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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    8 The frequency of serum reactions after intrathecal injections. —Flexner4 * remarks that possibly the manifestations of serum disease are more frequent after the intrathecal than after the subcutaneous injection of serum, and at first some of the figures relating to the naval cases appear to confirm this ; thus, out of 61 cases of cerebro-spinal fever which received Flexner’s serum intrathecally only and recovered or (if fatal) survived more than 10 days, 43, or 70 per cent., had a serum rash. Whereas out of Currie’s 3 50 cases of cerebro-spinal fever treated mainly by subcutaneous injection (36 by subcutaneous injection only, 13 by one intrathecal and the other injections subcutaneously, and 1 case by one intrathecal, one intravenous, and the remaining injections subcutaneously), 29, or 58 per cent., had rashes. The incidence of serum rashes after ordinary hypodermic injec¬ tions is given by Goodall6 * from analysis of a large number of cases, as about a third, so that the percentage of 70 is in excess of Currie’s and Goodall’s figures. But the naval cases, besides being rather few, were all injected with Flexner’s serum, which seems to be specially effective in inducing a serum reaction. Out of 241 naval cases given various brands of serum (in some instances hypodermically as well) during the first three years of the war, and surviving for ten days or more, rashes occurred in 99, or 41 per cent. This is indeed lower than the incidence (44 per cent.) of serum rashes among 37,277 cases of diphtheria treated by serum during the years 1898-1903 in the hospitals of the Metropolitan Asylums Board, and very much lower than in some other series where serum rashes were specially looked for and found in from 67 to 81 per cent, of the cases (J. D. Rolleston T). It does not therefore appear to be proved that the incidence of serum disease is higher after intrathecal than after the hypodermic method of injection. Bad effects from increased intracranial pressure caused by intrathecal injection of serum are so well known and the precautions necessary to avoid this accident so well recog¬ nised that they do not require further discussion. Intrathecal injections of serum in rare instances are followed by secondary infections through the wound, espe¬ cially after a large number of lumbar punctures. Secondary infection may also occur through the blood-stream, and it has been thought that this may be favoured by the injec¬ tion of serum. Netter and Salanier8 refer to 22 cases of 4 Flexner: Mode of Infection, Means of Prevention, and Specific Treatment of Epidemic Meningitis, The Rockefeller Institute, N.Y., p. 42,1917. s Currie : Jour. Hyg., Cambridge, 1908, viii,, 457. 6 Goodall, E. W.: System of Medicine (Allbutt and Rolleston), 1911, ix., 113. 7 J. D.Rolleston : Practitioner, 1905, lxxiv., 660. 8 Netter and Salanier: Bull, et Mem, Soc. Med. des H6p. de Paris, 1917,3e ser., xli., 789.
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