Hay-fever patients suffer greatly from mental depression, complain of lassitude, and their capacity for intellectual labor is diminished. They are often troubled with insomnia, and when such patients do sleep it is in a fitful way, and their rest is often broken by unpleasant dreams.
NOMENCLATURE AND CLASSIFICATION.—The various terms used to designate this disease are all misnomers, and up to the present time none has been devised which conveys any idea of the true character of the disease. Hay fever is incorrect, because hay is only a cause in a limited number of cases, and fever is by no means a prominent symptom. Hay asthma should be discarded, for asthma is far from being a constant accompaniment of the affection. Autumnal catarrh or early spring catarrh only serves to designate the time at which the two forms usually appear, but conveys no idea of the disease in its entirety; while the term pollen catarrh or pollen fever is objectionable on the ground that, although the disease is most frequently produced by that agent, there are causes other than pollen which may excite it.
Hay fever is variously classified by different authors, some, like Thorowgood and Beard, regarding it as a neurosis, while others (Bostock, Phoebus, and Wyman) appear to regard catarrh as its distinguishing feature. Zuelzer has recently classed it among the acute infectious diseases, but assigns no reason for placing it in that group.
DIAGNOSIS.—To any one at all familiar with the symptoms of the disease the diagnosis of hay fever is quite easy. Its distinctive features are: It appears at the same time every year (the early form about the 1st of June and the later about the 20th of August); the severity of the local symptoms which usher in the disease—sneezing, stoppage of the nostrils, the inflamed condition of the eyes, and above all the itching of the nose, eyes, skin, and mucous membrane of the root of the mouth. A detailed differential diagnosis is not as important now as it was formerly, when, as in the days of one of its early describers, Phoebus, "Man sah sie nicht, wo sie war, und sie sah, wo sie nicht war."
PROGNOSIS.—The number of elderly persons with hay fever, many of whom have passed the allotted threescore years and ten, and the fact that no one has ever been known to die from the disease, affords conclusive evidence that it does not shorten life. On the other hand, when once affected, except in those cases relieved by operative procedure, the patient remains subject to it during the remainder of his life. A few isolated cases are said to have recovered, but such a result is extremely rare. It is thought by some that a prolonged residence in the South may mitigate the disease, and eventually cure it, but this assertion lacks confirmation. It does not, like bronchial asthma, lead to secondary affections, the interval between the attacks giving the organs time to recuperate, nor does it predispose to other diseases.
TREATMENT.—Aside from its surgical treatment, to which I shall refer farther on, the only effectual remedy for hay fever consists in removal to a region which is exempt from the disease. By going to such a locality before the attack occurs, and remaining there throughout the critical period, complete immunity from the disease may be secured. The time of departure and return must be determined by the previous experience of the invalid in regard to the date upon which his former attacks have commenced. As the disease seldom comes on exactly on the same day every year, but often varies three or four days, he should be in his place of refuge at least a week before the usual time for the attack, and should remain until he can return with perfect safety. This is usually about the middle of July in the early variety, and after the first frost severe enough to kill vegetation in the autumnal form.
In the milder form which occurs in the spring the seashore affords considerable relief, except when the wind is from the land. It is therefore uncertain, and is only indicated when the circumstances of the patient prevent his visiting one of the exempt localities. On the eastern coast of the United States there are several places of this character, such as the Isles of Shoals, a group of rocky islands with little or no vegetation off the coast of New Hampshire, the climate of which is very like that of the ocean; and Fire Island, near New York. Similar to the above, but much more exposed to land influences, are Mount Desert and Nantucket.
The ocean itself affords complete exemption, and a sea-voyage is the surest means of avoiding the disease. It is true that persons have been known to be affected with hay fever even in mid-ocean, but in such cases it is more than probable that the cause of the attack could have been traced to the cargo. A case of this character came under the writer's observation during a voyage from New York to Charleston during the month of September, and was evidently caused by hay, a number of bales of which were stowed on the forward deck of the vessel. It makes comparatively little difference what particular voyage is undertaken, provided the vessel's course does not bring her too near land; but for most hay-fever patients a trip to Europe is to be preferred, especially for those suffering with the autumnal form, as by going to that country, where this variety does not exist, they avoid the necessity of remaining nearly two months on the water. A voyage to California is almost as good, and for the same reasons.
Whether this applies to the so-called June or rose cold, which is quite common in Great Britain and prevails to some extent on the Continent, has not as yet been definitely determined, but it is more than probable. Whether patients who have contracted the disease in Europe would escape in America is exceedingly doubtful. Two of the cases reported to the writer, who were first attacked (with the early form) in Europe—the one in Switzerland and the other at Florence—continued to have the disease after their return to this country; while, on the other hand, an English lady who was subject to the disease at home escaped entirely during her residence of three years in the Southern States. Of the exempt regions in the United States, the one most frequently resorted to, and which at the same time affords the surest relief, is that of the White Mountains of New Hampshire—not the whole of it, but a certain portion, which is bounded on the west by a line drawn from Littleton to Lancaster (but not including the former place, which is only partially exempt), on the north by Canada, on the south by Franconia, Crawford House, and Jackson, while to the east it extends as far as Bethel in Maine. Of the various places contained within this territory, Bethlehem and Jefferson, Whitefield, White Mountain House, Fabian's, Twin Mountain House, Crawford House, Glen, Gorham, and Mount Washington, may be regarded as entirely exempt; Franconia Notch almost equally so; while Dalton, Lancaster, and Bethel must be ranked as uncertain. Another exempt region extends to the north and east of the one just described, and comprises the lake region of Maine. Petoskey in Northern Michigan, at the head of Little Traverse Bay, is said to afford almost entire relief, and is resorted to by a large number of patients from the Western and South-western States. There are also several places in Vermont which offer more or less immunity, such as Mounts Mansfield and Stow, both of which, however, are inferior to those first mentioned. Canada, with the exception of a few cases reported at Toronto, St. Catherine's, and at a few places near its southern border, appears to be exempt. The same may be said of the Adirondack Mountains and Pottersville on Schroon Lake and Marquette. The Catskill Mountains and several places high up on the Alleghanies, such as Cresson, Pa., Oakland and Deer Park in Maryland, afford relief in many cases. Colorado is said to be exempt, but several patients who have gone there failed to obtain relief. California is free from the disease, and many hay-fever patients have escaped their attacks by removal to that State. I know of no place in the Southern States which affords relief except Florida, where the disease is rare; several cases have been entirely relieved during their residence there. In others, however, the experiment was unsuccessful.17
17 Two patients in their replies to the writer's circular claimed to have been entirely exempt—the one (early form) at Beaufort, and the other (autumnal) at Mount Airy, Habersham county, Ga. Wyman mentions four cases that were relieved at or near Beaufort.