To lessen the dangers and enable the patient to keep up his immunization for many months and years, Goodale borrowed an idea from Schloss, who fed his egg-oat-meal-almond anaphylaxis patient minute doses of these foods until he so raised his resistance that he was able to eat them in ordinary quantities without harm. Such artificial resistance must be kept up by eating a small quantity of the food each day or it will be lost (old King Mithridates again). As most of the pollens are not edible and as patients react to botanically allied plants, Goodale tried feeding the patient over long periods of time with vegetables and edible plants that were allied to the offending pollens, expecting that, as in Schloss's patient, some minute part of the protein would pass unto the blood unchanged and maintain the protection. So far, these feeding experiments have failed. Trial with homœopathically potentized pollens over long periods of time has not been made.
Conclusions on Pollen Extracts. My conclusions on the pollen treatment are that it is in line with our best practice of immunity but that it is still in an experimental stage, the pollens are possibly dangerous even in the hands of a skilled immunologist. In a disease that is usually so easily controlled by rosin-weed, faradism and ichthyol, I would not expose a hay fever patient to the very real danger of anaphylactic shock. The conditions governing immunity stated in the beginning of this chapter still hold good. It is transient. Already some of the early workers have discontinued the practice. The despair of Goodale has been quoted. Scheppegrell, probably the first in this country to use the pollens, has given them up and advises the patient to keep away from his irritant and to have the weeds cut in all cities as the best treatment obtainable (Journal of the A. M. A., March 4, 1916, page 710). The most hopeful aspect of the pollen extracts seems to me to be their administration all around the year in high dilutions, more homœopathico, and to this practice I believe the immunologist will eventually come.
Pollen Extracts not Vaccines. Some manufacturers and all British writers speak of pollen extracts as vaccines and of immunizing the patient as vaccination. This seems an unnecessary confusion. We have two kinds of vaccines already, the cow-pox vaccine and the killed cultures of bacteria introduced by Wright. For an account of the use of these vaccines in hay fever, we will pass to the next chapter.
CHAPTER XII
THE BACTERIAL VACCINES
In his paper in The Lancet, the pioneer in the use of pollen extracts, Freeman, observed that "many cases of supposed hay fever" were simply acute bacterial catarrhs. He excluded hay fever by the lack of any reaction when timothy extract was dropped into the eye. The bacterial infection was proved by culture from the eyes and nose, usually yielding the staphylococcus. The final proof was the cure of the patient by an autogenous vaccine made of the offending microbe. In the past few years, this observation has been confirmed and many cases of cure of "hay fever" by bacterial vaccines have been reported in the journals. The bacteria were chiefly staphylococci, rarely the pneumococcus or the micrococcus catarrhalis.
Oppenheimer and Gottlieb report cases of mixed hay fever where the skin reacts to pollen but the pollen extract failed to cure. In these cases, they found a bacterial catarrh of the eyes and nose. They suppose a vicious circle, the catarrhal inflammation and the hay fever sensitiveness mutually interfering with each other's recovery and they succeeded in curing the patient by using the appropriate pollen extract and the bacterial vaccine at the same time, believing that while the pollen extract was raising resistance to the pollen poisoning, the bacterial vaccine was raising resistance to the bacterial catarrh.
While hay fever is not strictly a catarrhal inflammation, the cure of hay fever by curing a coexisting catarrhal rhinitis or conjunctivitis seems easily possible. The surgeons taught us long ago that some cases of "hay fever" need nothing but good drainage of the nose, which they secured by freeing the nose from obstruction. Every physician sees mild cases of hay fever recover on various popular catarrh treatments. The tablets sold by homœopathic pharmacies, containing iodide of arsenic, naphthalin and quillaya, cure many cases of hay fever and these are the same drugs that cure catarrhal rhinitis. It is easily possible that my old inheritance, rosin weed, cures hay fever by curing the coexisting catarrh; for it was a famous remedy among the eclectics for catarrhal inflammation of the nose, throat and bronchial tubes.
If, then, operations or remedies that cure catarrhal rhinitis cure also some cases of hay fever, there is nothing inherently improbable in expecting the bacterial vaccines to cure some cases of hay fever, for the vaccines have made many cures of catarrhal inflammation. However, the physician using them should understand that they are not specific drugs against the pollen anaphylaxis but against a supposed catarrh or bacterial infection. He will be well advised to control the treatment by taking cultures from the nose to make sure that the bacteria are there, determine the variety present and, if possible, have an autogenous vaccine made up for treatment.