Serum disease after intrathecal injections of serum / by H.D. Rolleston.

  • Humphry Rolleston
Date:
[1917?]
Catalogue details

Licence: In copyright

Credit: Serum disease after intrathecal injections of serum / by H.D. Rolleston. Source: Wellcome Collection.

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    matory process, presumably by destroying the meningococci.. In discussing the injection of immune serum in acute polio¬ myelitis, Neal, Abramson, and others 1 point out that injec¬ tion of serum into slightly inflamed meninges sets up in most cases an acute aseptic meningitis shown clinically by fever, rigidity of the neck, and other signs of meningeal irritation. It seems probable that at the time of the serotoxic meningeal' reaction the meninges are slightly inflamed, and that, as this, is not due to meningococci, a fresh injection of serum aggra¬ vates the symptoms and possibly does harm rather than good. It is therefore desirable to have some means of determining whether there is a genuine relapse which will be benefited by serum or whether the condition is one of meningeal irrita¬ tion or meningism and a manifestation of serum disease which may be intensified bv a further injection of serum. This diagnosis can be made by examination of the cerebro¬ spinal fluid for the presence of meningococci, and also for the normal reducing agent (glucose) which is absent in relapses of meningitis and present in the meningism due to serum disease (Reveillet, Nove-Josserand, and Langeron2). This test, which takes a few minutes only, and so enables a. decision to be made on the question whether to withhold or inject serum at once, has been employed by StalE-Surgeon L. Warren, R.N., and by Dr. O'. Ker at the City Hospital, Edinburgh, where some naval ratings w»-re treated. This meningeal manifestation of serum disease is peculiar to intrathecal injection of serum, and though it occurs in a small proportion of cases should be more widely recognised in this country in view of the war-time increase of cerebro¬ spinal fever. It has not, however, passed unnoticed. Netter and Debre3 in 1911 gave a good account of it, and regarded1 it as a result of serotoxic oedema of the meninges. It may also be added that, as the mucous membranes originally attacked by diphtheria are liable to swell at the time of the- serum reaction, an analogous sequence may be suggested in the case of meningococcic infection of the meninges. If the meningism is part of the serum disease to be expected after intrathecal injection, the question arises why it is not noted more often. It does not appear to result from large quantities of serum given, for out of the 9 cases among the 58 naval cases with a serum reaction, 8 had less than 100 c.c., and 4 of these 8 less than 50 c.c. ; nor can it be explained as due to an intrathecal injection within a very few days of the appearance of the serum rash. That it is con¬ nected with some hypersensitiveness of the meninges is probable enough, but it is impossible to go beyond this vague statement. 1 Arch. Int. Med., Chicago, 1917, xx., 341. 2 Reveillet, Nove-Josserand, et Langeron : Jour, de Physiol', et Path,. Gen., Paris, 1914-15, xvi., 1080. 3: Netter et Debre : La Meningite Cerebrospinate, p. 264, Paris, 1911.
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