HAY FEVER, OR HAY ASTHMA.
Much interest is attached to this condition owing to the study of the phenomenon of anaphylaxis. The hypersensitive individual reacts to the pollen of certain grasses in the summer or to ragweed pollen in the autumn, as other sensitives do to a foreign protein, as egg albumin, cheese, &c. (see p. 69).
Dunbar's Pollantin is a serum obtained by immunising horses by increasing doses of various pollen; it is dropped into the eye. painted over the nasal mucosa or utilised in a dry form as snuff. At best its effects are evanescent.
Freeman recommends active immunisation by injecting into the tissues Pollen Toxin; this method is employed as a prophylactic and also as a therapeutic agent after the attack has commenced. The degree of sensitiveness of the individual can be ascertained by an ophthalmic test beginning with an instillation of 5 units of Allen•and lianbury's Toxin, and the dose is then proportioned to the degree of reaction produced : thus if redness follows, a dose of 2-4 units is injected, which is gradually increased at intervals of ten days, commencing two months before the usual seasonal attacks. The susceptibility of an individual to any particular kind of pollen can be determined by rubbing in the suspected pollen after a slight scarification of the skin, when a wheal arises in a few minutes. One single large dose of the serum from the blood of a rabbit injected for several months with pollen extract has been employed by other experi mentalists to produce passive immunisation. Though many successes are constantly reported. the results often fall short of expectation, and a considerable minority of cases are in no way benefited.
The underlying sensitiveness has been treated as in asthma and by improving the general health, administering nervine tonics like Arsenic, Valerianates, Zinc Salts and Strychnine, &c., but as a rule without result. Chloride or Lactate of Calcium in doses of 20 grs. thrice daily often affords marked relief, and should always be tried as a routine.
The treatment of the hypersensitive area gives sometimes reliable results. As hypertrophic rhinitis or a chronic congestive state of the nasal mucosa is often present, a radical attempt to remedy the local condition is often successful. The erectile tissue should be so cauterised
as to form an adherent cicatrix which will permanently bind down the mucosa to the periosteum, and at the same time insure the complete destruction of the hypersensitive areas existing in the nasal membrane. By cocaine solution the thickened mucous lining is rendered insensible, after which, with a fine blade or platinum point, a deep groove is burned with the galvano-cautery along the entire length of the inferior turhinated bone. In severe cases there should be no hesitation in removing both inferior turbinate bones. Sometimes the condition is completely removed by applying the cautery to the most sensitive part of the nasal septum (the tubercle), as in cauterisation for asthma. The prospects of a cure are hopeful when the affection is treated in this manner early in its career before repeated seasonal attacks have produced the markedly recurring tendency to attacks supervening upon the slightest irritation.
Yonge advocated resection of both nasal nerves when the cautery fails. A host of remedial agents have been employed to produce the same result without resorting to the cautery, hut their effects are very temporary or evanescent. Foremost amongst these are Cocaine and Adrenalin. A 2 per cent. solution of the former or a r in 3,00o solution of adrenalin may be sprayed into the nostrils, or a liquid of double these strengths may be painted over the mucous membrane with a brush, one or other or both of these drugs being used. Menthol dissolved in io parts of pure paraffin is also useful, and the addition of Camphor increases its efficacy, but these applications should never be persisted in for more than a brief period. The more severe method of treatment employed by the late Sir Andrew Clarke may be tried; this consists in swabbing the interior of the nose and the naso-pharynx by a mixture consisting of r gr. Corrosive Sublimate and 120 grs. Hydrochloride of Quinine dissolved in 2 oz. Glycerin of Carbolic Acid. The application should be made through the nostrils with a large camel's-hair brush.