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.