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21
surmised that something of the nature of an anaphylactic re-action had
occurred, causing some considerable prostration with albuminuria for
three days.
Ten c.c's constitute a very considerable injection in the matter of
bulk, and it is hoped that means may be found for concentrating the antitoxic
serum. The serum is injected into the vastus externus, and no
difficulty has been experienced in giving 10 c.c's to a child of sixteen
months. It is claimed that concentrated serum is now in use in America,
but I am not yet fully satisfied that the means of standardisation ars
sufficiently precise.
Two means are employed of determining the unit of toxin. One
is the amount of Toxin Skin Test Dose that will definitely produce the
Schulz-Charlton re-action in a susceptible subject and will give a negative
result in an insusceptible person. I apprehend that that amount of toxin
will vary within wide limits. The second is a measured quantity of a 1 in
1,000 dilution of a 5 days' broth culture of the streptococcus haemoliticus
scarlatinae. It is exceedingly problematical whether the organisms
have not very varying toxin producing qualities. The matter is one that
ought to be thoroughly investigated by hospital authorities in collaboration
with serological establishments.
It is worthy of note that the urine from a scarlatinal patient within
the first week of illness will produce the Schultz-Charlton re-action, in all
respects similar to the toxin produced by culture.
The probability is, therefore, especially as organisms are not found
in the blood of uncomplicated cases of Scarlet Fever, that kidney lesions
are caused by the scarlatinal toxin. The administration of anti-scarlatinal
serum may, therefore, be expected to rob the ailment of one of its worst
complications. Supplies are available at the Town Hall for medical
practitioners who desire to use it, either for treatment or prophylaxis.
Passive immunity is supposed to last for about a fortnight only.
Active immunity is stated to be acquired by the injection of 250 skin test
doses on two consecutive weeks, and on the third, of 500 skin doses.
The resultant immunity which is sufficient to cause a negative SchultzCharlton
re-action in about four weeks is protective over a period of
years, probably for life. In Tottenham, where only a small proportion
of Scarlet Fever patients are removed to hospital, it is possible that
contacts passively immunised against the disease may in some instances