This conclusion is borne out by Dr. Harrison Tumpeers experience that “minute quantities of foreign protein are highly antigenic. Clinically this fact has become amply demonstrated in some of the severe reactions to scarlet fever antitoxin which resulted in the production of extreme toxicity against that agent. Most of the children receiving scarlet fever antitoxin had previously received horse serum in the form of toxin-antitoxin.”.
In the Journal of Immunology tables are given showing that over 70 per cent. of children (116) who had been immunized by toxin- antitoxin (three injections) were hypersensitive to horse serum, compared with 50 per cent. of those children who had no previous injections (90).
In adults the percentage of hypersensitiveness was 90 per cent. in the immunized, compared with 74 per cent. in those who had not received any injection of serum or toxin- antitoxin. The whole difficulty is increased by the fact that there is no certain method of deciding before-hand if any given case is likely to react unfavourably, for, as Dr. Harrison Tumpeer states: “Reactions may occur even when skin tests are negative.”.
REMOTE EFFECTS OF SERUM.
(3) The more remote effects of serum inoculation have been emphasized by J.E.R. McDonagh in his most recent writings. His unique work on the chemico-physical properties of the blood, especially in regard to the colloidal protein particles, is worthy of the closest study. One of his particularly pertinent statements is as follows: “Serums are very liable to give rise to shock, and to the more obvious manifestations produced the term anaphylaxis is usually applied.
Owing to the peculiar constitution of protein the appearance of the signs and symptoms of shock may be delayed months and even years, and the longer the delay the more difficulty grows the problem of combating them. The long delay frequently results in the manifestations of chronic disease which, as often as not, remain for ever unconnected with the case. When death occurs, its does so slowly, and after a long period of time”.
Dr. C.A. Stewart, of the University of Minnesota, wrote in 1926: “It is proper and pertinent to point out that the public health officials, in urging toxin-antitoxin inoculations, are paving the way for evils which may well exceed those they are, no doubt honestly, desirous of avoiding”.
One of the more defined evil consequences is the onset of epilepsy. Dr. Prior, Medical Superintendent, Parramatta Mental Hospital, N.S.W., records an instance of this which in his opinion was quite definitely due to the injection of a prophylactic dose of antitoxin.
Finally, the use of the immunizing serums may seriously delay the natural evolution of epidemic diseases into their milder forms. “It is extremely doubtful”, writes McDonagh, “if the production of an infection, however mild, with an attenuated virus, with the object of preventing a more severe infection is ever justified. It cannot be repeated too often that every infection carries with it the weapons which are ultimately to destroy it. The action of these weapons . . . may be seriously interfered with by the production of man-made milder infections.”.
He sees a classical instance of such interference in the case of vaccination against small-pox. “Even to-day,” he writes, “no true measure of the after-effects of Jenners vaccination in man has been taken, and it is becoming more and more doubtful if the decreased incidence of small-pox is due to vaccination. Variola appears in recent years to have been replaced by alastrim. . . . It certainly cannot be accredited to vaccination because the rise of alastrim coincides with a rise of those who go unvaccinated. Indeed, it is possible that the change would have taken place earlier had vaccination not come into general use.”.
It is quite clear from the foregoing facts, which represent a part only of the available evidence, that both in its immediate and remote effects, the use of animal sera is fraught with considerable danger to the health and even life of the patient.
Moreover, these results are inherent in the properties of any animal serum sui generis, and are not to be accounted as “accidental” to its administration. In addition, in the realm of preventive medicine, the employment of such inoculations as prophylactics is likely to defeat the very object for which they are used by so interfering with the natural reactions of the body that evolutionary changes which normally occur in the virulence of epidemics may be seriously hampered. Their use, therefore, on the grounds of expediency, is seen to be fallacious and contrary to the interests of public health.
