EDITORIAL NOTES AND COMMENTS


Elsewhere in this issue we print by request of the above foundation the prize essay of one of the students of the New York Homoeopathic Medical College and Flower Hospital, a senior who has just won his degree of Doctor of Medicine. The essay ably reflects the painstaking efforts of the teachers in the department of Materia Medica, who without compensation, are giving of their time and money to educate homoeopathic physicians.


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.

“DESENSITIZATION.

“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.

“COMMENT.

“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.

Rabe R F
Dr Rudolph Frederick RABE (1872-1952)
American Homeopathy Doctor.
Rabe graduated from the New York Homeopathic Medical College and trained under Timothy Field Allen and William Tod Helmuth.

Rabe was President of the International Hahnemannian Association, editor in chief of the Homeopathic Recorder, and he wrote Medical Therapeutics for daily reference. Rabe was Dean and Professor of Homeopathic Therapeutics at the New York Homeopathic Medical College.