From what I have observed (says Professor Binz) of recent English publications on the subject of hay fever, I am led to suppose that English authorities are inaccurately acquainted with the discovery of Professor Helmholtz, as far back as 1868, of the existence of uncommon low organisms in the nasal secretions in this complaint, and of the possibility of arresting their action by the local employment of quinine. I therefore purpose to republish the letter in which he originally announced these facts to myself, and to add some further observations on this topic. The letter is as follows :— [Footnote: Cf. Virchow's 'Archiv.' vol. xlvi. p. 100]
'I have suffered, as well as I can remember, since the year 1847, from the peculiar catarrh called by the English "hay fever," the speciality of which consists in its attacking its victims regularly in the hay season (myself-between May 20 and the end of June), that it ceases in the cooler weather, but on the other hand quickly reaches a great intensity if the patients expose themselves to heat and sunshine. An extraordinary violent sneezing then sets in, and a strongly corrosive thin discharge, with which much epithelium is thrown off. This increases, after a few hours, to a painful inflammation of the mucous membrane and of the outside of the nose, and excites fever with severe headache and great depression, if the patient cannot withdraw himself from the heat and the sunshine. In a cool room, however, these symptoms vanish as quickly as they come on, and there then only remains for a few days a lessened discharge and soreness, as if caused by the loss of epithelium. I remark, by the way, that in all my other years I had very little tendency to catarrh or catching cold, while the hay fever has never failed during the twenty-one years of which I have spoken, and has never attacked me earlier or later in the year than the times named. The condition is extremely troublesome, and increases, if one is obliged to be much exposed to the sun, to an excessively severe malady.
'The curious dependence of the disease on the season of the year suggested to me the thought that organisms might be the origin of the mischief. In examining the secretion I regularly found, in the last five years, certain vibrio-like bodies in it, which at other times I could not observe in my nasal secretion. . . . They are very small, and can only be recognised with the immersion-lens of a very good Hartnack's microscope. It is characteristic of the common isolated single joints that they contain four nuclei in a row, of which two pairs are more closely united. The length of the joints is 0.004 millimetre. Upon the warm objective-stage they move with moderate activity, partly in, mere vibration, partly shooting backwards and forwards in the direction of their long axis; in lower temperatures they are very inactive. Occasionally one finds them arranged in rows upon each other, or in branching series. Observed some days in the moist chamber, they vegetated again, and appeared somewhat larger and more conspicuous than immediately after their excretion. It is to be noticed that only that kind of secretion contains them which is expelled by violent sneezings; that which drops slowly does not contain any. They stick tenaciously enough in the lower cavities and recesses of the nose.
'When I saw your first notice respecting the poisonous action of quinine upon infusoria, I determined at once to make an experiment with that substance, thinking that these vibrionic bodies, even if they did not cause the whole illness, still could render it much more unpleasant through their movements and the decompositions caused by them. For that reason I made a neutral solution of sulphate of quinine, which did not contain much of the salt (1·800), but still was effective enough, and caused moderate irritation on the mucus membrane of the nose. I then lay flat on my back, keeping my head very low, and poured with a pipette about four cubic centimetres into both nostrils. Then I turned my head about in order to let the liquid flow in all directions.
'The desired effect was obtained immediately, and remained for some hours; I could expose myself to the sun without fits of sneezing and the other disagreeable symptoms coming on. It was sufficient to repeat the treatment three times a day, even under the most unfavourable circumstances, in order to keep myself quite free. [Footnote: There is no foundation for the objection that syringing the nose could not cure the asthma which accompanies hay fever; for this asthma is only the reflex effect arising from the irritation of the nose. — B.] There were then no such vibrios in the secretion. If I only go out in the evening, it suffices to inject the quinine once a day, just before going. After continuing this treatment for some days the symptoms disappear completely, but if I leave off they return till towards the end of June.
'My first experiments with quinine date from the summer of 1867; this year (1868) I began at once as soon as the first traces of the illness appeared, and I have thus been able to stop its development completely.
'I have hesitated as yet in publishing the matter, because I have found no other patient [Footnote: Helmholtz, now Professor of Physics at the University of Berlin, is, although M.D., no medical practitioner. — B.] on whom I could try the experiment. There is, it seems to me, no doubt, considering the extraordinary regularity in the recurrence and course of the illness, that quinine had here a most quick and decided effect. And this again makes my hypothesis very probable, that the vibrios, although of no specific form but a very frequent one, are at least the cause of the rapid increase of the symptoms in warm air, as heat excites them to lively action.
I should be very glad if the above lines would induce medical men in England — the haunt of hay fever — to test the observation of Helmholtz. To most patients the application with the pipette may be too difficult or impossible; I have therefore already suggested the use of Weber's very simple but effective nose-douche. Also it will be advisable to apply the solution of quinine tepid. It can, further, not be repeated often enough that quinine is frequently adulterated, especially with cinchona, the action of which is much less to be depended upon.
Dr. Frickhoefer, of Schwalbach, has communicated to me a second case in which hay fever was cured by local application of quinine. [Footnote: Cf. Virchow's 'Archiv.' (1870), vol. li. p. 176.] Professor Busch, of Bonn, authorises me to say that he succeeded in two cases of 'catarrhus aestivus' by the same method: a third patient was obliged to abstain from the use of quinine, as it produced an unbearable irritation of the sensible nerves of the nose. In the autumn of 1872 Helmholtz told me that his fever was quite cured, and that in the meantime two other patients had, by his advice, tried this method, and with the same success. [Footnote: Prof. Helmholtz, whom I had the pleasure of meeting in Switzerland last year, then told me that he was quite convinced that hay fever was produced by the pollen afloat in early summer in the atmosphere.]
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