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]
FOOTNOTES:
[1] Throughout the middle ages, there was a firm belief in the existence in the human body of an indestructible bone which was thought to be the necessary nucleus of the resurrection body. With the revival of dissection and the study of anatomy in the sixteenth century, many anatomists searched for it eagerly but it was never found.