APPLICATION OF THE PHENOMENON 423 



po^ver in the arm for a day or two. All the patients ^vho showed 

 hypersensitivity ^vere successfully desensitized with the following 

 technique. Beginning with 0.1 c.c. of a dilution 1:3,000 of venom, 

 successive doses were increased by o. 1 c.c. luitil 0.6 c.c. was reached 

 and then by 0.2 c.c. until 1 c.c. was reached. Tlien the maximum 

 dose of 1 c.c. was resumed. 



Forty-two patients with a liistory of repeated epistaxis were 

 treated according to the method outlined. Many of these patients 

 manifested bleeding points, evidences of sinusitis or nasal ob- 

 struction, but no treatment ^vas administered to affect these con- 

 ditions dining the period of observation. The cases treated coidd 

 be grouped as follo^vs: 1. Tehmgiectasia of the nasal septum. 2. 

 Ulcerations of the nasal septum. 3. Bleeding without visible soince 

 and 4. Hemangioma of the nasal septinn. J. L. Goldman reports 

 that in a niunber of instances one or two injections of snake venom 

 sufficed to control the bleeding completely. Many of the patients 

 after a comse of therapy (from foin- to eight injections) were 

 free from bleeding for from six months to a year. Others after a 

 lapse of months had a tendency to recmrence, but even in these 

 cases the hemorrhages lessened in frequency and in sexerity. Such 

 patients required further injections of venom at intervals of from 

 two to foin^ xveeks to control the symptoms completely. Such sub- 

 sequent treatment has been termed "the maintenance dose." 



The folloxving observations made during the period of treat- 

 ment of these patients are offered as further evidence to substan- 

 tiate the claim that the cessation of bleeding is due to the action 

 of the snake venom and is not just a casual occurrence: 



When bleeding was controlled by two injections a week of large 

 doses it was often necessary to reduce the amount markedly be- 

 cause of the development of hypersensitivity. With the reduction 

 in the dose there was often a mild recurrence of the epistaxis. 

 This xvas soon brought under control when the full dose was 

 given. Finthermore patients who for some reason or other stopped 

 prematinely attending the clinic, after the control of their symp- 

 toms, often returned because of recurrences of the epistaxis. Such 

 bleedings soon ceased xvhen they again received injections of 

 snake venom. 



All the patients were observed once or twice xveekly for at least 

 two or three months. Twenty-one of the forty-two patients re- 

 turned for folloxv-up study. The interval periods for these pa- 

 tients xvere as folloxvs: two years, 2 patients; ten months, 2 pa- 



