19 Am. Journal of Med. Sciences, January, 1880, Philadelphia.
In April, 1882, William H. Daly of Pittsburgh, Pa., in a paper20 read before the American Laryngological Association, gave the histories of three cases of hay fever which he had succeeded in curing by means of operative procedure. In each of these cases the tissue over the inferior and middle turbinated bones was hypertrophied, and in one case it was so extremely sensitive that the slightest touch with the probe was sufficient to excite a violent paroxysm of sneezing. In these the diseased tissue was removed with the galvano-cautery or by the application of glacial acetic acid.
20 "On the Relation of Hay Asthma and Chronic Naso-pharyngeal Catarrh," Archives of Laryngology, vol. iii. No. 2.
The following year (1883) a much more elaborate article21 on the same subject was published by John O. Roe of Rochester, N.Y. After describing the highly vascular and somewhat erectile tissue covering the inferior turbinated bones and lower portion of the septum, the turbinated corpora cavernosa of Bigelow, he calls attention to its great susceptibility to the action of irritants, whether applied locally or to some remote portion of the body, citing as an example of the latter the swelling, and sometimes almost complete closure, of the nostrils supervening after exposure of the body to the action of a current of cold air. In this situation the tissue is liable to become hypertrophied, and in that state its susceptibility is greatly increased. If, when in this condition, it is exposed to the action of pollen, dust, or any other irritant, the substance produces a local irritation which is reflected through the sympathetic nerves to other parts of the respiratory tract; and it is to this reflected irritation that Roe attributes most of the phenomena of hay fever. He regards it as analogous to certain forms of laryngeal catarrh which, according to the recent testimony of many distinguished laryngologists, are clearly traceable to disease of the nasal cavity. Applying this theory to the treatment of hay fever, he removed the hypertrophied tissue in five cases, and in every instance succeeded in preventing a recurrence of all symptoms of the disease. His operation consists in the removal of the diseased tissue by means of Jarvis's wire écraseur and the galvano-cautery, caustics having proved less effective. The wire snare is best adapted for the removal of the tissue over the posterior portion of the turbinated bone, where, owing to its being pedunculated, it is readily caught in the wire loop. Over the anterior portion of the turbinated bone, as well as over the septum, the growth is more sessile, and is best destroyed by means of the galvano-cautery. To avoid inflammatory reaction and to guard against other unpleasant symptoms it is advisable to remove only a small portion of the growth at a time. After each operation the part should be sprayed with warmed vaseline to allay the irritation occasioned by the burning, and this should be continued until the surface is sufficiently healed over to admit of a repetition of the operation. The cauterization should be repeated until every trace of the diseased tissue is removed.
21 The Pathology and Radical Cure of Hay Fever, New York, 1883.
Prior to the publication of Roe's article Harrison Allen had operated successfully on two cases, the histories of which he has not as yet published, but has kindly communicated by letter to the writer, together with a description of his method of operating. This latter differs but little from that of Roe, except as regards the time at which the operation should be performed, Roe maintaining that the operation should never be performed when the patient is suffering from an attack of hay fever, while Allen considers this immaterial, and does not hesitate to operate even when the symptoms are at their height. If symptoms of hay fever recur after the operation, the nares should be carefully examined, and if, as is usual in such cases, any remnants of hypertrophied tissue be discovered, these should be at once removed. The operation is not regarded as a very painful one, and a patient of Allen's upon whom he had operated during an attack assures me that he left the doctor's office feeling much better than when he entered it. This is mentioned because hay-fever patients are excessively nervous, and timidity on their part has hitherto prevented many of them from availing themselves of this form of treatment.
It will be seen that, thus far, the operation has been performed in but ten cases, but the results have been so uniformly successful as to justify the belief that it is capable of relieving many cases of this hitherto intractable disease. Whether this hypertrophied condition is present in every case, as claimed by many, or in even the majority of cases of hay fever, has not as yet been determined; and until further observation shall have decided this question it will be impossible to form an opinion in regard to the general application of this method of treatment.