CONTENTS
| CHAPTER | PAGE | |
| [I.] | The Diagnosis | 9 |
| [II.] | Rosin-weed | 14 |
| [III.] | Ichthyol and the Point in the Naso-pharynx that Controls the Symptoms | 17 |
| [IV.] | Menthol and Eucalyptol | 20 |
| [V.] | The Faradic Current and Other Forms of Electricity | 27 |
| [VI.] | Hay Fever as Urticaria | 38 |
| [VII.] | Dr. Gueneau de Mussy. Hay Fever as Urticaria Again | 44 |
| [VIII.] | Hay Fever as Gout | 51 |
| [IX.] | The Uric Acid Theory | 66 |
| [X.] | Hay Fever as Anaphylaxis | 76 |
| [XI.] | Immunizing with Pollen Extracts | 91 |
| [XII.] | The Bacterial Vaccines | 108 |
| [XIII.] | Diet | 113 |
| [XIV.] | Rosin-weed Again. Historical and Pharmacological | 123 |
THE TREATMENT OF HAY FEVER
CHAPTER I
THE DIAGNOSIS
Under the name "hay fever" I include rose-cold and the so-called hyperæsthetic catarrh or vaso-motor rhinitis, all characterized by intense itching of the eyes, nose, and throat, free discharge, sometimes asthma, the attacks being precipitated by strong odors, dust, or pollen. There are many forms of the disease, some occurring in May or June, some as early as March, before the budding of vegetation, some even in the winter; but the large majority of cases occur in August, coincident with the flowering of late summer vegetation, notably the rag-weed and golden-rod. It is not so well known that the California privet, so widely used in hedges and parks, aggravates many patients, especially in June and July, when the scent of the flowers is strong. Others are irritated instantly by the odor of crude oil that is spread so freely on the roads in summer, by metal-dust, and by the cinders of a railway trip. Some patients are sensitive to one irritant, some to many irritants. I knew one man whose itching of the eyes began in March, nose and throat following in April and May, cough in July and August, who was sensitive to each and all of these irritants from March to October every year for thirty years.
If we follow the modern tendency and classify the cases according to the specific irritant, we shall have an endless number of varieties according to the endless number of possible irritants; and where will you classify the man who is subject to them all? In the present state of our knowledge, it seems better to regard the sensitiveness to irritants as the characteristic of these cases and to think of them as different forms of the same disease. In most text-books this idea is expressed by the terms hyperæsthetic catarrh and vaso-motor rhinitis; but there are serious pathological objections to the terms catarrh and rhinitis. These objections and the reasons for regarding the lesion as an angioneurotic œdema are discussed in Chapter VI, on Hay Fever as Urticaria, to which the reader is referred.
An additional reason for regarding all these varieties as superficially differing forms of the same disease is the fact that all of them are curable by the same methods. I am aware of the danger of error in this argument, the persuasive but misleading Analogieschluss, and would not advance it too strongly. However, for all practical purposes except the vaccine treatment, described in Chapter XII, all these hyperæsthetic cases may be regarded as varieties of the same disease.
With a patient suffering from hay fever, as with a patient suffering from any other disease, the first thing to do is to take the history and make an examination. Usually, the nature of the case will be clear from the history, but it is a mistake to rest here without looking into the nose and throat. In the nose, you may find anything from a polyp to a shoe-button, any of which may require mechanical removal before you will make any progress with your medicines, no matter how well selected. Usually, you will find nothing but a swelling of the mucous membrane of the turbinates with free discharge. If you are an adept at examining the nose, you will probably search for the sensitive areas, touching of which causes a spasm of sneezing. These may be found anywhere in the nose, but most commonly at the anterior and posterior ends of the middle and inferior turbinated bones. I apply ichthyol to the naso-pharynx to test the sensitive area described in Chapter III.
What constitutes a gross lesion requiring surgical removal? Competent men differ widely and the practice of the same man has differed widely at different stages of his career. For a time there was enthusiastic cutting of septal spurs and burning of redundant mucosa and cauterizing of sensitive areas. I think that the relation of the nose specialist to hay fever is similar to the relation of the abdominal surgeon to neurasthenics. The more experienced he becomes, the more he advises letting them alone or using gentle measures. Distinct polyps should be removed.
Having finished the examination and found no gross lesion requiring surgical removal, the treatment must be decided. The easiest plan for both patient and physician is to give rosin-weed, as described in Chapter II.
The most painful for the patient but often effective in severe cases is the application of ichthyol, as described in Chapter III.
If the patient is systematic and will attend to it, the ichthyol may be replaced by the frequent spraying with menthol and eucalyptol, as described in Chapter IV.
The best treatment of all, but that which takes the most time of both patient and physician, is the use of electricity, as described in Chapter V.
Consider the possible importance of diet in the case, as described in Chapter XIII.
Finally, ponder on the nature of hay fever, as discussed in Chapters VI to X, and the advisability of using vaccines or pollen extracts, and you will have done your whole duty by your patient and by your art.
CHAPTER II
ROSIN-WEED
For many years the fluid extract of rosin-weed has been known in my family as a remedy for rose-cold and hay fever. This use of it was discovered by my father, Dr. Alexander H. Laidlaw, in the epizoötic days of 1872, when horses were dying by the thousands all over the United States and Canada. Though he knew it first as a horse medicine, its use seems to be forgotten in veterinary practice, for I find no mention of it in available veterinary books, old or new.
In my father's practice this remedy acquired considerable fame, and I still receive a letter or two every summer from distant cities from some one who has heard of the miraculous medicine. For many years it was his intention to give this remedy to the world in proper form, supported by competent testimony; but, in a busy life, with many projects unfulfilled, this was never done. During my own professional life I have been interested in many things that seemed more important than hay fever and have not heretofore taken up the matter of publishing our experiences with the drug. Realizing that there were many hay fever victims both in this country and in Europe who might just as well be getting the relief that this drug would give them if they only knew about it, and having no desire to profit by my possession of the secret of this remedy, I made the announcement last summer, first to the American Institute of Homoeopathy and next to the United States Hay Fever Association. I announced it first to my old society, the Institute, believing that my friends there, who have known me many years, would credit my statements as made in good faith and give the drug a fair trial.
The Dose. Beginning ten days before the expected attack, give ten drops of the fluid extract of rosin-weed in a little water four times daily, after meals and on retiring. To children, give five drops. If the symptoms of hay fever appear, increase the dose to twenty and even thirty drops and continue this dose through the entire hay fever season.
It is better to begin ten days before the expected attack, for, in hay fever, as in all periodic diseases, prevention is better than cure, requires smaller doses, and is more certain. However, few patients are wise enough to anticipate trouble. Most patients apply for treatment when, literally, the disease is in full blast, and most of my observations have been made on the latter class. In case the disease has already begun, start with the same dose, ten drops. If not relieved in three days, increase the dose by five drops every third day up to thirty drops. If the symptoms should be relieved by the smaller dose, it is unnecessary to increase it.
Cure or Palliation? In regard to the permanence of the cure, most patients require it for several seasons. Some need it every season for many years. A few are permanently cured in one season.
For further information about the plant, rosin weed, its preparation and use in medicine, the reader is referred to Chapter XIV.
CHAPTER III
ICHTHYOL AND THE POINT IN THE NASO-PHARYNX THAT CONTROLS THE SYMPTOMS
While the use of rosin-weed was discovered by my father, the value of ichthyol in the treatment of hay fever and the point in the naso-pharynx that controls the symptoms are discoveries of my own or, at least, I fondly think so. In current medical literature, I find no reference to it. In Merck's History and Preparation of Ichthyol, a summary of its use to 1913, ichthyol is advised in hypertrophic and atrophic rhinitis, but hay fever is not mentioned. Reference to recent books, as Coakley, Ballenger, Ivins, Bosworth, Kyle, Grayson, show no knowledge of the use of ichthyol in hay fever nor of the spot in the naso-pharynx that controls the symptoms.
The point of the matter is this. In hay fever, the itching and redness of the eyes, nose, and throat are controlled from a sensitive point in the naso-pharynx. Local applications to this point will relieve almost instantly not only the itching of the throat but also the itching of the eyes and nose and all symptoms of the disease. In some cases such relief carried out for several seasons makes permanent cures.
My knowledge of it came about in this wise. At about the age of sixteen I developed a rose-cold that began in June and extended into September. A few years later it began in April and lasted until October. By one of those ironical tricks that fate plays on the great ones of the earth, rosin-weed, the family remedy that cured everybody else, gave me only partial relief. It is unnecessary to follow in detail the various experiments made. This was long before the days of Dunbar's pollantin, Holbrook Curtis' ambrosia, adrenalin, and the modern vaccines. I did not think cocaine a safe drug and never used it, preferring the hay fever to the cocaine habit. About this time ichthyol was introduced by Merck for the treatment of catarrh of all mucous membranes and I found that ichthyol, used in a certain manner, relieved the symptoms completely. On swabbing the naso-pharynx with pure ichthyol, there was a severe burning sensation for a minute or so, but, when the burning subsided, there was great relief, not only of the itching throat but also of the itching of the eyes and nose. That is, in the customary swabbing of the naso-pharynx, we touch a point that controls the whole group of symptoms of the eyes, nose, and throat.
In those days the laryngeal and pharyngeal tonsils were very much to the fore in medical discussions, and at first I thought that this point was probably the pharyngeal tonsil of Luschka. However, judging from the location of the most severe burning, the controlling point is rather on the upper surface of the soft palate. The exact location of this point is not of practical importance. If you swab each side of the naso-pharynx with plenty of ichthyol, the reflex contraction of the pharynx while the swab is in it will spread the ichthyol over the right territory.
CHAPTER IV
MENTHOL AND EUCALYPTOL
The ichthyol treatment described in the last Chapter is very effective, but it burns severely for a few minutes and, for this reason, some patients will not endure it. With children, it is impossible. Another disadvantage to the patient and, sometimes, to the doctor, too, is that it requires the patient to come to the doctor every day for the application, though Dr. Hollister tells me that he had one patient who learned to apply the ichthyol to her own naso-pharynx and, what is more wonderful still, kept up the treatment long enough to get well. In recent years I have hit on a treatment that is more comfortable than ichthyol and in many cases equally effective, though a little slower in giving relief. It can be carried out by the patient with little trouble and requires no skill in handling nasal swabs, an important matter with nervous patients and children.
I have found that the ordinary solution of menthol and eucalyptol and thymol in liquid albolene will relieve hay fever if applied to a certain spot a certain number of times a day. At this point I can see the reader's face assuming an expression of pained surprise. What is there wonderful about that? Is there not a bottle of this solution on the table of every doctor in the country and does not every modern textbook on the Nose and Throat advise inhaling vapor of such a solution to relieve hay fever? True. Note that I did not say that simply spraying this solution in the nose and throat will cure hay fever. I said that it must be applied to a certain spot a certain number of times a day. It is a case of the technique being more important than the remedy; for I have no doubt that there are other medicines than ichthyol and menthol that will relieve if put on the right spot. The reason that every doctor has not discovered for himself the full value of this commonly used solution is that he did not put it on the right spot and he did not use it often enough.
The Right Spot, as related in the chapter on Ichthyol, is either the vault of the pharynx or the upper surface of the soft palate.
Frequency. Once or twice a day is insignificant. It must be used every hour or oftener when the symptoms are acute. Here I borrow an idea from the dermatologist who learned long ago from Unna that when an ointment rubbed on twice a day fails to cure an eczema, it may be cured by keeping the same ointment constantly applied to the part, day and night. The naso-pharynx of the hay fever patient requires the same continual application of the cure and we come as near as possible to a continual application by applying the solution every hour or two.
Such frequent applications are impracticable as office treatments, but must be carried on at home or at business by the patient or a member of the family. If an expert hand is available to spray the naso-pharynx, the tip of the atomizer should be pointed forward so that the spray is directed into the posterior nares and the posterior surface of the soft palate as well as the vault of the pharynx. An adroit patient may learn to do this, but even an adroit patient, unfamiliar with the anatomy of the throat, may spray only the front of the palate and fail to get the solution correctly applied. To avoid these mistakes and insure the oil getting on the right spot, the patient should be taught the following simple technique.
Method of Application. Taking an ordinary atomizer full of the oil, the patient lies on the back with the head low or on one flat pillow. He must be able to breathe freely through the nostril to be treated. Usually, one side of the nose is free and he begins with that side, inhaling the oily spray freely. He then remains lying on the back with the head low while the oil runs backward into the naso-pharynx, especially on the upper surface of the soft palate, where it burns a little but not nearly as much as ichthyol. After two minutes or so, the other side must be treated, but it must first be opened up so that the patient can breathe freely through it. This is done by turning on one side so that the stuffy side is upper-most. In a few minutes this side will open up and the spray can be inhaled through it freely back into the throat. To be thorough, the patient treats each side several times. For the first few days the treatment should be carried out every hour or so. After a few days or a week mild cases get perfect relief and even severe cases may drop to four treatments daily. Such a method is far safer than cocaine, which should never be put in the hands of the patient for any purpose whatever.
For obstinate cases ichthyol remains the most effective of the local applications. With those adults who can learn to spray the naso-pharynx and who are heroic enough to bear the sharp burning for a few minutes for the sake of ultimate relief, I mix one-tenth ichthyol with the albolene spray solution. Ichthyol leaves the throat raw and uncomfortable for a few minutes. For this reason it should not be used as frequently as the albolene solution.
Ichthyol does not mix well with the albolene, but precipitates quickly. As it does not mix readily by shaking, the mixture must be stirred before using. The manufacturers, McKesson and Robbins, were good enough to experiment in their laboratory with mixtures of ichthyol and albolene. They report that they were unable to make a satisfactory combination and that "the only way to get a permanent mixture of the two would be by a process of emulsion, which would be too thick for spraying purposes."
It may be objected that my newly discovered point in the naso-pharynx is merely the posterior end of the inferior turbinated bone, as described by Mackenzie and Sajous and others long ago, and that the spraying of the nasal passages simply benumbs the sensitive areas, anterior, middle, and posterior, that are well known to rhinologists. This may be so. At any rate, the method just described makes possible a treatment of these areas in every case, though far from skilled assistance. The treatment by cautery must always remain a treatment by the skilled specialist in selected cases. Even if my sensitive spot in the pharynx is nothing new, this method will at least place in the hands of thousands of hay fever sufferers a simple method of relief, which thought there is more satisfaction than in being reputed the discoverer of the resurrection bone itself.[1]