CHAPTER XVIII 



THE CLINICAL SIGNIFICANCE OF ANAPHYLAXIS 



SERUM SICKNESS 



WE have mentioned that Rosenau and Anderson attacked the 

 problem of hypersusceptibility primarily in the hope of casting light 

 upon the nature and cause of the distressing symptoms which in 

 human beings often ensue upon the injection of diphtheria antitoxin. 

 It has been one of the staple objections of lay opponents to the use 

 of antitoxins that the injections are apt to cause severe illness and 

 occasionally death, and indeed a few cases are on record in which 

 sudden death has followed the first injection of diphtheria antitoxin. 

 Since it was known by accumulated clinical experience as well as 

 by experiments like those of Bertin, 1 of Johannesen, 2 and others 

 that the harmful effects were not dependent upon the antitoxin con- 

 tents, but could be produced by injections of normal horse serum, it 

 was but natural to bring these ill effects into analogy with the phe- 

 nomena of hypersusceptibility. A large number of references to 

 such antitoxin illness or SERUM SICKNESS have appeared in the lit- 

 erature since the first beginnings of the therapeutic use of sera, yet 

 no careful analysis of the condition was made until von Pirquet and 

 Schick, 3 in 1905, published their studies. 



As a rule the results of serum injection have been mild and with- 

 out danger, though sufficiently frequent and troublesome to call for 

 thorough study and attempts to discover the prophylactic measures. 

 As stated above, a few cases are on record in which sudden death 

 has followed a single first injection. There are no reports in the 

 literature known to us, however, of fatalities after second injections, 

 although not infrequently such cases have taken on alarmingly seri- 

 ous aspects. 



The percentage of incidence and the variety of symptoms have 

 been the subjects of many reports. The most frequent and striking 

 single occurrence has been an urticarial rash. Rolleston, 4 in a large 



1 Bertin. Gam. Med. de Nantes, 1895. Quoted from Levaditi. 



2 Johannesen. Deutsche med. Woch., No. 51, 1895. 



3 Von Pirquet u. Schick. "Die Serum Krankheit," Deuticke, Leipzig 1 , 

 1905. Also Munch, med. Woch., 53, p. 67, 1906. 



4 Rolleston. The Practitioner, Vol. 74, 1905. 



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