DESENSITIZATION VS. HOMOEOPATHY.-In the Journal of the American Medical Association for June 2, 1923, is an interesting article by Albert Strickler, M.D., Dermatologist to the Samaritan Hospital and Assistant Dermatologist to the Philadelphia General Hospital, Philadelphia, entitled “The Value of the Toxin (Antigen_ of Rhus Toxicodendron and Rhus Venenata in the treatment and Desensitization of Patients With Dermatitis Venenata.”
Dr. Strickler states:
“In this contribution I present a statistical discussion of two problems. The first is a study of the relative value of the antigen method of treating dermatitis venenata due to poison ivy or poison oak, as compared with the older methods of local applications. The second phase of the discussion is whether or not this specific toxin (antigen) treatment is of value in the prevention of attacks of dermatitis venenata due to poison ivy or poison oak, as compared with the older methods of local applications. The second phase of the discussion is whether or not this specific toxin (antigen) treatment is of value in the prevention of attacks of dermatitis venenata in those who are highly susceptible to it. The data represent the accumulated experiences, not only of myself, but of many other physicians throughout the country who have utilized this method of treatment.
“TREATMENT OF THE ATTACK OF DERMATITIS VENENATA.
“The attack of dermatitis venenata represents a state of hypersensibility on the part of the person affected to this particular form of irritant. The old method of local application utilized remedies of dermatitis venenata due to poison ivy or poison oak, which were either slightly astringent and itch- relieving, or medicinal substances which were, in themselves, irritants. The first group of remedies, by their cooling and soothing influences, attempted in this fashion to quiet the inflammatory reaction of the skin, diminish its subjective and objective cutaneous manifestations, and thus limit the spread of this form of dermatitis.
The second group of remedies, those applied in the nature of counter-irritants, attempted to overcome this specific cutaneous inflammation by increasing the amount of defensive substances sent to the inflamed skin, and thus conquer the inflammation and control its spread. This method, owing to the possibilities for harm, has never enjoyed great popularity among the profession. The great weakness of this mode of treatment is the attempt to overcome a specific reactionary inflammation with nonspecific remedies. It has occurred to us that the employment of the active principles derived from the plants, capable of producing a dermatitis venenata in the susceptible subjects, represented the rational therapeutic method of procedure.
“The most authoritative work shows that the active principle of poison ivy or oak is a substance of glucosidal nature. This substance is nonvolatile even when mixed with acetic acid and alcohol. The method of isolating the substances has already been discussed.1 Strickler, Albert: “The Toxin Treatment of Dermatitis Venenata.” J.M.A., 77: 910 (Sep. 17) 1921.
“The toxin (antigen) treatment of dermatitis venenata, caused by poison ivy, which is the most common type in the eastern United States, consists in the intramuscular injection of a solution of this specific antigen. The authors technic consists in giving a series of from three to five injections, the number administered varying with the severity of the attack and the response on the part of the patient. The dose of the present preparation varies from 0.3 to 0.5 cc., although doses up to 0.7 cc. may be given.
“The first two doses are given at a twenty-four hour interval, the remainder at intervals of from forty-eight to seventy two hours, depending on the response of the patient. As a rule, to which there are few exceptions, the itching associated with this form of dermatitis disappears completely, or is greatly modified, within twenty-four hours after the first injection.
“With the relief of the itching, the swelling and redness of the parts affected begin to disappear, and vesicles present begin to dry up and form crusts, which soon fall off. The skin is usually restored to normal in from four to five days after treatment is instituted, expect in those generalized and violent cases of dermatitis venenata in which the restoration of the skin to normal may be more delayed. These results are accomplished without the aid of any external remedies whatsoever.
“Tablet I gives a detailed account of the results achieved in the treatment of more than 350 cases of dermatitis venenata due to poison ivy or oak treated with the toxin (antigen) method.
“A study of the table shows that there are records of 356 patients suffering from dermatitis venenata due to either poison oak or poison ivy and treated with the toxin antigen) method. Of this number, ten patients, or 2.8 per cent., received no benefit whatsoever and nine patients, or 2.5 per cent., received some, though doubtful, improvement. These results compare favorably and, indeed, are vastly superior to those obtained by any form of local application as yet devised for the treatment of this affection.
“In some instances, improvement was noted as early as two hours after the institution of treatment; and when success was attained, improvement never occurred later than forty-eight hours after treatment was begun. In the vast majority of cases, improvement was noted twenty-four hours after the institution of this mode of treatment. In many instances, one or two injections were all that were required to cure, but in the larger number of instances, three or four injections were deemed necessary.
“The desensitization that can probably be conferred by the antigen method of treatment against dermatitis venenata by poison ivy or poison oak is in all probability of short duration and one which has to be renewed from time to time. It also appears probable that this immunity is a tissue immunity similar to that of hay-fever. Various immunologic studies have failed to disclose any immune substances in the blood serum of susceptible patients.
The technic for immunization varies slightly from that employed in the cure of the attack. The injections, numbering four, are given intramuscularly, three or four days apart. The dose varies from 0.3 to 0.5 cc. After the course of intramuscular injections, the patient is advised to take the tincture of rhus toxicodendron on the tincture of rhus venenata, as the case may be, by mouth, for a period of one month. The dose of this mouth, for a period of one month. The dose of this mouth remedy varies from 5 to 10 drops of the tincture well diluted in water, after meals.
“In the treatment of dermatitis venenata due to poison ivy or poison oak, the toxin (antigen) method of treatment constitutes the best method of procedure. Counting the unsuccessful and doubtful results in this series of 356 cases, there were noted nineteen cases, or slightly more than 5 per cent., in which failure or only slight improvement resulted. I know of no method of treatment in which such a small percentage of failures has been encountered. It is to be emphasized that these results were obtained without the additional use of local applications.
It is also to be remembered that relief is obtained usually within twenty-four hours after the institution of treatment, and only occasionally and in very severe and generalized ceases does a forty-eight hour interval elapse before relief is obtained. Cure of this condition is obtained within from four to five days after the institution of this mode of treatment.
“In the desensitization of highly susceptible patients, our results seem to be encouraging. With the small series at our command, one cannot be too dogmatic or over-enthusiastic. All that can be said is that the use of this method is to be encouraged, as it is incapable of doing harm, is worthy of a trial, and the results thus far obtained by a number of different physicians, including myself, are very highly encouraging.
“The method of desensitization is a rational one, and it is based on principles that have been successfully applied in the desensitization of other disease conditions”.
F. Jay Shamberg also of the Quaker City, a year or so ago published his similar procedure of desensitizing the victims of poison ivy. Of course homoeopathic prescribers know that not all cases yield to the specific antigen (Rhus tox. in potency, usually high).
Some cases seem determined to manifest their own peculiar individualistic symptoms, plus those of the ivy toxin, and will therefore require their own peculiar remedies such as Anacardium, Grindelia, Ipecac, Sepia, Sulphur, etc. the latter are fully capable of desensitizing patients who correspond to their indications, and this fact, no doubt, explains Stricklers 5 per cent. of failures. Nevertheless, it is true, as he observed, that the large majority of patients suffering from dermatitis venenata will be desensitized by Rhus itself, inasmuch as the violence of the latter usually overwhelms its victim and established its own peculiar pathogenesis.
But the most interesting fact of all is that Strickler, with an apparent and no doubt supremely blissful ignorance, ignores in his account of therapeutic success the foundation principles of homoeopathy upon which is success depends. Perhaps, even in staid old Philadelphia, he has at some time heard of one Constantine Hering and that the latter was reputed to be somewhat of a homoeopathic physician, who expounded the principles of his science and art with considerable ability, we are told. Or are we coming to the point where anaphylaxis and negative phase must be substituted for aggravation and desensitized must be employed instead of homoeopathically cured? “A rose by any other name would smell as sweet,” but why change a name which after all has the merit of classic accuracy and has ably stood the test of time?.
At all events, Stricklers achievement, which deserves all praise, and his pronouncement in favor of internal over local treatment, may well cause some homoeopaths to sit up and take notice that after all their own methods should be good enough for them and ought to be more faithfully adhered to. As our German colleagues would aptly say, “Warum in die Ferne schweifen, wenn das Gute liegt so nah?”
The hay-fever season is with us again and the usual army of sufferers seeks relief. Many have been tested for good anaphylaxis, as well as for a host of flowers, shrubs and plants, until long-suffering cutaneous open spaces are filled up with the scarifications of diagnostic tests and now resemble the checkerboards of our youthful days. Cats and dogs are studiously avoided, even silk lingerie (say it softly) is shunned by some, while the ubiquitous motorcar has happily well- nigh banished the fear of horse dander along country roads and lanes.
The hay-fever specialist is among us, his capacious pockets well lined with the green paper tender of the realm, while distracted patients roam the country in search of immune health resorts.
Pharmaceutical manufacturing concerns now flood the obliging journals with their “aids,” much as do the chicken ranchers, who in early spring fill the agricultural journals with their alluring announcements of day-old chicks, direct from producer to buyer. Caveat emptor, let the buyer beware and watch his step most carefully!.
It seems to be agreed that, in the Eastern States at least, timothy is responsible for most of the hay-fever sufferers trouble, though along in August and September the rag-weed (ambrosia artemisiae folia) and even golden-rod (solidago virga aurea), our national flower, are capable of causing much discomfort as well. It is said that timothy pollen (phleum pratense) is responsible for 90 per cent. of the cases. Well, perhaps so! Kent taught that a psoric diathesis underlies the hay-fever constitution and that antipsoric remedies only, are likely to bring about a real cure. We believe this to be true, but must put the soft pedal on the statement “cure.”
In spite of what most of us can do, these patients seem to go through the annual torment, yet it must be admitted that our remedies have a most remarkable power of modifying and shortening the attack. We say this without fear of contradiction, for many times have we seen such remedies as Arsenicum iod., Allium cepa, Carbo veg., Nux vom., Sabadilla, Silicea and Psorinum, not to mention Succinic acid and a few others such as Wyethia helenoides, Arundo mauritanica and Sanguinaria nitrate, do marvelous things. Of course, the trick is to get the indications for a certain choice, then shoot high, the higher the better, and quick relief will follow.
Take Arsenicum iod. for example. Burning in the post-nasal space is apt to be present, sneezing, lachrymation, negative pressure headache over the frontal sinus, acridity of the discharges, prostration, general inclination for the cooler open air, yet relief from heat, locally applied over the nose and forehead.
Allium cepa indications are those of the usual well-known coryza and need not be rehearsed except to say that August is the, open season for this remedy and peaches a sworn enemy.
Carbo veg. suits the obese, worn-out, run-down patient, whose protuberant paunch betokens much previous abuse of the digestive organs. Puffy, cyanotic countenance, oxygen hunger, flatulence and gaseous eructations, which incidentally to give relief, although not altogether pleasant for the ears of polite society. Sneezing in the Carbo veg, patient is not a matter of unalloyed bliss, for often it is quite a struggle, with many vain attempts to consummate the impending sneeze; the repertory puts it more succinctly by saying “ineffectual efforts to sneeze,” a symptom, by the by, which is found in Silicea and Calcarea fluorica also.
Of course Nux vomica is known to all; do no forget the cantankerous mentality of the individual who needs it, the morning aggravation, the gastric symptoms and the constipation. In the Nux coryza, alternate stoppage and opening of the nostrils will be found, with excoriating watery discharge, a rasped throat, and although the Nux patient is sensitive to cold and is chilly, so far as his coryza or hay-fever is concerned, he feels better in the open air. Headache, either frontal or occipital, will usually be present.
Sabadilla is a useful little remedy and Sabadilla and sneeze are practically synonymous. Chilliness, left-sided soreness of the throat and watery coryza are all characteristic.
Silicea may come in, even during the attack, though, like Psorinum is more likely to be a constitutional, basic remedy. Both remedies hate cold, both avoid drafts, both like to be warmly dressed and wrapped up. Silicea is particularly sensitive to drafts about the head and suffers from pain in the occiput, which is relieved by warmth. Offensive and excoriating foot- sweat or such a sweat which has been unwisely suppressed by salicylic acid or alum foot-baths is a symptom of importance. Offensiveness belongs of course to Psorinum and practically all discharges and even the patient himself is apt to have an offensive body odor.
Succinic acid has for us done splendid work, though we must confess that its use has been somewhat empirical and its indications negative, i. e., when well-marked symptoms of other remedies have been lacking. Carl Rust, of Cleveland, first called our attention to it. Rust is that rare bird, the nose and throat specialist who still attempts to for his patients in the good, old-fashioned homoeopathic way,instead of shooting medicated sprays from an impressive air compressor against every mucous membrane he may chance to meet.
Wyethia hails from beautiful California and presents a much irritated and inflamed mucous membrane of the entire naso- pharyngeal tract, with constant tickling and an insistent desire to cough; itching of the palate and of the posterior nares is a symptom of value, found, however, in Arundo, Silicea and some others also. Dryness of the epiglottis and burning.
Arundo mauritanica is an Italian grass; itching of the palate as just mentioned and itching in the nose are characteristic; sneezing and watery coryza are of course present.
Sanguinaria nitrate is a splendid remedy when the symptoms agree. These are often violent-watery, burning, excoriating nasal discharge, sneezing, rawness, burning in the throat, nasal obstruction are all typical.
Recently we found occasion to resort to the specific antigen of our O.S. friends in two old chronic hay-fever cases, marked not only by the usual distressing nasal features, but also by most violent asthma. The symptoms, though severe, were not especially suggestive of any of our usual remedies, ands for this reason we decided to give a potency of timothy grass itself, Phleum pratense.
This we did, obtaining the 6th centesimal potency and giving this in frequent repetition, in both cases with practically immediate and beneficial effect. In one case the asthma subsided within two hours and did not return, although the patient continued to remain in the country, surrounded by timothy grass on all sides. In this case, later on, a few remaining nasal symptoms were quickly relieved by Arsenicum iodatum 200.
This interesting experience we give for what it is worth; the experience of others may be confirmatory or otherwise, though to us it seems worth following up in suitable cases. To be sure, the remedy should receive a careful homoeopathic proving, so that we might define its exact position and know its finer indications. In the meantime we are thankful that in these two cases at least we have been able to desensitize our patients and that per oram, without restoring to hypodermic or other cumbersome and obnoxious methods. The simplest way is assuredly the best and homoeopathy offers the simplest method every time. By all means, then, let us help our patients, even though we must resort to desensitization to do it!
VACCINE IN PILLS.-
Under this caption, The Brooklyn Eagle of May 21, 1923, gives space to a news item, received by cable from Paris, France, of the same date, in which it is stated that a method of administering anti-typhoid vaccine by pills instead of injections under the skin has now been proved so effective that agitation is under way, seeking to introduce this method into the French army. The article further states:
“In the process, originated and perfected by M.Besredka of the Pasteur Institute, the vaccine is contained in a pill, which when dissolved in the mouth gives immunization against typhoid. The method does not produce the painful reaction which follows when the vaccine is injected subcutaneously. It is declared to be not dangerous to babies.
“In a recent typhoid epidemic in a small area at Pas de Calais the pill method was employed with great success under the direction of Dr.Lois. Villani, medical inspector of the Department of Hygiene. Out of 1236 inhabitants vaccinated with pills, only five developed typhoid, whereas four out of 173 vaccinated by the hypodermic method developed the malady.
“It was ascertained that all nine of the victims were attacked by the fever before the vaccine had the necessary time to take effect”.
Here we have another bit of evidence that the advanced men in the Old School are approaching nearer and nearer to homoeopathic methods. Logically potentization will follow in time and ultimately foundation principles of homoeopathy will be adopted in all their completeness, even though their so-called sectarian origin may not be acknowledged and the nomenclature may be changed. The main thing, however, is that suffering mankind will have the benefit.
During the annual convention of the State Medical Society (Old School) in New York City in May, the public press was well provided with accurate reports of the proceedings and gave much valuable space to their presentation.
The New York Herald of May 24th contained an account headed “Finds Pneumonia Serum Cures 93 Per Cent. Care Needed to Suit Vaccine to Individual, Dr. Cole Tells Physicians.” The account then proceeds:
“Dr. Rufus I. Cole, medical director of the Rockefeller Institute for Medical Research, in all address yesterday before the State Medical Society, in session at the Waldorf-Astoria, said that the results obtained by the institute in the use of the anti-pneumococcus serum for treating lobar pneumonia show the vaccine to be virtually 100 per cent. effective if properly administered.
“He revealed for the first time that of 221 cases treated by the institute since he perfected the serum, in 1914, there have been only twenty-four deaths, or a mortality of 10 per cent. Six of these deaths, he said, were complications resulting from pneumonia before the serum could be administered; hence the actual mortality should be administered; hence the actual mortality should be placed at 72 per cent., he said. “DEATH RATE HERE IS 10,000.
“These figures gave great encouragement to the 2000 physicians attending the annual meeting. They visualized a considerable decrease in the annual death toll of 150,000 in this country from pneumonia. The death rate in this city amounts to more than 10,000 a year, it was pointed out.
“Dr. Coles treatment is for the Type I of lobar pneumonia, which constitutes about 60 per cent. of all cases. He pointed out that for the general practitioner “the difficulties of administering the serum are very great. but called attention to the aid offered by the State Board of Health to physicians engaged in private practice.
“He said that in order to make this treatment effective it is necessary that in each case the type of pneumococcus causing the infection be determined before treatment is commenced In most cases, however, he added it is possible to do this within a few hours after the patient comes under observation”.
The public at large will naturally derive much comfort from Dr. Coles announcement and the medical profession will reap a considerable reward as a result; the psychology of this publicity is unquestioned; it is good and legitimate advertising; the homoeopathic school ought to, and could, if it would bestir itself, adopt similar methods of publicity; homoeopathy is sadly in need of legitimate propaganda; but in order to make this effective, it must first of all be able to produce results. It must use the weapons of the old school; this means that something of the same sort must be done as was done sometime ago by Dr. G. Harlan Wells of Philadelphia, in the Hahnemann Hospital of that city.