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 1,2 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 consider * Hay Fever and Asthma: Cause, Frevention, and Cure. By Wm. Scheppegrell. Lea & Febiger, 1922. able 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. 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, 1922-421 421 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. 2 Hay Fever and Asthma: Cause, Prevention, and Cure. By Wm. Scheppegrell. Lea & Febiger, 1922. DATES OF GREATEST INTENSITY. The period of greatest intensity of fall hay fever in the Eastern, Middle, and Southern States is in September, as the common and giant ragweeds, the principal cause of the disease, reach their full stage of pollination during this month, and during a large portion of September the wind is sufficiently high to cause a general distribution of the pollen. At our New Orleans station, for instance, in September, 1917, the wind reached a velocity of 10 or more miles per hour during 28 days; in September, 1918, during 25 days; in September, 1919, during 26 days; in September, 1920, during 25 days; in September, 1921, during 24 days; and in September, 1922, during 26 days. The active pollination of the weeds supplying the pollen and the general wind disturbances for distribution of the pollen are therefore the reasons that September is the bête noir of hay-fever sufferers. The rain is nature's most effective means of percipitating the pollen for the relief of the patient; but, unfortunately, the rainfall during September is usually below the average in most hay-fever sections. At our New Orleans station, for instance, the rainfall during August and September, respectively, was as follows: 1917-August 6.92 inches, September 2.69 inches; 1918—August 6.19 inches, September 4.82 inches; 1919-August 7.38 inches, September 2.93 inches; 1920-August 4.18 inches, September 6.47 inches; 1921-August 3.09 inches, September 3.51 inches; 1922 (omitting a heavy rainfall on August 1)-August 3.56 inches, September 0.93 inch. It will be noted that with exception of September, 1920, in which month it totaled 6.47 inches, the rainfall for this month for the other years was between 2.69 and 4.18 inches. The records of our clinic also show that the general average of hay-fever attacks during September, 1920, was considerably below the general average, and that during September, 1922, when the rainfall was only 0.93 inch, they were unusually severe. These records also show that the seasons of marked intensity of fall hay fever were as follows: 1917, August 30 to October 12; 1918, August 17 to September 29; 1919, August 24 to September 26; 1920, September 3 to October 7; 1921, August 18 to October 13; 1922, September 18 to October 3. TERMINATION OF THE ATTACKS. The cessation of the fall hay fever, uncomplicated with mixed infection, was as follows: 1917, October 24; 1918, October 28; 1919. October 23; 1920, October 11; 1921, October 24; 1922, October 26. The long hay-fever season in the Southern States is due to the mildness of the climate, which prolongs the pollinating season of the ragweeds. At our station at Hendersonville, N. C. (altitude, 2,250 feet), the cool nights check the pollination much earlier, and the hay-fever season is rarely prolonged after September 30. LOCAL TEMPORARY RELIEF. Marked natural relief from the attacks during the hay-fever season, except in localities where the wind may blow from a noninfected area, as on the seashore, results from a general rain that settles the pollen. On October 17, 1916, a rain of 2.58 inches caused the ragweed pollen to disappear from the plates during that day, showing the air to be free of pollens, and this was also the case the following day (1 per square centimeter), in spite of the fact that the wind had reached a velocity of 24 miles per hour and was from a northerly direction. The complete local precipitation of pollen, and the consequent relief to hay-fever sufferers, also occurred in 1917 on August 17, 28, and September 15;. 1918-August 19 to 21, September 20, October. 11; 1919-August 18 to 24, and September 13; 1920-only on September 21; 1921-August 24 and September 25; 1922-October 3 only.. The rains on these occasions were so continued and extensive that the absence of atmospheric pollen gave entire relief from hay fever for several successive days. Unless the physician is familiar with the natural course of hay fever and the influence of weather and other extraneous conditions, the apparent beneficial results of the treatment may be misleading. The numerous so-called "cures" of hay fever depend mainly on these natural causes for their apparent benefits. In no other disease is it so important to take cognizance of the numerous circumstances that may affect the course of hay fever, and the successful immuniologist should be fully equipped for making careful records in order to attain success in the mastery of this disease. SPLEEN AND BLOOD EXAMINATIONS FOR MALARIA. A STUDY OF THE RELATIVE MERITS OF THE SPLEEN AND BLOOD PARASITE INDICES FOR DETERMINING MALARIA PREVALENCE AS FOUND IN DUNKLIN COUNTY, MO. By M. V. VELDEE, Assistant Surgeon, United States Public Health Service. The positive diagnosis of malaria by the blood smear method is very reliable in the hands of a trained laboratory diagnostician. However, the method is time consuming and is usually not available on short notice. This is especially true with reference to the public health official who, in doing field work, must often examine a large number of individuals and know the results promptly. The development of a method of diagnosis equally reliable and less time consuming would greatly facilitate the work in the field. It is the pur |