Autumnal Catarrh.

Synonyms.—Hay Fever; Hay Asthma; Summer Catarrh; Rose Catarrh.

Definition.—An affection of the mucous membrane of the eyes, nose, and upper-air passages, characterized by coryza, laryngeal irritation, and asthma, and occurring during the summer months, usually August and September, and disappearing with the first heavy frost.

Etiology.—The predisposing cause is the possession of a peculiar idiosyncrasy, which is so subtle as to escape detection. It develops suddenly, occurs each year with almost mathematical precision, and, once acquired, the habit is seldom ever lost, but grows more confirmed with each year. The conditions favoring this peculiar habit are race, temperament, mode of life, age, sex. education, and heredity.

Race.—It is a little singular, but the English and the Americans are the principal sufferers from hay fever, it being extremely rare in Norway, Sweden, Denmark, France, Italy, Spain, and Russia, and when found is generally confined to the English resident. Dr. Jacobi, of New York, a few years ago, stated that he never had met with a case in a German. The French people seem singularly exempt, though the nervous temperament largely predominates in that race.

Temperament.—While all persons suffering from hay fever are not necessarily extremely nervous or excitable, yet it is largely a nervous lesion, and is found most frequently in persons of an active, energetic, and nervous temperament.

Education.—Another peculiar feature of this disease is, that it is almost entirely confined to the educated or cultured class and those who enjoy social position. McKenzie states that he never met a case in hospital practice, while Blakely reports forty-eight cases, every one of which belonged to the educated class, and Wyman reports forty-nine out of fifty-five cases as belonging to the cultured class.

Mode of Life.—Although pollen is supposed to be the most common cause, it is a recognized fact that the class of people who are most exposed to this exciting cause seldom have the disease; namely, those residing in the country, and agricultural laborers. Beard found only seven cases, out of two hundred recorded, in persons living in the country. No doubt the quiet of the country allays the nervous irritability that is so often incited by city life.

Heredity.—Heredity undoubtedly plays some part in favoring the disease, since a history of the disease in some of the relatives can be found in from twenty to thirty per cent of all cases of hay fever.

Age.—It seldom occurs in the extremes of life, though McKenzie reports that he met with a case in a child two years of age, and cases have been recorded when it first occurred after the age of sixty. From puberty to the age of thirty is the most prevailing period.

Sex.—Males are more frequent sufferers than females, owing, no doubt, to greater exposure to the exciting cause.

Exciting Cause.—The most common cause is the pollen of various plants, though dust may act as the irritant, and sometimes emotional excitement is sufficient to bring on an attack in one possessing the peculiar idiosyncrasy.

Symptoms.—The disease comes on more or less suddenly with a sense of tightness or constriction of the head, a burning or itching sensation in the eyes, especially in the inner canthus, and also in the nose and throat. Soon violent sneezing occurs, accompanied by a profuse watery discharge from the nose and eyes.

The eyes, nose, and cheeks become swollen, and the patient has the appearance of having a long crying spell. The mucous membrane of the nose becomes hyperemic and swollen, which obstructs nasal breathing. Often the irritation extends to the larynx and bronchi, giving rise to hay asthma.

An attack may be confined to the nose and eyes, coryza being the troublesome symptoms; but in the most severe cases the throat and bronchi become involved, the asthma and coryza going together. The patient breathes with difficulty, paroxysms of coughing occur at intervals, and the patient presents a depressed and worn appearance. These attacks, varying from the mild to exacerbations of the most intense character, according to exertion, weather, and the presence of irritating pollen, dust, etc., last from four to six weeks, or till frosts cut short the disease.

Diagnosis.—The disease is easily recognized by the sudden onset of sneezing and severe coryza—these symptoms occurring in a person of a neurotic temperament—and the almost mathematical precision of its return, August and September, and its defiance to medication, leave no doubt as to its identity.

Prognosis.—The prognosis is favorable as to life, but unfavorable as to cure, unless the patient removes to some climate where the exciting cause possesses no power to influence the sensitive nervous system.

Treatment.—Where the patient is financially able to profit by such advice, he should be advised to visit the lake resorts of Michigan—Petosky, Mackinac, and the Soo being a few of the many places of this character where he may get relief; also the Adirondacks, the White Mountains, or a sea voyage. He should go a few days before the fever's annual return or as soon as it occurs, and remain till after frost.

Sterilizing the nasal chambers with Dobell's solution, as recommended by Hollopeter, and followed by plugging the nose with cotton saturated with a mild solution of menthol in albolene, affords great relief. Internally, specific belladonna, ten drops to a half a glass of water, a teaspoonful every one, two, or three hours, has given good results. Sticta pulmonaria is also a good agent where the coryza is marked, accompanied by asthma and a dry, hard cough. Specific aralia is another remedy that should not be overlooked.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.