The Treatment of Hay Fever by rosin-weed, ichthyol and faradic electricity / With a discussion of the old theory of gout and the new theory of anaphylaxis

by George Frederick Laidlaw

A series of light scratches are made on the skin of the forearm or the inner side of the arm where the skin is delicate. The scratch must be only superficial and not draw blood. Really the best method is to make a round denuded spot by twirling a small brad-awl. A drop of extract of different pollens or a speck of the pure pollen protein is rubbed into each scratch and the result awaited for fifteen minutes. Within that time, a redness and swelling, like a hive or a bite, will appear at some of the scratches.

This swelling is the skin reaction to that pollen. Its appearance indicates the presence in the skin of reaction bodies to that pollen. It is argued, and partially proved by practice, that the pollens to which the skin reacts are the pollens to which that patient has been sensitized and these pollens are selected for administration.

The Dose. The first dose of pollen extract is the danger dose and differs for each patient according to his susceptibility for a given pollen. It is determined by dropping the pollen extract into the eye or rubbing it on the skin. To avoid anaphylactic shock, this dose must be incredibly small. Noon and Freeman's first dose was one-third c. c. of the weakest dilution of which one drop in the eye would cause hyperaemia. This was usually four drops of a millionfold dilution in water. Later doses were never more than 1 c. c. of a 1 to 100,000 dilution "to avoid unpleasant reactions."

Goodale begins with five drops of that dilution that just fails to cause a skin reaction. Later, to avoid the risk of shock, he advises one-tenth of this dose.

Koessler's theoretical initial dose of rag weed extract is one drop of the weakest dilution that will just redden the conjunctiva. As he finds rag weed more toxic than the English timothy, his actual first dose is one-half of this theoretical dose. The actual first dose will vary from one drop of a 1 to 1,000,000 to one drop of a 1 to 20,000 dilution, the smaller of which he estimates to contain of pollen protein one one-hundredth part of a millionth of a gramme or .000,000,01 gramme.

Shade of Samuel Hahnemann, the first and greatest homœopath! And they drove you out of Leipzig into poverty and exile for teaching that in using drugs that are similar to the disease there is serious danger of aggravating the disease; that the dose must be extremely small; and that disease so sensitized the patient that a dose so small as to be inappreciable in health becomes active in disease!

The smaller doses of pollen extract are given every three or four days and increased as rapidly as possible, judging the increasing tolerance or resistance by a diminishing eye or skin reaction. With larger doses, the interval is longer, a week or ten days. The pioneer, Noon, and all workers since, warn against increasing the dose too fast, for the reactive power of the patient is easily exhausted, his resistance lowered and he may be left more sensitive than before.

Dangers of Pollen Injections. Treatment by pollen injection is beset with dangers for the unlucky patient. It has been noted how Dunbar nearly killed his first patient by injecting the serum of the horse that had been immunized to pollen. All experimenters, without exception, say that the injection of pollen extract is attended with danger to the patient, danger of anaphylactic shock, and warn against the use of any but the most infinitesimal doses. The hay fever patient is a human being who, in some way, has been sensitized to pollen. He is in a state of exquisite anaphylaxis and a dose of pollen injected into his blood may kill him in twenty minutes. Goodale reports shock (faintness, nausea, vomiting) in two patients following the mere rubbing of a drop of pollen extract into a scratch on the skin. Evidently the scratch was too deep and the pollen poison was absorbed rapidly into the blood instead of being stopped by the deep epithelia. I have seen a similar absorption and general reaction in children after a skin test with tuberculin, when the tuberculin entered the blood through too deep a scratch.

Another danger lies in the instability of the pollen extracts. Koessler expressly warns against commercial preparations of pollen protein because of the danger of decomposition. His extracts do not keep more than three weeks and are dangerous to use after that time. On the other hand, Goodale, making his extracts with 15% alcohol, reports them as active and fit for use after more than one year. Oppenheimer and Gottlieb object to commercial preparations on different grounds. The commercial preparations contain many different pollens so as to be sure to include those to which the patient is sensitive. They point out that in these mixtures, the dose of the individual pollens cannot be adjusted to the changing conditions of the patient and, in addition, injecting into the blood of the patient pollens to which he is not already sensitive may sensitize him to these pollens also and leave him worse than before.

There is the lesser danger that the patient will not be immunized by the injections but become more sensitive to his old pollens than he was before, as Noon pointed out in his first paper; for artificial immunity is a difficult thing to control and is by no means as easy as it looks in the book. Nor is it as easy to immunize a human being over many years of life, subject to so many conflicting influences, as it is to immunize a guinea-pig living in a cage.