1915] Mark J. Gottlieh and Seymour Oppenheimer 129 



ceptible person becomes ill from the action of the pollen contents 

 on his respiratory mucous membrane and the skin of the face. If 

 a quantity of air laden with pollen is directed into the stomach or 

 rectum, the Symptoms are localized in the stomach or rectum and 

 do not appear in the nose, eyes, mouth or face, If a large dose of 

 pollen extract is injected subcutaneously into a susceptible individ- 

 ual, typical Symptoms of anaphylaxis result, as has been observed 

 in a patient to whom we administered an excessive dose of the ex- 

 tract. Within ten minutes thereafter, this patient feit a sense of 

 oppression in the ehest, a suffusion of the face, her breathing be- 

 came labored, there was marked palpitation of the heart, and within 

 forty-five minutes, a giant urticarial rash covered her entire body. 

 All of the Symptoms subsided within two hours and the patient feit 

 well enough to get up. Pollen grains of many varieties are capable 

 of producing this condition, and not all individuals are sensitive to 

 the same pollen. Among the most common plants in this country 

 whose pollen induces hay fever are timothy, red-top and blue grass, 

 and ragweed and golden-rod. The grasses cause the early or 

 spring variety, whereas ragweed and golden-rod produce the late 

 or autumnal variety. 



Our experience has been mainly with the autumnal variety of 

 hay fever. The majority of our patients were susceptible to rag- 

 weed alone; a few were markedly sensitive to ragweed and also 

 slightly to golden-rod. 



There are three methods by which it is possible to determine 

 which kind of pollen is operative in a given case. A drop of each 

 of a given series of weak pollen extracts may be instilled into the 

 lower conjunctival sac of the eye. The one which produces con- 

 gestion and swelling of the caruncle and mucous membrane of the 

 lid is the one to which the patient is sensitive. Very minute quan- 

 tities of the available extracts may be injected intracutaneously and 

 the extract of the pollen to which that patient is anaphylactic will 

 cause swelling and redness around the point of introduction. When 

 a very minute quantity of pure pollen is gently rubbed into a small 

 scarification wound of the skin, a wheal will develop at and around 

 this point of scarification, if the patient is susceptible to that pollen. 

 Some patients are sensitive to more than one pollen; and it seems 



