120 ANAPHYLAXIS AND ANTI-ANAPHYLAXIS 



few exceptional cases rigors, convulsions, drowsiness, 

 dyspnoea, collapse, vomiting, diarrhoea, abdominal 

 pains, and high temperature, were noted. These 

 symptoms were always part of an immediate reaction, 

 and were not often of long duration. The shortest 

 period noted between the primary and secondary 

 injection was sixteen days and the longest seven 

 years. Out of a total of 203 reinjected patients, 

 36 per cent, exhibited no symptoms of anaphylaxis 

 at all. 



The third group given by Goodall consists of a 

 small collection of cases in which there is absence of 

 latent period with sudden onset of severe symptoms 

 which may rapidly terminate in death. Instances 

 are met with in persons who have never been inocu- 

 lated with serum before, whilst a considerable number 

 of the patients have been found to be asthmatics. 

 About forty fatal cases have now been recorded in 

 medical literature (Kolmer).^ Goodall considers that 

 these cases have probably been born anaphylactic, 

 or have been sensitised in some unknown way. 



Up to the present time the most extensive observa- 

 tions made in man have been carried out with diph- 

 theria antitoxin. In the case of tetanus a few records 

 exist of serious anaphylaxis in man following prophy- 

 lactic injections of antitetanic serum from immunised 

 horses, and presumabl}* further details will soon be 

 forthcoming as the result of the prophylactic treat- 

 ment of war wounds. Vernoni^ has recently pub- 

 lished a list of twelve cases of anaphylaxis following 

 serum injections for tetanus, with one death. He 

 considers that the antibodies responsible are diffused 

 throughout the bodj'', but do not appear to penetrate 

 the meninges unless the latter are diseased. For 



^ " Infection, Immunity, and Specific Therapy," 2nd edition, 

 1917. 



- Rivista di Clinica Pediatrica, xv., p. 337, 1917. Quoted in 

 Journal of American Med. Assoc, Ixix., p. 949, 191 7. 



