By ALEXANDER RIXA, M.D., New York.
In the May (1890) number of the _Therapeutic Gazette_ I furnished some
contribution to the "Treatment of Hay Fever." I reported therein a
favorable result in the treatment of this mysterious disease in the
experience of my last year's cases.
My experience of this year is far more gratifying, and worthy of
receiving a wide publicity.
I treated six cases in all, four of which have been habitual for years
to hay fever proper without complications, while the other two used to
have the disease aggravated with reflex asthma and bronchial catarrh.
I succeeded in preventing the outbreak of the disease in every
individual case. The treatment I applied was very simple, and
consisted of the following:
From the fact that I had known all my patients from previous years, I
ordered them to my office two weeks before the usual onset of the
disease. I advised them to irrigate the nose with a warm solution of
chloride of sodium four times a day--morning, noon, evening, and on
retiring; and, a few minutes after the cleansing of the parts, had the
nares thoroughly sprayed with peroxide of hydrogen and c.p. glycerin,
half and half. Those subject to a conjunctivitis I prescribed a two
per cent. solution of boric acid as a wash. At this period no internal
medication was given, but three days previous to the usual onset of
the disease I prescribed phenacetin and salol, five grains of each
three times a day.
On the respective expected days, to the great surprise of all the
members concerned successively, who have been in the habit of getting
the disease almost invariably at a certain date, no hay fever symptoms
appeared, though everyone had been the victim of the disease for a
great number of years, varying from five to nineteen years' standing.
It is self-understood that this treatment was kept up all through the
season, and, as no symptoms developed, the applications were reduced,
toward the termination, to twice and once a day. The internal
medication, however, was stopped after the expiration of the first
week, and all the patients could attend to their various respective
vocations, something they never have been able to do in previous
years.
In two cases, though no nasal symptoms developed, about two weeks
after the calculated onset, slight symptoms of asthma made their
appearance. However, I could easily suppress them at this time with
the aid of the hand atomizer and ozonizer, a very ingenious little
apparatus, of which I gave a thorough description in my last year's
article. I used the ozone inhalations every four hours, in connection
with the internal administration of the following prescription:
Rx Iodide of ammonia, 8;
Fl. ex. quebracho, 30;
Fl. ex. grindelia robusta, 15;
Tr. lobelia, 12;
Tr. belladonna, 8;
Syr. pruni, virg., q.s., ad 120.
Sig.--Teaspoonful three or more times during twenty-four hours.
However, toward the end of the fourth week, especially in one case--a
stout, heavy-set gentleman--very grave asthmatic symptoms developed,
which compelled me to apply Chapman's spinal ice bag, as well as
resort to the internal administration of large doses of codeine during
the paroxysm, with the most beneficial result.
I gave also oxygen inhalations a fair trial in the two cases. I find
them to act very soothingly in the simple asthma, facilitating
respiration after a few minutes; but during the paroxysmal stage they
cannot be utilized, for the reason that respiration is short and
rapid, and does not permit of a control in the quantity of the gas to
be inhaled. Consequently, it is either of little use as a remedy; or,
if too much is taken, a disagreeable headache will be the consequence.
During the catarrhal stage, which, however, was very mild compared
with last year, I derived great benefit from the administration of
codeine, in combination with terpine hydrate, in the pill form. The
codeine has the advantage over all other opium preparations that it
does not affect the digestive organs, and still acts in a soothing
manner. While during last year's sickness my patients lost from ten to
twenty pounds of their bodily weight, this year but one lost eight
pounds and the other five pounds.
As the etiology of this troublesome disease is yet enveloped in
obscurity, we may fairly conclude, by the success of my treatment, if
it should meet with the confirmation of the profession, that the much
pretended sensitive area, situated, according to Dr. Sajous, "at the
posterior end of the inferior turbinated bones and the corresponding
portion of the septum," or, according to Dr. John Mackenzie, who
locates this area "at the anterior extremity of the inferior
turbinated bone," need not necessarily be removed or destroyed by
cautery, in order to accomplish a cure of hay fever proper.
I examined my patients twice a week, and the closest rhinoscopical
exploration would not reveal the slightest pathological change in the
mucous membrane of the nares.
Now, what is the etiological factor of the disease? Is it a specific
germ conveyed by the air to the parts and--_locus minoris
resistencia_--deposited at the pretended area, or is the germinal
matter present in the nasal mucous membrane with certain persons, and
requires only at a certain time and under certain conditions
physiological stimulation to manifest periodical pathological changes,
which give rise to the train of symptoms called hay fever? Dropping
all hypothetical reasoning, I think some outside vegetable germ is
causing the disease in those predisposed, and peroxide of hydrogen
acts on them as it does on the pus corpuscles, _i.e._, drives them out
when and wherever it finds them. I hope the profession will give this
new measure a thorough trial and report their results.--_Therapeutic
Gazette._
* * * * *