A system of practical medicine. By American authors. Vol. 3

by Unknown

¹⁶ Op. cit., p. 9.

The spring form of the disease, known as June cold in the United States and as hay fever in England, differs from the late variety in the time of its occurrence, the attack coming on, as its name implies, in the late spring, usually between the 15th of May and the 15th of June, sometimes much earlier; one of my patients reporting that she commences to sneeze as early as the middle of April. The attacks in this variety usually cease during the first or second week in July, although a few continue on into August—a fact which induced Beard to establish a third or middle form of the disease. The symptoms are essentially the same in both varieties, but are much less severe in the early form, which is also of shorter duration. They differ as to cause, the spring variety being usually due to newly-mown hay. It occasionally happens that one person has both forms of the disease, or that a person who has hitherto had the early form fails to have it in the spring and is attacked in autumn.

INDIVIDUAL SYMPTOMS.—There is occasionally a stage of incubation, lasting about a week, during which there is slight feverishness and undue susceptibility to nervous impressions. The patient often experiences a feeling of lassitude and weakness; the digestion is disturbed, as indicated by a coated tongue, want of appetite, and constipation; he is disposed to be wakeful, and when he does sleep his rest is often disturbed by unpleasant dreams.

The first effect of exposure to the irritant is itching of the nose, slight in the beginning, but increasing in severity as the disease advances, until it at last becomes unbearable. The mucous membrane is red and swollen, the swelling being often so great that it interferes with the passage of air; a watery discharge sets in, which, although slight in the early stages, soon becomes copious, and in severe cases is so abundant that it actually streams from the nostrils. Sometimes, when both nostrils are stopped, if the patient changes his position and lies on the side the uppermost nostril will become free. These symptoms are attended with sneezing—not the sneezing of an ordinary coryza, but powerful sternutatory efforts repeated in quick succession and utterly uncontrollable. In one case which has come under my observation the sneezing invariably brought on menstruation in advance of the regular period, and on some occasions caused abortion.

These symptoms just mentioned often appear and disappear with great rapidity, especially in the early stages of the disease, and are usually worse in the morning on awakening.

Itching of the eyes begins at the inner canthus and generally extends over the greater portion of the conjunctiva, slight at first, but becoming more troublesome as the disease progresses. There is also redness of the conjunctiva, sometimes of the lids alone, at others extending over the whole mucous membrane, and giving to the eyes a bright-red appearance. The lids in severe cases are not infrequently oedematous, lachrymation is greatly increased, and the tears, trickling down the face, are liable to cause excoriation of the skin. Pustules and styes often form on the lids. There is more or less photophobia, according to the severity of the attack.

Owing to the occlusion of the nostrils the patient is often compelled to breathe through the mouth, thus causing an uncomfortable drying of the mucous membrane. There is a peculiar itching of the hard palate, which the patient attempts to relieve by rubbing the roof of the mouth with the point of the tongue. This itching sensation extends over the pharynx, posterior nares, and upward through the Eustachian tubes to the ears, causing a disagreeable irritation, which the patient tries to alleviate by thrusting the tip of the finger into the external meatus. The mucous membrane of the pharynx is red and swollen. The dryness observed early in the attack gives place later to increased secretion, which is sometimes quite abundant. On the anterior surface of the velum of one of my female patients I observed a hard papule about the size of a lentil, which she assured me was always coincident with the attack, and never appeared at any other time.

In addition to headache, which is quite common, patients frequently complain of a heaviness and fulness, also of a peculiar sensation as though the head were constricted by a band. This latter symptom I have found present in about one-half of the cases investigated.

Itching of the skin is quite common, especially of the face, between the shoulder-blades, and over the sternum, and is frequently accompanied by a slight vesicular eruption and occasionally by urticaria.

The whole respiratory tract is in a state of catarrh, but there is very rarely any cough during the first week. This usually commences in the second week, and at that time is short and dry, and becomes every day more frequent until the third week, when it changes its type and becomes paroxysmal. During the first three weeks there is little or no expectoration, and what there is consists of small transparent glutinous masses. About the fourth week the irritation reaches the finer bronchi, and in many cases there is more or less asthma, which, like ordinary bronchial asthma, usually comes on at night. The asthma is sometimes quite severe and long-continued. Wyman states that very few escape cough. This does not accord with the writer's experience, as in 65 of his cases 15 had no cough.