738 PASSIVE IMMUNIZATION SERUM THERAPY 



CONTRAINDICATIONS TO PASSIVE IMMUNIZATION 



The chief contraindications to the therapeutic use of a serum, if any 

 ever exist, are those dependent upon the serum itself, for, as will readily be 

 understood, the introduction of antibodies themselves does not mean an 

 extra strain upon our body-cells, but rather the reverse. The question 

 before us, then, is one regarding the possible contraindications to the in- 

 jection of a foreign serum, and the dangers dependent upon its use. It 

 may be stated at once that, in the great majority of cases, the adminis- 

 tration of a carefully prepared and properly administered serum is free from 

 danger. Since the introduction of diphtheria antitoxin in the prophylaxis 

 and treatment of that disease many thousands of injections have been 

 given, in all parts of the world and under all sorts of conditions, and the 

 number of fatalities is so small as to be regarded as almost negligible. 

 Serum therapy should not, however, be abused to the extent of using 

 the serum indiscriminately. I am opposed to using the serum as a 

 prophylactic unless the indications for its employment are distinct; for 

 example, in diphtheria it suffices to immunize only those who have been 

 brought into immediate contact with the infection. When, however, 

 the indications are clear and the symptoms of infection are present, I 

 believe in using the serum early and generously. 



1. Of all possible dangers consequent to the use of serum therapy, 

 that of anaphylaxis is uppermost in the minds of practitioners. While 

 it is true that anaphylaxis has been the cause of some fatalities, the 

 likelihood of this accident taking place is so remote, in the great majority 

 of cases, that it should not occupy a prominent place in the physician's 

 mind, nor interfere with the use of the serum, as, for instance, anti- 

 toxin in the treatment of diphtheria. It is true that serum sickness is 

 comparatively common, and while the symptoms are frequently dis- 

 tressing, they are not dangerous and do not constitute the dreaded and 

 fatal anaphylaxis. With a little discrimination and care on the part 

 of the physician the risk of anaphylaxis may be rendered still more re- 

 mote if attention is given to the following questions: 



(a) Is the patient sensitive to horse protein? This is probably the 

 most important single question, as in several of the fatal cases of ana- 

 phylaxis on record it was learned afterward that the patient was usually 

 rendered uncomfortable, and that sneezing, asthma, or even an urti- 

 carial rash would develop when the patient came into close proximity to 

 horses, as in a stable, or when driving behind them, etc. Fortunately, 

 these cases are very few, but several of the fatal cases of anaphylaxis 

 on record occurred in just such persons, and at the present time a 



