1915] Mark J. Gottlieh and Seymour Oppenheimer I33 



spect has suggested the Substitution of a method that is less labori- 

 ous and time consuming, and on which we are now working. The 

 f act that the product is not completely soluble shows that denatur- 

 ation occurred. For this reason we are now endeavoring to perf ect 

 a method of extraction which will prevent such a result. 



Results of treatment with the Vaccine. Eleven cases were 

 treated in 1 914, before and during the season for autumnal catarrh. 

 Six cases were treated in advance of the attack. One of these was 

 cured for the season, four had very mild Symptoms, and one was 

 not improved. Five cases were treated during the attack. The 

 Symptoms of four subsided after one to four injections, whereas 

 one patient received no benefit. Altogether, there were five eures 

 for the season. In four cases there was marked improvement. In 

 two cases there was no improvement. Of the two cases that were 

 not improved, one had a polypoidal degeneration of the middle 

 turbinate with underlying bone necrosis. The patient had distinct 

 asthmatic attacks every night and it was impossible to say whether 

 the attacks were due to his hay fever or his local nasal condition. 

 The other was a physician who reacted to both ragweed and 

 golden-rod pollen. He received in all thirty-three injections, alter- 

 nating the ragweed extract and the golden-rod extract. He came 

 very irregularly. It is possible that at times the treatment was too 

 intensive. His physical condition was so poor that possibly he 

 could not develop a tolerance. 



DiscussiON. Nine of our cases reacted to ragweed pollen 

 and two reacted to that of both ragweed and golden-rod. Both of 

 these latter cases received both golden-rod and ragweed antigen 

 hypodermically. One was cured but "the other was not improved. 

 When a patient is sensitive to more than one pollen, individual doses 

 of each extract should be administered, in order to determine when 

 the tolerance is sufficiently raised for each. Mixing the antigen is 

 too empirical, 



There are two ways of determining when a patient has become 

 sufficiently immune to Warrant discontinuance of the treatment. 



1. With the complement-fixation test. 



2. From the size, intensity and duration of the wheal produced 

 by skin scarification, at different times, namely, before and during 

 the treatment. 



