=Functional Pathology.=—Certainly in this disease there is ample
evidence of marked perversions of function or functional pathology.
Kyle believes that in many cases the cause of local irritation lies
in “some chemical change in the constituents of the mucus-secreting
glands,” and “it is a well known fact that in many cases of hay fever
the irritation is not limited to the nasal mucous membrane. The eyes
and mucous membrane of the stomach and bladder, and even the intestines
may be markedly irritated.”
These chemical changes in the secretion of the mucous membranes,
together with the excess of uric acid would seem to point either to
a general perversion of the secretory mechanism or to a deficient
elimination, or to both. The periodic occurrence may be accounted for
by assuming that the systemic strain is sufficient to initiate the
symptoms. The fact that the attack is actually delayed or hastened in
susceptible individuals by the late or early beginning of hot weather,
and that these cases get relief by going to a more moderate climate is
further evidence of this.
Again we are reminded of Dr. Still’s teaching, that the body maintains
its own chemical laboratory which adjusts or tends to adjust its work
to the needs of that body, but under abnormal strain this adjustive
mechanism may fail to meet all of the demands of function. It seems
here that the osteopathic concept may easily include all environmental
causes as well as internal causes in the predisposition to deficient
function or disease.
=Structural Pathology.=—During the attack there is a general catarrhal
inflammation of all nasopharyngeal membranes, accompanied by a watery
discharge and marked swelling of the turbinates. Sensitive areas may be
found on the middle turbinate and opposite wall of the septum. Probably
it is this hypersusceptibility to irritation that causes the attack
from the air-borne irritants.
The pseudo-membrane which may be found covering a part or all of the
mucous membranes of the nares probably results from this irritation and
is formed for the purpose of protection.
=Clinical Types.=—Clinically, three rather indefinite types of hay
fever may be recognized, viz.: Vernal, those cases which have their
attack sometime during May, June or July; Autumnal, in which the attack
occurs in August or September and usually lasts until the beginning of
cold weather, and an indefinite or pseudo form occurring at any time
of the year, with no characteristic attack, as in the other forms, but
with indefinite symptoms resembling hay fever.
=Symptoms and Diagnosis.=—Patients usually go to the physician self
diagnosed. The characteristic sneezing, the watery discharge from
the nose, and the irritation of all membranes of the nasopharynx and
conjunctiva will serve to make a diagnosis in most cases. Direct
examination will reveal the nasal congestion and other characteristic
pathology as described above.
=Termination.=—Most cases of the autumnal form, unless successfully
treated, continue with equal or increased severity until after
the first or second frost, when they usually terminate in asthma,
bronchitis or sinuitis, which lasts for several weeks or months. Each
year the attack lasts longer and is more severe and the asthma occurs
earlier and is more severe.