Ever since Bostock in 1816 gave us a very accurate description of what we to-day know as hay fever, a new etiology has been brought forward by nearly every investigator.
The disease described by Bostock, later called Bostocks catarrh, is one which appears during the summer months, brought on or aggravated by odor of certain flowers, hay, horses, dogs or cats, by dust, fogs, heat or cold, but not aggravated by these causes at other seasons of the year, thereby eliminating from this category paroxysms of nervous sneezing to which to many are subject.
The treatment of hay fever as an uric acid disease, while perhaps in part true, has nevertheless brought relief to many sufferers.
The bacterial origin of hay fever has many advocates. Stricker insists that it is an infectious germ disease.
The theory of anaphylaxis is the latest.
As Stricker seems to have studied the various theories more technically than most writers let me quote from his great work on Bostocks Catarrh in Nothnagel (American edition).
“The annual attack is ordinarily ushered in with premonitory symptoms which last from a few hours to two weeks. This stage is absolutely denied by the followers of the pollen theory with which it is not consistent. Frontal headaches, general malaise, digestive disturbances, heaviness or sleepiness after eating, oedema of the face or other parts of the body and irregularity of the menses for the previous two months.”
I have found in many cases this prodromal stage.
He also says: “The conclusion that a certain constitutional anomaly underlies the individual predisposition to Bostocks catarrh is becoming more and more positive. Moreover, it cannot very easily be denied that this diathesis is what the French and English call the arthritic, which expresses itself in the hereditary predisposition of families to rheumatism, gout, diabetes, corpulency, migraine, furunculosis, bronchitis, asthma, etc.” In proving “lithemia” in Bostocks catarrh, Haig, Bishop and others confirm it.
The limitation of the disease to a relatively small number of people living under the same conditions as thousands who remain free, its pronounced predilection for a certain class of society and for a certain race; its repeated appearance in members of the same families, the ineradicable tenacity with which it clings to life, the typical changes that it undergoes with years, sufficiently prove that the principal cause of its origin lies in the affected person himself.
Furthermore, the typical course of the individual annual attacks, and the undisputed possibility of escaping them by avoiding certain local necessary conditions, point unquestionably to external exciting causes that must reach the susceptible individual before the disease can originate.
Bostock mentioned his own gouty condition. A Dr.Kirkman wrote to Phobus that before his first attack of hay fever he had a nettle rash every June. This never occurred after the advent of the hay fever. DeMussey, in 1868, strongly advocated the theory that a gouty constitution caused the individual susceptibility. Geo. F.Laidlaw has written a very interesting book let on hay fever, giving various theories and modes of treatment but emphasizes his theory of urticaria and his rosin – weed and ichthyol.
Ballinger says: “Hyperesthetic rhinitis or hay fever is characterized by annual paroxysms of sneezing accompanied by a severe and prolonged coryza and asthma.” He gives as the predisposing cause constitutional, cause, climatic, geographical, racial and altitudinal.
Under constitutional causes he mentions gout and rheumatism, and says further: “A gouty or rheumatic diathesis is held to be the basic cause. It is obvious, however, that there must be a reason form the gouty or rheumatic expression.”
A hyperesthetic rhinitis is an oversensitive rhinitis which we see at all times of the year, and is not always a true hay fever. These cases are many times cured by cautery, opening diseased sinuses or cells, and by the homoeopathic remedy alone, but many cases with sinus trouble do not have have hay fever, and many cases of hay fever have had tonsils out, spurs removed, turbinates trimmed and sinuses operated and continue to have hay fever.
Lane, in New York Med. Journ., Nov. 16, 1918, says: “Bostocks summer catarrh or true hay fever, is very difficult to cure, even the authorities most at variance with one another are agreed on this point.”
I believe that most of the different opinions concerning hay fever are true as viewed from the different angles, but as the two views of the stereopticon when properly focused, give us a finer picture, so those views taken from different angles, when properly focused, dovetail into each other and give us a more comprehensive picture of this many – sided disease.
The majority of cases first come to us when their hay fever is just starting or in full bloom. Our duty is first to give them as much relief as possible during the attack. Our materia medica is quite rich in first aids to these sufferers.
Hale in his excellent work on “Practice” mentions a number of the usual remedies but especially Chloral hydrate, which he says has that serous acrid discharge which runs down the posterior nares and causes such constant hawking it prevents sleep. He says: “I my own case I suffered greatly from these symptoms and never found any remedy for them until I took five grains, of Chloral every hour. After the fourth dose I fell asleep and did not wake until nearly morning, when I found to my surprise that the thin acrid discharge was replaced by a bland thick mucus, and in a few days afterward the catarrhal symptoms disappeared. This has since been the invariable result in nearly every case in which I have prescribed it.”
E.B. Nash was another hay fever subject. In discussing Lachesis, he says: “Headaches extending into the nose, come mostly in acute catarrh, especially when the discharge has been suppressed or stops after sleep. This kind of headache is often found in hay fever, with frequent and violent paroxysms of sneezing. Now, if the hay fever paroxysms of sneezing are decidedly aggravated after sleep, even in the day time, Lachesis 2000th may stop the whole business for the season.”
Laidlaw uses rosin weed 10, 20 or 30 drops after meals, but Dr.Kirtland reports a case cured by the 3rd taken every three hours.
Ambrosia in some cases where the respiratory tract in its entire length is stopped up; lachrymation, smarting and burning eyes, watery coryza, sneezing and asthma.
Aralia racemosa; asthma coming on after first sleep, frequent sneezing with copious excoriating salty discharge, brought on by exposure to the slightest current of air.
Naphthalin might help some cases where the hay fever and asthma were better in the open air. Some cases have a very irritable bladder with very frequent desire to urinate that Naphthalin might cover.
Sabadilla has been frequently used. It has the eye, nose and throat symptoms, but the asthma is worse from cold and cold drinks and better from warm food and drink and being well wrapped
Iodine is worse in a warm room, discharge burns and excoriates; but there is one thing that differentiates it from all others, the patient immediately begins to emaciate when the complaint comes on and is very hungry.
Arsenicum album and Arsenicum iodide are excellent remedies, but Arsenicum album wants to be warm and is relieved by hot cloths over the eyes and nose. These cases do not do well when sent north. The Iodide of arsenic is worse in a warm room but much relieved in the cool air.
One of my patients had suffered from hay fever for fifteen years, and thought she had tried everything. After the attack she would be very weak and would not begin to region strength until December. She would then be fairly comfortable until April or May when she would begin with the premonitory symptoms. During the summer months she would be confined to her bed most of the time with her sneezing, asthma and irritable bladder, sometimes having to urinate very fifteen minutes. Succinic acid 3x every three hours brought absolute comfort in thirty six hours. She has taken this remedy for the past six years and has no dread of hay fever. This year she took in all twenty powders.
I have also used Nux vom., Chrom – kali – sulph., Pulsatilla, and Sulphur.
Is some cases I have used the Bacterins, a very small dose once a week, but always with the remedies. In those cases in which I used the Bacteria alone I did not get the desire result.
Harold Wilson has recommended the use of Calcium chloride, saturated solution, a teaspoonful in water, after meals. Ball uses this remedy but with the application of Argyrol on a cotton pledget in the nose every third day.
I would like to mention a few things which have given great relief to my patients.
Those who get relief from cold should bathe the face very frequently during the day with cool water. Some you will find get relief from hot compresses. A little white petroleum or cocoa butter rubbed in the inner and outer canthus of each eye on retiring is soothing and relieves irritation.
Many patients who are perfectly comfortable lying still in bed will, on the slightest movement of the legs, begin to sneeze. This is caused by contact with a cooler part of the sheet. Have them wear long stockings during the night, or better still, flannel pajamas with light woolen or cashmere socks pulled over the legs of the pajamas and they will avoid their night or morning sneezing.
Woolen stockings and wristlets with light underwear make an excellent combination. The legs and wrists perspire easily and unless protected are very sensitive to the slightest change of air and their chilling starts the sneezing.
Cut down meats, fats, rich blood and sometimes certain of the fruits.
Having eased the patient through this period of great torture, our hardest task begins. We must try and find the basic cause. As soon as the nose in a normal condition, careful search should be made for sinus or cell infection.
The teeth, tonsils, gall bladder, ovaries and prostate should be considered, but great attention should be given to the digestive tract in its entire length.
The majority of my cases of true hay fever I find to be, or have been, subject to urticaria, or have gouty joints. One woman over 50 years of age, suffers with her finger joints until the appearance of the hay fever, Aug. 15th, and has absolute relief of the joint trouble until the hay fever ceases.