culous at the time of the operation. The
disease is one of young adults, 20 of the 35
being 30 years of age or younger.
The ''past histories" of these patients were
interesting. In 5, there had been scarlet fever,
producing a possible "locus minoris resisten-
tia." One case had suffered from a swollen
left knee 4 years before admission; another
from an obscure abdominal inflammation 10
years previously; a third had been operated
on for tuberculous submaxillary glands; a
fourth had had "malaria" as a child, pneu-
monia at 25 years, and cough and hemop-
tysis at 40 years. Other patients had been
treated for rheumatism, appendicitis and la
grippe.
In these cases, the probable duration of the
disease varied from 2 months to 17 years,
with an average of 4yi years. The first-
noticed symptoms were vesical in 17 of the
35, but a close scrutiny of the histories and
comparison of the clinic and pathologic find-
ings, convinces the author that in the great
majority of cases, female urinary tuberculosis
originates in the kidney. With the widest
margin in favor of primary bladder infection,
but 5 cases were classed under this heading.
The author has seen but 2 cases of undoubted
vesical tuberculosis, in which other portions
of the urinary system were normal, and one
of these had extended through the bladder
wall from a primary genital lesion.
The physical condition of the patients var-
ied greatly, some presenting the picture of
health and others appearing to be at death's
door. While bad hygienic surroundings are
most important in producing the desperate
condition, the two chief factors are lack of
free drainage and the loss of sleep from irrit-
able bladder.
A probable diag^nosis can be made from a
careful history alone. Pain in the back, side
or inguinal region, together with a disturb-
ance of the bladder function, leads one to
suspect tuberculosis. The kidney is usually
palpable and tender, and the thickened ureter can
generally be palpated per vaginam. While
these conditions may be found in other forms
of inflammation, tuberculosis being by far
the most frequent, the patient should be
warned against possible contamination of the
surroundings by the urinary excretion. The
finding of signs of tuberculosis elsewhere
makes the diagnosis more certain.
It is confirmed by (1) the tuberculin test.
(2) By finding tubercle bacilli in the urine.
They can be found in practically every case.
' Do not make 20 or 30 slides in one day, but
examine 1 or 2 daily for a week, for there is
likely to be a shower of bacilli from a freshly
broken down focus. It must not be forgotten
that the urine may be clear for days, even
when the patient is the most ill, due to the
blocking of the ureter. (3) The injection of
guinea pigs. (4) Cultures. The tubercle
bacilli seldom growing, a sterile culture is
most suggestive. (5) Cystoscopic examina-
tion. Only those who use this instrument
can appreciate its value in accurately deter-
mining the exact conditions. A strong pro-
test is made against the catheterization of the
ureters, when the bladder is diseased.
The summary of the operations is as fol-
lows: Nephrotomy, 3 cases, 2 deaths (11
weeks and 2 years). Nephrectomy, 9 cases,
1 death (6 weeks), 8 living. Nephrectomy
and partial ureterectomy, 7 cases, all living.
Nephro-ureterectomy, 13 cases, all living.
Nephro-ureterectomy, with partial cystec-
tomy, 3 cases, 2 deaths (15 days and 6 days).
There were thus 5 deaths, 2 of which were
as the result of the operation. Sixty-three
per cent, are now in good health. (Johns
Hopkins Hospital Bulletin, January, 1904.)
Results of Hysterectomy for Carcinoma. —
Glockner reports the results of the treatment
of carcinoma uteri at the university clinic in
Leipzig. Between 1887 and 1901, 974 cases,
with an average age of 53i^ years, entered the
hospital; of these 260 (26.9%), averaging 45 J4
years, were operated upon. More than half
of the patients waited over 3 months after
the first symptoms before seeking relief. The
cancer was cervical in 90%, fundal in 10% of
the cases'; 86.5% of the operations were vagin-
al. The total mortality for the 14 years was
8.4%, but this has been reduced to 3.3%
during the past five years.
Of 132 patients observed for at least 5 years
after the operation, 47 have remained free
from recurrence; of these two-thirds were
cases of fundal carcinoma. Seventy per cent
of all returns came within the first year, and
nearly 50% within the first 6 months.
^ The necessity of early diagnosis and opera-
tion is emphasized. (Zent. f. Gyn., 1904. No.
4.)
Digitized by
Google —
176
PROGRESS OF MEDICAL SCIENCE.
Jour. M. S. M. S.
PHARMACOLOGY AND THERAPEUTICS.
Under the charge of
W. J. WILSON, JK.
Radium. — Becquerel carried a small par-
ticle of radium in a glass tube in his vest
pocket. It set up a dermatitis, followed in
three days by a burn, and from this an ulcer-
ation resulted, taking about two months to
heal. A tube containing radium attached to
the back of a mouse resulted in its death
in twenty-four hours. A few milligrams put
beneath the skin of a mouse resulted in its
death in three hours. Placed over the closed
eyelids, a tube of radium gives a sensation
of light. Seeds subjected for some time to
Uie radium influence lose their power of germ- •
inating.
Sir Henry Crookes has carried out some
experiments which show that radium has .
marked bactericidal properties. Caspari ex-
posed cultures of the Micrococcus prodigiosus
to a preparation of radium which • destroyed
the germs in three hdurs. Soddy of England
has suggested the inhalations of the emana-
tions of raaium for consumption. Tracy of New
York has very recently carried out some ex-
periments in induced radioactivity. He finds
a normal salt solution one of the best media
for receiving this radioactivity. This prop-
erty suggests the hope of finding an effective
way of using it internally.
It has already been clearly proven that
radium rays have a very decided influence in
inhibiting the progress of diseased tissue'.
These emanations of radium seem to offer
some advantages over the X-ray in the treat-
ment of deep-seated cancer. The X-ray has
not been a success in this affection. Owing
to the penetrating power of the emanations
of radium, ;t will be possible to apply these rays
to the seat of the disease. Reports of cases of
lupus, rodent ulcer, cancer, blindness, epithel-
ioma, in which it has been used successfully,
are appended. (Inglis, Journal A, M. A., Feb.
Gth, 1904.)
Dinonin (ethylmorphine hydrochlorate) —
A new agent in ophthalmic therapeutics.
Conclusions:
1. That dionin possesses properties at pres-
ent inherent in no drug thus far used in ocu-
lar therapeutics.
2. That it is an analgesic of no little power,
and is frequently of value in alleviating the
pain of iritis in those cases in which atropine
does not relieve.
3. That the action of atropine seems to be
cnhaYiced by dionin.
4. That is has, upon the eye, a powerful
vasodilator and lymphagogue action.
5. That it is of value, if used to the point
of distinct reaction, in promoting the absorp-
tion of exudation deposits upon the anterior
capsule in the pupilary space, and also in
helping the absorption of post-operative debris
after cataract.
6. That it certainly does help to clear up
the corneal opacities in some cases of inter-
stitial keratitis.
7. That it seems without effect in all other
forms of corneal opacities.
8. That its influence on the glaucoma pro-
cess is yet unsettled.
9. That it should be widely used and the
effects of such use reported, in order that a
final correct estimate of the value of the drug
may be made. (Therapeutic Gazette , Feb. 15,
1904, Reber.)
Scarlet Fever. — In treating scarlet fever, use
as an initial purge:
5^ Hydrargyri chloride mitis;
Sodii bicarbonates;
Sacchari albi^ aa .06 or gr. j;
Met. ft. chart no j;
for the fever,
5 Tincturae aconite radicis, 1. or mxvj;
Liquoris ammonii acetates, 60. or 5'iJ
Met. Sig. Teaspoonful every 4 hours;
in the post febrile stage,
R Potasii citratis, 5. or ^\%\
Tincturae ferri chloridi, 10. or 3 iiv;
Aquae menthae pip, 30. or 3j;
Syrupi simplicis q. s. ad 120. or Jiv;
Met. Sig. Teaspoonful or more three times
a day;
when the disease is ushered in by convulsions,
5t Chloralis hydra tis, 1. or gr. xvj;
Sodii bromidi, 4. or 3j;
Aquae distillatae, 30. or 3J;
Syrupi, ad 60. or 3UJ
Met. Sig. Teaspoonful as directed;
for high temperature, use warm baths and
one-half grain doses of Phenacetin.
Throughout the disease, given plenty of warm
drinks, carbonated water, or lemonade, and
keep the nose and throat cleansed with a mild
alkaline antiseptic; when streptococcal com-
plications arise, use a good brand of anti-
streptococcic serum.
For a stubborn cough, use,
5^ Heroini, .1 or gr. ij;
Terpini hydratis, 1. or gr. xvj;
Ammonii iodidi, 2. or gr. xxx;
Met. ft. caps no xvj.
Sig. One every 4 hours.
Digitized by
CmOO^'Z
The Journal of the
Michigan State Medical Society
PUBLISHED UNDBR THB DIRECTION OP THE COUNCIL
Vol.. Ill
DETROIT, MICHIGAN. MAY. 1904
No. 5
Original Brticlee
SOME INVESTIGATIONS ON HAY FEVER.*
OTTO SCHERER.
Detroit.
John Bostock, before the Medico-Chir-
urgical Society of London, on the 16th
of March, 1819, read a paper entitled "A
Case of Periodical Affection of the Eyes
and Chest," describing his own case. His
attention was evidently "attracted by the
periodical annual return of the trouble,
and bearing this in mind, he realized that
he was dealing with a trouble entirely
different from all known diseases, with a
new clinical entity. This characteristic,
the annual recurrence of the attack at
about the same time, is of the utmost im-
portance. When its reason is once eluci-
dated, we will know vastly more of the
nature of the affliction. Ignoring this
feature of periodical recurrence, Wm.
King, in 1843, denied that Bostock's
"Catarrhus Aestivus" was a clinical entity.
He confused with it ordinary catarrhs and
asthma. Many an author since that time
has done likewise, and has thus helped to
blur a clear and very accurate picture of
a clinical entity, such as we have from
Bostock's description. The best writers
on the subject have given due and proper
*Read before Section on Laryngology of
Wayne County Medical Society, Jan. 25th, 1904.
consideration to this characteristic, and all
that have, speak of it as the one important
feature of the disease. W. C. Hollopeter
says, "The salient feature of hay fever
is its periodicity, or annual recurrence.'^
This is part of its very nature, is the cen-
tral point of diagnosis, is its chief charac-
teristic, and to its elucidation, Holmes
says, "all existing theories tend.'' The
overlooking of this characteristic has
caused a great amount of confusion. It
has caused many writers to call condi-
tions hay fever, which are not hay fever,
and it has brought confusion into the eti-
ology, the pathology and the treatment
of this trouble.
I am compelled to draw particular at-
tention to this pointy as wc cannot arrive
at accurate conclusions in regard to any
disease, unless we are able to exclude
conditions, which may he similar, but
which we know are not identical. We can
only intelligently study a disease, when
we view it as a clinical, a pathological
entity, when we can exclude all conditions
that are foreign to it. This I believe we
can do with hay fever, if wel^ear in mind
its characteristic of periodical recurrence.
Digitized by VjOOQIC
I7S
HAY FEVER— SCHfiREft.
Jour. M. S. M. S.
and refuse to recognize as hay fever all
conditions that do not show this feature.
In my study of hay fever I have done this,
and I have gone eyen further. I have
considered that the fall hay fever of this
country is a clinical and pathological en-
tity with sharply defined characteristics.
I believe it to differ from the spring or
summer hay fever, and from Bostock's
Catarrhus Aestivus, in a sufficient degree
to allow us to consider it as a distinct clini-
cal and pathological entity. I believe that
we are justified in doing the same with
spring hay fever. To study them intelli-
gently we must consider each a disease by
itself. That they differ clinically we know,
as the patient suffering from fall hay fever
does not have the spring hay fever, and
the patient subject to the latter does not
have the former. Furthermore we are
justified in considering them distinct from
one another, pathologically, for this same
reason. I admit that there is a great re-
semblance and similarity in the two condi-
tions, and in all probability the solution
of the one, will bring with it the solution
of the other.
Pollen was first suspected to be the ex-
citing cause of hay fever by Elliotson, of
London, in 1831, but not until Blackley
published his work on hay fever, in 1873,
did the belief in the pollen theory become
widespread, and even then there were
many who could not attribute to pollen
any causative properties. Blackley found
by tests that very many pollens, in fact
all that he tried, had quite irritating, action
on himself, and on others who were hay
fever sufferers, when applied to the con-
junctiva, to the nasal mucous membrane,
or to the skin, denuded of its epidermis,
while they did not show this action on
those who were not subject to hay fever.
These tests were made principally, as far
as I can learn, during the hay fever sea-
son and therefore are open to grave ol>-
jections. i
Blackley attributed this reaction to the
mechanical irritation of the pollen on the
parts to which it was applied, and princi-
pally to some property of the living proto-
plasm of the pollen. He also assumed a
personal, individual predisposition of the
hay fever sufferer to the irritating influ-
ence of the pollen, an idiosyncrasy. He
found that the amount of pollen in the
air was usually quite proportional to the
severity of the hay fever attacks. He ex-
plained the freedom from hay fever on
the ocean and in localities exempt from
it, by the absence of pollen. He tried to
explain all the symptoms by the local irri-
tation of the pollen on the mucous mem-
branes. This was not always possible,
and often conflicted with known facts.
There was much about the theory, as he
brought it out, that was very fascinating,
and yet it was open to the gravest objec-
tions. Many workers in this country also
ui)hekl and attempted to further the pollen
theory, but like Blackley, they never
brought convincing proof of the truth
of it. The reasons for this are various.
The results of their tests were very often
conflicting, their theory did not explain all
the characteristics of true hay fever. By
being us^d to explain the peculiarities of
spurious cases, the theory was easily prov-
en to be fallacious. To-day, probably,
the great majority of physicians believe
that pollen has some irritating properties
on the hay fever patient, but I think that
there are but very few who believe that
ix>llen is the sole cause of hay fever.
In the spring of 1903, Prof. Dr. Dun-
bar, of Hamburg, Germany, published a
monograph entitled "The Cause and Spe-
cific Cure of Hay Fever.'' .A lona series
Digitized by VjOO VlC
May, 1904.
HAY FEVER— SCHERER.
179
of very carefully conducted experimental
investigations led him to the belief that
the spring hay fever of Europe is caused
by the pollen of the plants belonging to
the family of Gramineae, or glasses, and
that this is the duly cause of hay fever,
acting. of course in connection with the
individual predisposition. His work, al-
though given due consideration by most
writers, has not been received by all as
conclusive proof, as to the etiology of hay
fever. There are some features of this
disease that his investigations do not sat-
isfactorily explain. Until the pollen the-
ory elucidates hay fever in all its various
phases and aspects, it cannot be accepted
as proof positive of the etiology and path-
ology of this disease.
When I began the investigation of the
etiology of hay fever, it seemed to me that
the pollen theory, even with all its short-
comings, was the most plausible one, of
all those advanced, to explain this trouble.
I decided to look into the matter more
deeply, and by direct proof try to advance
the pollen theory, or to overthrow it. It
struck me very forcibly that pollen would
better explain the periodical recurrence
of the trouble, than any other external ex-
citing cause that had been advanced. I
came to the conclusion that it would have
to be the pollen from an anemophilous
plant, as the pollen of the entomophilous
plant is not carried by the air, and so
could not produce any trouble, unless the
patient came into direct contact with the
plant. The plant, from which the pollen
came; would have to be one which is very
common and widespread in its habitat, and
would probably prove to be wild growing,
one not cultivated, as only such a one
would produce pollen at about the same
time annually.
While living in the country last summer
and fall, I gathered all the various pollens
that ripened about the time that the fall
hay fever attacks begin. I incidentally
noted the time of their production, the
amounts produced, how they were carried
to the pistillate flowers, and the time when
they ceased to be formed. As a result of
these observations, I found that the pollen
of the Ragweed, Ambrosia Artemisiae-
folia, also commonly known as Roman
Wormwood, Hogweed, and Wild Tansy,^
is the only one that has all the character-
istics of my hypothetical exciting cause
of hay fever, and this corresponds with
what many before me had suspected.
The first ragweed pollen that I could
find was discovered on the 6th of August,
and then only traces of it were found.
After the 13th of August, it was produced
in very large quantities and from the 30th
of August on, the amount of it became
progressively less, so that none was found
in the country after the 10th of Septem-
ber. In Detroit, I found some as late as
the 14th of September, but this was the
last seen, and then there was only a trace
of it. Ragw^eed is a purely anemophilous
plant, is one of our commonest and most
ubiquitous weeds, and its habitat, is given
by Britton, as covering the country from
Nova Scotia to Florida, and from Brit-
ish Columbia and Mexico. It is found in
the West Indies and South America. It
is not prevalent in Europe, only having
been introduced there as a weed. Paren-
thetically, I might call your attention to
the absence of fall hay fever in Euroi^e.
When one's attention is once called to the
plant, it is surprising how prevalent it is,
even in the heart of a large city. I doubt
whether there is a spot in the city of
Detroit where in a radius of five hundred
feet it would be impossible to find sanij^s
i8o
HAY FEVER— SCHERER.
Jour. M. S. M. S.
of the plant. Ragweed prcxluces pollen in
very large quantities during the two
weeks from the middle of August to the
beginning of September. This pollen is
carried freely by the wind, probably to
great distances, being exceedingly light.
During this time it is present in the air
of the city. This was easily demon-
strated. I filtered air through cotton,
drawing it through by means of a filter
pump, and in every saijiple collected dur-
ing the hay fever season I found the
pollen grains. As the tests that I made
last fall do not show accurately the
amount of ragweed pollen present in the
air during the critical period, being made
to prove only its presence and not its
amount, I will carry out similar experi-
ments this coming fall with improved
methods. ^
Blackley very conclusively proved this
for the pollen of the grasses. As ragweed
pollen is formed and scattered in the same
manner, we are justified in drawing the
conclusion that it must be present in like
large quantities during the season of its
production.
Ragweed pollen in bulk is a lemon
yellow, odorless, tasteless, non-sticky
powder. The individual grains are per-
fectly spherical, 28 microns in diameter
on the average, and consist of an inner
protoplasmic mass, which shows no struc-
ture. A thin membrane, called the intine,
envelops the mass of protoplasm. Out-
side of this there is an outer covering
called extine, which is covered with very
many small projecting spines, like a chest-
nut burr. The grains do not contain any
starchy matter, and in this are different
from the pollen grains of the gramineae,
which all contain very minute rod like
bodies, which show very strong starch
reactions.
I have isolated from the ragweed pollen
a white, amorphous substance, which has
a toxic action on the hay fever patient-
It is soluble in salt solutions and glycerin,
but not in alcohol or ether, can be filtered
through a Berkefeld filter and w-ill not
dialyze through animal membranes.
When heated to a temperature of 80
degrees C, or almost that high, it loses
its toxic properties. I have named it
ambrosin. The residue left, when the
ambrosin has been extracted from the
pollen grains, is perfectly inert, having no
irritating action whatever on the hay
fever patient.
I made no tests on hay fever sufferers
during the hay fever season, as the result
of such tests would for obvious reasons be
unreliable, and not convincing. I reasoned
that I would be able to get the irritating
effects of the pollen at any time of year,
if it were the causative factor of hay
fever, acting on a person with the peculiar
susceptibility. Preparatory to these tests
I made various trials with numerous pol-
lens on immunes, meaning by immunes
such as never have hay fever. I placed
smaller and larger amounts of solid and
of ground pollens into the conjunctival
sac of my own eyes and into those of
many others, who kindly submitted to
these tests. All of the pollens so tried were
without irritating effect, except the slight
mechanical irritation that they produced,
and this passed off' in about two minutes
after the pollen was removed. This
mehanical irritation was only present in a
more marked degree w^hen very large
quantities of pollen were used. In no case j
was any irritation produced that could be
attributed to a pollen toxin, so called, and
this lack of irritating properties was still
more marked when solutions of the pollen
were used, as these solutions were free
Digitized
May, 1904.
HAY FEVER— SCHERER.
181
from any solid particles. These solutions
are as inert as so much water, when
applied to the immune, while when
apphed to the hay fever patient, the result
is strikingly different.
On October the 27th, I made my first
test on a fall hay fever patient, and as this
was a typical case with a typical result, I
will describe it more minutely. The
patient, Mr. K., has been a hay fever
sufferer for twenty years, his attacks
coming on every fall about the 15th of
August, and lasting, if he remained in
Detroit, the usual length of time. His
attacks are so severe that he is compelled
to leave his home, which is in this city,
and go north, where he is at once relieved
and where he remains free from the affec-
tion. Should he return before the hay
fever season has passed, he has a renewed
attack, lasting until the critical period is
over. His eyes and nose are quite ser-
iously affected, and he also has very
severe attacks of asthma. He has been
treated by many physicians and many
methods, but his hay fever returns with
unfailing regularity. The asthmatic
attacks are now much more severe than
they were, when he was first affected by
the hay fever. The only means of relief
that he has found is to go north, or to
some othpr locality where there is no hay
fever. Ground ragweed pollen was used,
and as small an amount was applied to the
conjunctiva of the lower lid as was pos-
sible to do, and still be certain that some
had been applied. The amount was about
as much as a pin point. At once there
was very severe smarting and burning,
and very soon the eye began to discharge
tears freely. Within five minutes the
ocular and palpebral conjunctiva and the
lid margin were intensely injected. The
difference of the two eyes was very strik-
ing and could be seen easily at a distance
of fifteen feet. Shortly after this the eye
was chemotic, so that the conjunctiva was
raised at least one-eight of an inch above
the cornea, slightly interfering with the
free closure of the lids. The lower lid
swelled to about three times its normal