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Pollenometric and meteorologic data, New Orleans, La.--Continued.

OCTOBER, 1922–Continued.

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The tables of the physical reports contain the records of the atmospheric-pollen plates (sample plates shown in Figs. 1-4) in relation to the daily maximum and mean wind velocities and directions, the estimated number of pollens per cubic yard of air, the mean temperatures, and the rainfall. They give the number of grass pollens, of Ambrosia pollens (common and giant ragweed, Figs. 1 and 2), and of “other pollens,” the latter including the docks (Fig. 4), amaranths, chenopods, marsh elders, and cockle burs, all of which give a positive reaction for hay fever, but, in view of variations in different localities, are only of local importance.

HAY-FEVER AND ASTHMA CLINIC. The clinical data on which this analysis is based is taken from the records of the Ilay-fever and Asthma Clinic of the Charity Hospital, New Orleans, La. This clinic was established in 1918, and has grown steadily in popularity and attendance. The number visiting the triweekly clinics during the fall hay-fever season of 1922 frequently exceeded 100 patients, including both white and colored.

All items of importance in the history of the disease, or for the immunizing treatment, are noted in these records, which include the following data:

1. The age of the patient, the time at which the hay fever developed, and the duration of the attack. Also the sex and color of the patient.

2. The months in which the hay-fever attacks are present, as this is a check on the diagnostic tests.

Public Health Reports, Vol. 38, No. 28, July 13, 1923.

PLATE 1.

FIG. 1.

Fig. 2.

pustomicrographs of atmospheric-pollen plates. Fig. 1, ragweed pollens, X 250 diameters; September 29, 1916. Fig. 2, ragweed and Johnson grass pollens, X 250 diameters; September 25, 1918.

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Phnt micrographs of atmospheric-pollen plates. Fig. 3, tree pollens 250 diameters; March 25, 1921. Fig. 4, pine and curly dock pollens, X 250 diameters; April 8, 1922.

3. The residence of the patient (as the locality frequently has an important bearing on the severity of the attacks, and on the corresponding degree of immunity to be attained).

4. Near relatives who have, or have had, hay fever or asthma.

5. The condition of the nose, and any operation that may have been performed.

6. Condition of the chest and heart, pulse pressure, urinalysis. 7. Report of radiograph of chest (asthma cases only.)

8. Complications, such as asthma, bronchitis, affections of the accessory sinuses, ears, throat, eyes, and skin.

9. Diagnostic tests, first of the three major and five minor groups of po le 1, and afterwards, if required, of other proteins that may form the principal or complicating cause. The results of these tests, indicating the sensitivity of the patient, are recorded on a percentage basis, and form a constant guide for the immunizing doses.

10. On the back of the chart is a complete record of each dose administered, including the date, the number of units of the pollen extract or the amount of vaccine, and whether this is stock or autogenous, and the name of the manufacturer or the laboratory which prepared it. Finally, special clinical notes, such as the degree of the local or general reaction, dates of severe paroxysms, and the condition of the patient generally.

Such complete data, and based on such a large number of cases, necessarily have marked clinical value, which is especially important in hay fever and asthma, in which the symptoms, course, and seasonal variations are so largely influenced by weather and other extraneous conditions.

DATES OF INCIPIENT FALL HAY FEVER ATTACKS. Many patients have the belief that their attacks commence on a certain date of each year; but as the amount of pollen necessary to develop the attack is influenced not only by the stage of growth of the incriminating weeds but also by wind conditions, this regular periodicity is rarely the case, the occasions on which such regularity happens being simply coincidences.

Our clinical records show that minor attacks of fall (Ambrosia) hay fever (average, 8 per cent) were recorded on the following dates (the maximum velocity of the wind and its direction on the same dates being also given): 1917, August 2(12 miles, NW.); 1918, August 10 (22 miles, SE.); 1919, August 6 (14 miles, NW.); 1920, August 3 (12 miles, NW.); 1921, August 6 (14 miles, W.); 1922, August 11 (11 miles, NW.).

The common and giant ragweeds in the Southern States begin to pollinate about August 1, but it is not until August 24 that a considerable number of these weeds are in bloom, and not until about September 10 that the full stage of pollination is reached, the latter being the average date for most of the States east of the one-hundredth meridian. With a sufficiently large number of plants in bloom, the velocity of the wind and its direction are the determining factors of the attacks.

* Hay Fever and Asthma: Cause, Prevention, and Cure. By Wm. Schepperrell. Lea & Febiger, 1922. 2 Hay Fever and Asthma: Cause, Prevention, and Cure. By Wm. Scheppegrell. Lea & Febiger, 1922.

The early cases of fall hay fever usually develop in patients of a high degree of sensitivity, or with less sensitivity but with excessive exposure, as, for instance, when their residence is surrounded with large areas of weeds or they visit weed-infested localities. The majority of patients, however, do not develop their attacks until the air contains a considerable amount of pollen, the number of patients varying with their degree of sensitivity. An average of 17 per cent developed their initial attacks on the following dates: 1917, August 19 (17 miles, NW.); 1918, August 16 (12 miles, NW.); 1919, August 17 (20 miles, NW.); 1920, August 24 (10 miles, NE.); 1921, August 18 (12 miles, NW.); 1922, August 28 (15 miles, E.).

After these dates, initial attacks developed in the remaining cases until about September 10, the final dates of the initial attacks being as follows: 1917, September 8 (14 miles, NW.); 1918, September 10 (15 miles, E.); 1919, September 11 (16 miles, NE.); 1920, September 3 (23 miles, N.); 1921, September 11 (26 miles, NE.); 1922, September 13 (18 miles, NE.).

There is a small percentage of patients whose resistance is so high that in some years they fail to have hay fever at all, and they develop attacks in other years only at times of unusual atmospheric pollen infestation. Such a condition occurred on the following dates: September 29, 1916—the number of pollens per cubic yard air reached 365, and the wind 22 miles per hour from the northwest; September 21, 1918--357 pollens, wind 19 miles from northeast; September 19, 1920-296 pollens, wind 22 miles from northeast; September 14, 1921---382 pollens, wind 24 miles from the north; and September 18, 1922-421 pollens, wind 23 miles from northeast. On account of the long and irregular intervals of their attacks, few of these cases are recognized as hay fever.

These records show, therefore, that the initial attacks of hay fever vary within certain limits in different years, and that they are always associated with wind disturbances. In the locality of our station A, from the records of which these data are taken, the large weed areas are toward the north, east, and west, so that the winds associated with these attacks are usually from those directions. This would not be the case, however, in stations in which the principal weed areas were differently situated.

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