214 PUBLIC HEALTH BACTERIOLOGY 



antitoxin has been recommended as a cure for asthma. 

 A record of a fatal result in a man of 52 years, who died 

 in tonic spasm ten minutes after receiving the serum, 

 elicited particulars of 16 similar cases, and in the 

 " Therapeutic Gazette " for March 15th, 1909, a short 

 account is given of these, with 14 others, making 30 in all, 

 in which alarming symptoms followed shortly after the 

 injection, and ended fatally in 16 cases. In 22 of the 30 

 cases there was a history of asthma or some similar 

 affection. (Goodall in Public Health, January, 191 1). 



2. Where there is a record of a previous administration 

 of serum, while the immediate symptoms may be very 

 alarming and dangerous, so far no fatality has been 

 reported. The use of serum day after day in a severe case 

 of diphtheria is not followed by these manifestations, 

 unless a period of at least ten days separates the first dose 

 from that causing the symptoms. It is this feature which 

 suggested that the symptoms were due to supersensitive- 

 ness to serum, following on an attack of serum disease. 

 The condition, beginning ten days after the first injection of 

 serum, has been present in persons after five years, and may 

 yet be found at a longer period. Experimental work on 

 the subject has shown that rabbits injected with horse 

 serum are very sensitive to a subsequent dose, show severe 

 symptoms, and often die. This has been called the 

 " Phenomenon of Arthus." The " Phenomenon of 

 Theobald Smith " is that guinea-pigs used to standardize 

 antitoxin, when injected with a toxin-antitoxin mixture 

 were always killed on the subsequent injection, after ten 

 days, of normal horse serum. Otto, Rosenau, and Anderson, 

 working independently, showed conclusively that the action 

 of the serum was without relation to its antitoxin content ; 

 that sensitation of the guinea-pig was most marked after 

 10 days ; that very small doses were efficient (o-ooi c.c. or 

 less) ; that the condition was transmissible from mother to 

 offspring ; that it was specific for the particular serum 

 used ; that it was not a hemolytic nor precipitin action ; 

 that the condition could be conferred on another animal by 

 injecting it with the serum of a sensitized animal ; that a 

 considerable dose of serum (5 c.c.) is required for the 

 second injection ; and that the symptoms are prompter in 



