[I do not regard hay fever in its act ive form as a disease per cc. but merely as the symptom-complex of a sudden cessation of the inhibitory functions of the nerve-centres presiding over the physiological processes of the upper re spiratory tract. These nerve-centres, under the influence of hereditary or ac quired disease of an adynamie type, having themselves•become adynamie, are able to carry on their functions under ordinary circumstances: hut. when de mand is imposed upon them for inordi nate functional activity, they lose all power of control. and give rise to the symptoms observed after section of the spheno-palatine ganglion, or of the cer vical sympathetic, as shown by Claude Bernard, most marked of which symp toms is hyperfesthesia. Hence the name "hyperresthetic rhinitis," submitted by me some years ago in lieu of the absurd term "hay fever." The main predisposing influences are, in my opinion, the diseases of childhood and disorders inherited or acquired, tend ing to induce adynamia: i.e., a lowered, cellular activity. affecting• mainly the nerve-centres alluded to. The art]ri time of the French, and the gouty or uric-acid diathesis (Bishop), being but results of deficient cellular activity, merely repreTsent, from my stand-point, a single—though important—class of fac tors among the that are capable of promoting the vulnerability of the nerv ous centres previously weakened through acquired or inherited adynamia. Hay fever would practically be a universal disease were an excess of uric acid in the blood its only or even its main eause. IIA BT.ES E. DE M. SAJO US.] There can be no doubt that Dunbar has succeeded in extracting from the pollen of certain grasses (maize, wheat, rye. etc.) a toxin which, when instilled into the eyes or nostrils of people pre disposed to hay fever, produces in these parts the characteristie subjective !Ind objective symptoms of the disease. The toxin, when injected into the eyes or nostrils of people not predisposed, pro duces, in the great majority of cases, no symptoms whatever. But it certainly appeared as if there were instances of transition in which, although the per sons experimented upon never suffered from typical hay fever, they were yet more susceptible to the influence of the toxin than the ordinary run of people. The effects of the toxin in people suffer ing from hay fever are as variable in intensity as arc the attacks of the affec tion itself. both with regard to the local and the constitutional symptoms. Pun bar's antitoxin certainly produced im mediate disappearance of the subjective, and after a few minutes, great amelio ration of the objective, symptoms. The mixture in equal parts of a toxic solu tion (1 in 500) and the antitoxic serum suffices to neutralize the specific effects of the toxin. The effects of the anti toxin appear in some instances to be suf ficient to prevent a reappearance of the subjective symptoms, while in other instances repeated instillations of the antitoxin were required to produce ulti mately the return to normal conditions. But all we know at the present is not sufficient to build the therapeutic hopes on, and this for the reason that we are ignorant of the nature of the special predisposition which exists in hay-fever subjects. Sir Felix Semon iBrit. Med. Jour., March 28, 1003).
Hay fever is most frequently met with among brain-workers, professional men, clergymen, lawyers, merchants, etc. It may occur at any age, and seems to pre vail with more frequency in men than women.
Treatment. — Careful examination of the nasal cavities and removal of any abnormal condition that may be present is of primary importance. Indeed, cases
in which polypi, spurs, hypertrophies, etc., are found and removed often yield the most satisfactory results. Appro priate surgical treatment seems, in some cases, to relieve the hyperaesthesia of the mucosa and, by eliminating one of the three causative factors, to arrest the dis ease. In some cases, repeated cauteriza tion with glacial acetic acid of any unduly sensitive spot found in the intranasal tissues, especially the middle turbinated bone, by gently passing a probe over them, prevents the attack if the appli cations are made twice a week within the month preceding it. Galvanocautery and chromic acid tend to give rise to cicatricial induration and local dryness, if applied over broad areas, and therefore less valuable than glacial acetic acid.
The medicinal treatment indicated may be divided into two parts: that tending to counteract the nervous ady namia and that aiming to arrest the active symptoms. Strychnine in gradu ally increasing doses fulfills the first in dication, atrophic the second. I have found the following measures productive of excellent results when begun three months before the expected attack. The patient is given 1/6U grain of strychnine during meals one week; after this, the dose is gradually increased until grain is taken three times a day. This dose should be reached by the second month and be continued throughout the latter and up to two weeks prior to the expected attack. The purpose of the strychnine is mainly to stimulate metab olism. The elimination of products of waste should then be encouraged by the administration of salicylate of sodium, 10 grains three times a day, large quan tities of lithia-water being given simul taneously.
On the day the paroxysm is expected a granule of atropine, grain, is taken on rising and repeated in the evening if necessary. One granule daily is usually sufficient to prevent the attack if the nasal cavities are sprayed several times a day with a solution of menthol in albo lone, 5 grains to the ounce. Cocaine was at one time extensively used in these cases, but it is a pernicious drug, by caus ing secondary local paresis and subse quent aggravation of the symptoms. The measures for the asthmatic manifesta tions do not differ from those indicated in the classical form (see ASTHMA, vox. i).
Inhalations of the ordinary cologne water produce marked sedative effect during paroxysms, a few whiffs being sufficient at times to arrest the intense pruritus. Molare (Lyon Sled., Jan. 21, '95).
The habits of the patient, both as to food and exercise, should be regulated with the greatest care. With restoration of the digestive tract, the general nutri tion established upon a firm foundation, and the previously unstable nervous sys tem steadied and invigorated, the pa tient is enabled to resist such disturbing influences as once proceeded from the contact of atmospheric irritants with the hyper:esthetic pituitary membrane. C. P. Grayson (Ther. Gaz., Oct. 15, '97).
We have in the aqueous extract of suprarenal glands a powerful, local vasoconstrictor agent, and a contractor of erectile tissue, which it is safe to use in very considerable amounts without any dangerous or deleterious effects lo cally. or to the general constitution of the individual. In acute congestions it has its widest application and greatest opportunity for good. but in certain chronic conditions of the hay-fever type where redundant tissue seems prone to develop it can be relied upon as one of the most helpful adjuvants which we have at command. II. I. Swain (Med. Record, June 4, '9S).