Samuel M. Peck

Attempts at Treatment of Hemorrhagic Diathesis by Injections of Snake Venom

In 1930 the author attempted to produce a Shwartzman phenomenon (local hemorrhagic necrosis following local and intravenous injections of bacterial toxic filtrates with fungus extracts). These efforts were unsuccessful. In the hope that previous local injections of a vascular poison might render the reaction site more sensitive to hypothetical toxic substances in fungus cultures, snake venom was employed. This again proved unsuccessful. Later, in collaboration with Dr. Harry Sobotka, 1 the author showed that if 14 days to one month were allowed to elapse between the time of injecting of rabbits with snake venom and the elicitation of a Shwartzman phenomenon, a large number of the animals became refractory to the latter. Since no circulating antibodies could be demonstrated to explain the refractory state, and since antivenin had no effect on the course of the Shwartzman phenomenon, the induced refractory state was thought to be due to some change in the vessel walls which made them resistant to toxic filtrates and this prevented the hemorrhage. With this possibility in mind, the author then treated with snake venom diseases which can be grouped under hemorrhagic diatheses. Patients showing certain allergic phenomena such as urticaria, neurodermitis, as well as asthma and hay fever were also treated. Clinical trial was made in 44 cases which can be divided roughly into 3 groups: Group I consists of 3 cases of thrombocytopenic purpura, 20 one case of Henoch-Schönleins syndrome (Franks capillary toxicosis), and 2 cases of hemophilia. The hemorrhagic purpura cases had such symptoms as epistaxis and purpura; and in 2 of them there was a history of prolonged and profuse menstrual periods. Two of this group have been under treatment with snake venom for 9 months, and one for 6 months.

FUNGUS ANTIGENS AND THEIR IMPORTANCE AS SENSITIZERS IN THE GENERAL POPULATION

Disease manifestations caused by both bacteria and fungi can be divided into those which are directly due to these organisms and those special forms which have arisen because of the development of sensitization to the organisms and/or their products. The latter have been grouped under the general heading of cutaneous micr0bids.l The clinical manifestations of microbids depend on a development of an acquired hypersensitivity to the organisms and/or their products after the primary infection has existed for some time. The degree of acquired hypersensitivity is dependent on the causative organism, on individual predisposition, and on many other factors which cause more intimate contact between the living organisms and the living cells. In the group of microbids, we have trichophytids when the trichophyton fungus is the primary cause of the lesion, epidermophytids when an epidermophyton is the causative organism, and levurids when monilia cause the primary infection. Trichophytid is the general term which has been applied to the microbid associated with fungus infections. The term in the literature has often been shortened to ((ids.” The allergic manifestations due to fungi which are most commonly encountered in the general population are those associated with the superficial fungus infections. Of these, almost all are associated with infection due to T. mentagrophytes, especially dermatophytosis of the feet.

Coagulating Power of Bothrops Atrox Venom on Hemophiliac Blood

Barnet and Macfarlane 1 have recently reported on the use of snake venom for local hemostasis. Their best results were obtained with venom of the Russel viper. We have been working along similar lines with the venom of the Bothrops atrox (Fer-de-Lance). This reptile is a native of Central and South America and is fairly easy to obtain and keep in captivity. Thus, unlike the Russel viper venom, a plentiful and relatively cheap supply of this venom is readily available. Two different samples of the dried venom were obtained through the courtesy of Dr. R. P. Connor, of the United Fruit Co. The samples represented pooled venoms from “milkings” carried out at the Serpentarium, in Tela, Honduras, several years ago. In the experiments, the venom was diluted with physiologic saline. The minimum lethal dose for pigeons (intravenous route) weighing 250-350 gm. varied from 0.2-0.25 mg.; the minimum lethal dose in rabbits (intravenous route) of approximately 2 kilos, was 0.015-0.02 mg. These figures were determined on a large series of pigeons and rabbits with both samples. V. Brazil gives 0.01 as the m.l.d. for pigeons and 0.07 mg. as the m.l.d. for rabbits We have consistently found, as can be seen from our figures, that pigeons were much more resistant than rabbits to the toxins (neurotoxins) of the venom. The haemorrhagine content of the Bothrops atrox venom was titrated according to the method of Witebsky, Peck, and Neter. 2 One sample failed to elicit hemorrhage in a 1% solution, while the other sample produced a moderate amount of echymosis in 3 minutes when 1 cc. of the 1% solution was added to the chicken embryo. It was, however, decidedly poorer in hemorrhage-producing substance than Moccasin venom. The coagulating power of Bothrops atrox venom was tested on the blood of 2 hemophiliacs: L.E., age 25, whose clotting time was 58-60 minutes and V.B., age 36, whose clotting time varied from 1 hour and 40 minutes to 1 hour and 46 minutes.

Intradermal Venom Reaction. A New Method of Determining Capillary Fragility

Summary A new capillary fragility test based on intraderimal injections of titrated moccasin snake venom is described. This test was found helpful in the niaiiagement of thrombocytopenic purpura heniorrhagica. Its applicability as a guide to local, general and toxic capillary changes is discussed.

Alkaline Toilet Soaps Are Not the Cleansers of Choice in Routine Pediatric Care: A Cross-Over Study Comparing Alkaline Toilet Soap Against a Neutral Detergent As a Routine Cleanser

†Associate Attending Dermatologist, The Mount Sinai Hospital, New York City; Consultant Dermatologist, Greenpoint Hospital, Brooklyn, New York. ‡ Instructor, Dermatology, College of Physicians & Surgeons, Columbia University. This study was supported by a grant from Lever Brothers Company, New York City. CLEANSING hygiene r~f the skin of the well child is managed, say most textbooks of pediatrics, by the use of a nonirritating toilet soap bath. The child with dry and sensitive skin is told to avoid fre-

Additional data on the treatment of uterine bleeding with snake venom

Abstract In a previous report the therapeutic effects of moccasin venom (Ancistrodon piscivorus) in twelve cases of functional uterine bleeding were presented. 1 The clinical results obtained warranted further trial in cases of this kind. The present report embodies subsequent observations on some of the cases already reported, with the addition of new cases.

Cataphoretic Separation of Toxic Components of Moccasin Venom.

Attempts at separation of the various active components of snake venoms have not been very successful. These principles are probably proteins or substances closely related to proteins. 1 They are quite unstable. 1 , 2 For this reason, chemical procedures used in their separation, such as precipitation, extraction or absorption often resulted in the destruction of the less stable elements. Separation of the hemorrhagic and hemolytic components of moccasin venom by cataphoresis was attempted because it was thought that this procedure might be less destructive. This method had been tried by others without success in an attempt to separate the neurotoxic and coagulant principles of Bothrops venom 3 and the neurotoxin and hemolysin of cobra venom. 4 In the present studies, a cataphoresis chamber was used as described by Todd. 5 An electrical potential of 120 volts D.C. was applied to solutions of moccasin venom for 3 to 5 hours at different hydrogen ion concentrations. The liquids in the anode and cathode chambers were then tested for hemorrhagin and hemolysin. The hemorrhagin was assayed by using the intradermal venom test in rabbits. 2 It was found that at pH values of 6 and above, the hemorrhagin migrated only to the anode, below pH 4 only to the cathode. Very little migration occurred in the neighborhood of pH 4-5. This indicated that the isoelectric point of the hemorrhagic component of moccasin venom was between pH 4 and 5.

Demonstration of Hemorrhaging in Snake Venom by Means of the Chicken Embryo

Summary The addition of moccasin venom in sufficient concentration to 3-day-old chicken embryos produces hemorrhages in the vascular network. This method may be used for the demonstration of hemorrhagins in venoms. Further studies should be made to determine whether this method is applicable for the quantitative determination of hemorrhagins.