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gestation being almost certain. The fourteen others recovered, and thirteen children were born living, one of them being born at the eighth month."
Dr. Galbraith-Mr. President, all questions of diagnosis complicated with pregnancy are of considerable importance, and of considerable interest, as I have reason to know, from a late experience. About four weeks ago I was called to see a lady; an extremely fleshy lady. I had not seen this case previous to this time, and was not aware of any abdominal trouble. The symptoms were those of local peritonitis. There was great and severe pain. The question of what was the trouble came up. The lady said she was seven months advanced in pregnancy. The foetal heart sounds could not be heard. A surface examination of course confirmed the conclusion of pregnancy. I called my friend, Dr. Charlton, in consultation in regard to tapping; the symptoms demanded that something should be done. There was bloody urine prevalent and the bowels could be moved only with great difficulty. While we were deliberating as to the question of tapping, spontaneous delivery came on of a seven months' child, which was extremely feeble, probably brought about by the use of morphia; in five or six hours it died. Of course the lady became immediately relieved of the urgent symptoms and I have never been able to examine the case since that time; but there is undoubtedly an ovarian tumor there.
Dr. Fields-Did this disappear?
Dr. Galbraith-No sir. The immediate symptoms disappeared.
Dr. Harvey-Mr. President, I think that wherever an ovarian tumor exists we may expect to have trouble. `Whether a woman is pregnant or not, we will have trouble. The average duration of life with a tumor is three years, and it is a condition that calls for an operation. The addition of pregnancy to it makes it a very dangerous affair.
Dr. Hibberd-Do you say that in all cases of ovarian tumor, a woman becoming pregnant, operation should be done and done im-· mediately?
Dr. Harvey-That is the point exactly in all cases, whether there are any bad symptoms or not, because there will be bad symptoms in time.
HAY FEVER-ITS ETIOLOGY, PATHOLOGY AND TREAT
BY A. J. BOSWELL, M. D., FORT WAYNE, IND.
DEFINITION :-Hay fever may be defined as an acute catarrhal inflammation of the nasal respiratory mucous membrane, extending often to the mucus lining of the pharynx, larynx, trachæ and bronchii, complicated with sympathetic inflammation of the eyes, conjunctiva, palate and eustachian tube. The inflammation is characterized by extreme pruritus of the naso-pharyngeal mucous membrane and conjunctiva, which often also extends to the contiguous mucous membrane of the eustachian tube, palate, and not infrequently to the trachea and bronchii. There is a morbid increase of sensibility of certain points in the anterior nasal fossa, and on the anterior and posterior portion of the inferior turbinated bones and the adjacent portions of the nasal septum. Attending the itching of the nose and eyes there is an extreme lachrymation and photophobia, violent fits of sneezing and certain reflex symptoms, as cough and asthma. Some constitutional disturbance is manifest in a slight febrile action. There is pain in the head and frontal sinuses and paroxysmal occlusion of the nostrils. An increased secretion of the entire respiratory tract in the more severe cases prevails. There is an obvious increase of sensibility and irritability of the nervous system (erethism) during the inception and progress of the disease.
ETIOLOGY:-Let us turn our attention to the science of the causes of this annoying malady. The theories of the causes of hay fever are numerous and varied. From the time of Bostock, the eminent English physician, who first described the disease in 1819,
until the present time, have the causes of hay fever been under the scrutiny of scientific research, with the result of the revelation of important knowledge in regard to its predisposing and exciting
To Elliotson belongs the honor of first pointing to pollen as the probable cause, while Pheobus, a distinguished German physician, was the first to maintain heat as the etiological factor. He maintained his views with great ability and respect, but weakened his theory in the admission virtually conceded in the following lines, that emanations from grasses would cause the disease. He says: "The first heat of summer is a stronger cause of the disease than all the grass emanations put together." Great credit is due Pheobus for his careful and extended painstaking investigation on the condition, symptoms, progress, geographical distribution and prevalence. He issued in circular form to the profession a series of interrogatories regarding methods of prevention and treatment. From the facts thus obtained he evolved his theories of heat as the factor in causation. The theory of his contemporaries more or less inclined to the belief in the pollen of flowers, hay, etc., as the probable cause. Helmtroltz, himself a sufferer, maintained the theory, unique in itself, that vibrio, a family of minute, colorless organisms, found in the tartar of the teeth and artificial infusions, etc., existed also in the nasal fossa and sinuses, and that the heat of summer awakened them into activity, and the morbid symptoms in hay fever were due solely to their presence. Many facts disprove this theory. It need only be mentioned that many persons are affected by the product of different kinds of vegetation, various exhalations, diffused in the atmosphere, and that individuals are exempt in locations where they are not present, be the summer heat never so in
Dr. Morrill Wyman, of Cambridge, Massachusetts, the first American author on this disease, maintained two distinct forms. The form of the disease occurring in the early spring and summer months he regards as corresponding to the Rose or June cold of England, and now so frequently observed in the United States. It must be admitted that the form of the disease peculiar to this country occurs most frequently in the autumn; but that they are two distinct diseases, as claimed by Wyman, can not be successfully
maintained. As my argument advances, evidence will be introduced to prove that pollen is the most common factor in causation, and that a knowledge of vegetable growth in England and the United States determines the Autumnal Catarrh of Wyman to be the same in its causation and pathology as in the June cold of both countries. There are two great varieties of vegetation in the botanical world, which constitute the flora of these countries, viz.: the Graminacea and the Compositæ, the one flowering in May and June and the other in August and September. The order Graminacea comprises about four thousand species of plants, while the order Compositæ are still more numerous, comprising as it does one thousand genera and nine or ten thousand species, each shedding its pollen from May until September. The abundant variety of pollen shed from this extensive flora being so universal during the season of June or Rose cold, of both countries, as well as in the season in which the autumnal variety of the diseases prevails in this country, successfully argues the identity of the two diseases, and is a rational argument in support of the pollen of flowers and grasses as a general exciting cause.
The form of disease most prevalent in America occurs in the autumn, commencing about August 20th, as stated by Wyman, to which he gave the name of Autumnal Catarrh. The apparent discrepancy of identity with hay fever of spring is reconciled, however, when a knowledge of the two varieties of flora indigenous in both countries is brought to our assistance. The flowers of the order Graminacea, flowering in May and June, and the Compositæ in August and September, being admitted to cause the disease, makes consistent the idea of one distinct pathological factor, one identical disease, brought into activity by one particular, if not universal exciting cause in the individual, so unfortunately predisposed.
The predisposing element in the etiology of the disease necessary to an intelligent understanding of the mode of production of the series of symptoms in hay fever, is pertinent in this connection. In order that pollen, from either of these great families of flowers, or other emanations may produce the disease, there must exist in the individual exposed to them a peculiar susceptibility to their influence, inherent in the system, a certain intrinsic disposition of
mind or body, in short, an idiosyncrasy, otherwise the pollen from flowers or other emanations are not excitants, and the individual enjoys immunity from the disease. It goes without saying that, for the disease to be manifest, there must first be pollen or other emanations in the air breathed as the necessary exciting cause. It follows then, that the individual must have an idiosyncrasy against these offending elements in the inspired air. In the discussion of the pathology to follow, the peculiar sensitive areas of the anterior nasal fossa, and the inferior turbinated bones, and the adjacent sides of the septum will be prominently discussed.
If either of the three essential elements of the disease is absent: there is no manifestation of the symptoms. If the idiosyncrasy is. not present the individual is not troubled with hay fever, no difference how heavily the atmosphere is laden with pollen. If the exciting cause does not prevail alike, freedom exists from the disease. If the hyperesthetic areas are absent, a similar exemption obtains. The three are necessery to the whole. It is curious to know that some persons afflicted with the disease can expose themselves with impunity to the emanations of some flowers or grasses. and still escape all symptoms, while another person exposed to the same cause will suffer with the disease in its most severe form. Likewise, a person having an idiosyncrasy against the pollen of some particular autumn plant, enjoys like immunity from the pollen of the flowers that bloom in the spring. One individual may have idiosyncrasy against the pollen from one particular flower, or emanation from some particular substance which will produce the disease in that person and will not excite the first symptoms of it in another who has a different idiosyncrasy. It is therefore not necessary for the disease to exist at the same time or at different places, or for the same thing to produce the disease in every sufferer in order to call it the same disease-to believe in their identity.
The air may be laden with pollen or vicious emanations or the peculiar hyperesthetic areas exist in the nose, and yet none of them displeasing to the idiosyncrasy existing in that peculiar habit of nervous system. An instance in point of the distinctive features of idiosyncrasy in different individuals is well illustrated in the case of "Anne of Austria, who would faint at the odor of roses,' and in that of "Goethe, who was particularly fond of the smell of