79 
Heubner a and von Bokay * * * 5 expressed the opinion that these mani- 
festations were due to other properties than the antitoxin in the 
serum. 
Johannessen c believed that the agent in horse serum which pro- 
duced these symptoms was due to the introduction into the booty of 
an alien serum, for he produced the same effects by injecting normal 
horse serum. In 22 cases fever resulted, and skin eruptions in 12. 
Sevestre d referred the exanthems which appear in eight to ten 
days back to the serum which had been injected. However, he 
thought that the measle-like eruption and fever was the expression 
of a streptococcus infection. Netter, however, in the discussion, 
believed these symptoms to be caused by the serum. 
Almost all authors express the opinion that the symptoms caused 
by the injection of serum are of minor consequence. The fact that 
from time to time serious symptoms and even death followed the 
injection of diphtheria antitoxic serum does not alter the general 
impression that as a rule such injections are harmless. The benefits 
far outweigh the danger. q 
Gottstein, 6 in addition to the Langerhans case, collected 8 deaths 
following the injection of serum in those having diphtheria and 4 in 
those not sick with diphtheria. 
We have collected from the literature 19 cases of such unfortunate 
results, and know personally of several more which have not been 
reported. Yon Pirquet and Schick express the opinion that a critical 
examination of these cases may be otherwise explained, and authors 
generally have not permitted this rare accident to counterbalance 
the great benefit possible from the use of diphtheria antitoxic serum. 
It seems to have been definitely shown that the skin eruptions and 
other symptoms following the injection of horse serum follow in 
direct proportion to the amount of serum injected. This has resulted 
in endeavors to concentrate the serum as much as possible. 
a Heubner: Praktische Winke zur Behandlung der Diphtherie mit Heilserum. Deut. 
med. Woch., 1894, p. 701. Kliniscke Studien iiber die Behandlung der Diphtherie 
mit dem Behring’schen Heilserum. Leipzig, 1895. Tiber die Amvendung des Heil- 
serums bei der Diphtherie. Jahrb. f. Kdheilk., Bd. 38, p. 231. 
& Yon Bokay : Die Heilserumbehandlung gegen Diphtherie im Budapeste Stefanie- 
Kinderspital. H. f. Kdh., Bd. 44, 1897. Meine Erfolge mit Behring’s Diptherieheil- 
serum. Deut. med. Woch., 1895, p. 233. Meine Erfahrungen mit dem Moser’schen 
polyvalenten Seharlach-Streptokokkenserum. Deut. med. Woch., 1904. 
c Johannessen : Tiber Injektionen mit antidiphtherischen Serum und reinem Pferdeserum. 
Deut. med. Woch., 1895. Tiber Immunisierung bei Diphtherie. Deut. med. Woch., 
1895. 
<2 Sevestre: Des accidents causes par le streptococque a la suite des injections de serum 
de Roux. Bull, de la Soc. med. des hopiteaux, July 19, 1895, Jan. 31, 1896. La med. 
moderne, 1896. 
e Gottstein : Tiber Todesfalle, welche bei der Anwendung des Diphtherieheilserums beo- 
bachtet worden sind, Therap. Monatsh., 1896. 
