422 LOCAL TLSSUE REACTIVriY 



l\\c ,st'(<)ii(l i^ioiij) iiuliidc'd ';2 allci^ic cases ol the lyjK* j)ie- 

 viously iiientioiied. In the majority o\ them the results have not 

 been satislactory. In a lew (ases, however, very definite clinical 

 improvement seemed lo Inllow tlie treatment. 



The \enom used ^vas that ol the moccasin snake {Ancistrodon 

 l)iscLVorus) . The standard dose for an adidt was 0.2 c.c. of a 

 1:3,000 solution in j^hysiological saline given intradermally. This 

 ^vas increased in most cases to two injections of 0.2 c.c. each in 

 different sites. The injections Avere given once or twice Aveekly, 

 and the duration of the treatment varied \vith the cases. 



These authors considered the therapeutic effect sufficiently satis- 

 factory to Avarrant fiuther clinical trials of venom therapy. 



|. L. Goldman (1936) treated patients having recurrent epi- 

 staxis with moccasin snake {A. piscivorus) venom. Since, as men- 

 tioned before, this material proved more effective in creating 

 the refractory state in the phenomenon of local tissue reactivity 

 tlian other venoms tested {Bofhrops and rattlesnake venoms) , the 

 initial dose was 0.5 c.c. of 1:3000 dilution. Subsequent injections 

 Avere rapidly increased to 1 c.c. as a maximum dose. For children 

 the initial dose was 0.3 c.c, 0.8 c.c. being the maximum amount. 

 In a number of the patients hypersensitivity to the venom pro- 

 tein became manifest after the fourth or hfth injection. The pa- 

 tients Avere given injections t^vice a Aveek for variable periods, 

 depending on the symptoms. In instances in Avhich the epistaxis 

 was readily controlled, from four to eight injections constituted 

 a course of treatment. If the nasal bleeding was not entirely con- 

 trolled after this period, t^vo injections a Aveek were continued 

 until the clinical result Avarranted cessation of the treatment. 

 Some of the patients in the grouj) Avith telangiectasia required a 

 maintenance dose e\ery one or tAvo Aveeks for satisfactory control 

 of the epistaxis. Two such patients had been recei\'ing treatment 

 for over one year. There seemed to be no contraindication to 

 more frecpient injections of the \enom \vhen this Avas desirable. 

 Repeated injections of 1 c.c. had been given with no untoAvard 

 effect. The reaction in all the cases in which hypersensitivity Avas 

 evidenced was conhned to the local area of injection. No systemic 

 symptoms were encountered. The local reaction usually consisted 

 of sAvollen, red, j)ainhil areas \'arying in size from several centi- 

 meters to the entire size of the arm. They usually occurred within 

 twenty-four hours after the injection, subsiding quickly with wet 

 dressings. In a few instances the patients complained of lack of 



