , The rashes occurred 

 in rather more than one-third of the cases inoculated ; 

 they were most common at the site of the injection, 

 but were frequent also on the exterior surfaces of 

 the extremities, and varied in duration from a few 

 hours to a few days. Goodall also noted that a 

 combination of urticaria and erythema in the same 

 patient was not uncommon, and suggests that it 

 may have been due to a mixture of serum from two 

 horses during manufacture. Pyrexia was usually 

 transient, but occasionally lasted as long as a fort- 

 night. The temperature was rarely very high, but 

 was sometimes accompanied by enlargement of 

 glands, tonsillitis, or albuminuria. The joint pains 

 generally affected the wrists, elbows, ankles, and 

 knees, and were seldom serious. An analysis of 464 

 consecutive cases shewed a latent period for normal 

 serum sickness of three to twenty-two days — most 

 commonly six to fifteen — between the first injection 

 and the onset of symptoms. 



In the second group of true anaphylactic reactions 

 in persons reinoculated after a period of at least ten 

 days, the latent period was much shortened and the 

 symptoms of unusual severity. Besides profuse 

 urticarial rashes with gigantic weals, the mucous 

 membranes of the mouth, nose, pharynx, and larynx, 

 were often involved ; the tongue was swollen, respira- 

 tion embarrassed, and prostration followed. In a 



