SPASMODIC SNEEZING. - This repre sents but a manifestation of a physio logical function repeated frequently or continuing beyond the usual limits. It may be caused by an hypenusthetic state of the pituitary membrane coupled with the presence of foreign particles capable, by their shape, of keeping up a titillation of the epithelial surfaces. It may be caused reflexly through the eyes, by sun shine, pregnancy, etc. I have witnessed two cases in which the menopause ap peared to be the main etiological factor. The condition appears to me to be due to a temporary adynamia of the reflex cen tres. This is sustained by the fact that tonics and stimulants are usually bene ficial.
Treatment. — To arrest a paroxysm, Koch recommends firm pressure upon the hard palate with the thumb, exerted before the close of the deep inspiration that precedes sneezing. In many cases, however, the palliative measures indi cated below, under HYPERMTHETIC RHINITIS, must be resorted to. The application of chromic acid to the mu cous membrane is an effective remedy when the condition has assumed chro nicity. The acid may be applied melted by heat to the end of a flat probe, once a week, six or seven times.
Hypermsthetic Rhinitis (Hay Fever; Rose Cold).
Symptoms.—The early symptoms of an attack of hay fever vary; in some cases there appear, one or two weeks before the access, a mild coryza, heaviness about the brow, general malaise, chilly sensa tions, itching at the roof of the mouth and eyes; but these manifestations do not always present themselves, the attack of hay fever beginning suddenly at pre cise dates,—August 10th for hay fever, May 10th for "rose cold,"—in the major ity of cases. The disease occurs twice in the year in some individuals, but the great majority only suffer from one at tack a year. "Rose cold" is somewhat shorter in duration than hay fever, which usually lasts about six weeks. Subjects of the disease can usually point to the exact day, and sometimes the hour of the expected attack.
The access usually begins with a sen sation of itching in the nostrils, which soon becomes very intense, and causes violent and prolonged sneezing. A prick ling, burning sensation in the inner canthi, followed by profuse lacrymation, may accompany this symptom, or consti tute the first evidence of the attack. Very soon the nose becomes occluded through intumescence of its lining mem brane, and respiration through it is prac tically impossible. A watery discharge appears, which soon becomes very pro fuse, and its strongly alkaline character causes it to irritate the nostrils and the upper lip, sufficiently sometimes to give rise to painful excoriations. Violent
sneezing may begin at once, or occur when the watery discharge begins to trickle down along the intranasal walls, and the patient makes futile efforts, by immoderate use of the handkerchief, to clear the nose of the cause of obstruction and irritation. Chilly sensations, frontal headache, tinnitus aurium, loss of smell and taste, violent itching at the roof of the mouth, pain over the bridge of the nose, facial pruritus, and general symp toms, such as slight pyrexia, urticaria, disordered stomach, and flatulence, are among the possible accompaniments of this stage.
As the affection progresses, the nasal secretion assumes more of a mucoid char acter, becoming at times muco-purulent.
The conjunctiva may become greatly in flamed, and photophobia and marked che mosis follow, rendering, in some cases, a prolonged stay in a dark room necessary. Asthma may occur as a complication of the affection, or as its only symptom. It may present itself any time during the course of the disease; it manifests itself suddenly as soon as the irritating agent is inhaled. In the majority of cases, how ever, it begins a few days after the pri mary nasal symptoms have shown them selves, and as soon as these become marked.
Etiology and Pathology.—As at pres ent interpreted, the morbid factors lying behind this disorder are: (a) an organic disorder of the nasal mucosa, (b) general nervous debility, and (c) an external irri tant, the bloom of rag-weed, the pollen of flowers, dust, etc. In a certain propor tion of cases cure of the nasal disorder, especially when nasal polypi, septal spurs, etc., are removed, prevents a return of hay fever; in others, removal to a coun try or district in which the irritating factor is not present also prevents the access. Two of the causative elements are thus demonstrable. The neurotic factor (abnormal excitability of the sym pathetic system, according to John N. Mackenzie) may also be clearly traced in a large proportion of cases, while the family history often shows the presence of the disease in parents or near rela tives. The periodicity of the disease is accounted for by the periodical appear ance in the air of certain pollens. Thus, an individual whose nervous system is susceptible through general adynamia, and whose nasal mucous membrane is hyperwsthetic through a local lesion, de velops an attack of hay fever or rose cold only when the pollen to which he may be susceptible is present in the air he breathes. This special susceptibility to one or more substances—pollens, is comparable to that presented by many persons in respect to various drugs: bella donna, opium, etc.