Arthus Phenomenon

The death of a five-year-old child a year ago last week was momentous to Medicine. She proved in drastic fashion that serums can sometimes be extremely dangerous. Although the history of her case was certain to scare readers, it was important as a warning as to how Medicine's serological tools must be used. So last week the Journal of the American Medical Association gave the child's doctors (Isidor Harrison Tumpeer, Abe Matheson and David C. Straus) space for their report.

When the child was one year old, she received toxin-antitoxin against diphtheria. The serum came from a horse. Last year she was exposed to diphtheria. The doctor injected a protective dose of antitoxin (derived from a horse) in her left buttock. The part swelled. Three days later the doctor found diphtheria germs in cultures from her nose and throat, and at once gave her a large dose of antitoxin in the right buttock. That antitoxin also came from a horse. The left buttock was still swollen. Within a few days the right buttock swelled and, as the days passed, became gangrenous and fell away. The child died within the month. The devastation in this tragedy seemed inexplicable.

Anaphylaxis, or sudden, violent death after serum injection, occasionally occurs. Immunologists are seeking explanation. The Chicago child had lingered a month. Her doctors searched the medical literature for enlightenment. In 1903, they found, Maurice Arthus, who is now professor of physiology at the University of Lausanne, had described the "Arthus Phenomenon" in rabbits. Repeated injections of a protein (serums are protein) make rabbits sensitive to the same protein. Subsequent doses become progressively more poisonous. Four years ago Dr. Wesley Emmett Gatewood of Portland, Ore. and Dr. Clarence William Baldridge of Iowa City reported six cases which seemed to prove the Arthus Phenomenon in humans. Their report made little impression on doctors. The Chicago child's death was more impressive.

Serum taken from a horse had become poison to her. That was the medical lesson her death taught. Serums must not be discarded. They are too useful. But if a patient shows a bad reaction to a specific serum, the doctor should wait until the symptoms subside. If time is a factor, as it is in an attack of diphtheria, he should use a serum taken from a different kind of animal, to whose blood the patient is not sensitive. If horse serum was used at first, use serum from a goat, sheep or cow next time.

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