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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    Reprinted from The Lancet, December 1, 1917 &H1L A SERUM DISEASE AFTER INTRATHECAL INJECTIONS OF SERUM. By H. D. ROLLESTON, C.B., M.D. Camb., K.R.C.P. Lond., TEMPORARY SURGEON-GENERAL, ROYAL NAVY; SENIOR PHYSICIAN, ST, GEORGE’S HOSPITAL, The clinical aspect of serum disease is so familiar that some apology is necessary for raising the subject again, and this perhaps may be offered in a brief comparison between its manifestations after the intrathecal and after the more usual hypodermic method of serum injection. It might naturally be anticipated that intrathecal injection would make a difference, inasmuch as any local reaction in the meninges comparable to the rash sometimes seen to start from the neighbourhood of a hypodermic injection of serum might, from the proximity of the spinal cord and brain, cause special nervous symptoms. The following statements are based on analysis of the clinical notes of cases of cerebro¬ spinal fever in the Royal Navy. Meningism due to serum disease.—During the third year of the war out of 96 bacteriologically proved cases of cerebro¬ spinal fever treated by serums and surviving for ten days or more, 58, or 60 per cent., had a serum reaction, as judged by the appearance of a rash. Among these 58 cases there were 9, or 15’5 per cent., in which the rash was preceded or accompanied by a more or less definite recrudescence of meningitic manifestations, thus, especially when preceding the rash, suggesting a relapse of the disease. These symptoms are relieved by lumbar puncture, and under the assumption that they point to a relapse a fresh injection of serum may be given, as was done in 6 out of the 9 cases. The 3 cases not so injected recovered, and of the 6 cases injected intrathecally with serum 5 were probably made worse, 4 eventually proving fatal, though it is not suggested that death was thus induced. The effect of intrathecal injection of serum presents some peculiar features. Whereas, as is well known, injection into a healthy intrathecal space sets up an aseptic chemical meningitis, injection of anti¬ meningococcic serum in cerebrospinal fever—as is shown by the clearing of the cerebrospinal fluid—reduces the inflam-
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