Autumnal Catarrh.
Synonyms:—Hay fever; hay asthma; rose cold; periodical rhinitis; rag-weed fever; pollen catarrh.
Definition:—An acute asthmatic disorder, occurring about the same time each year and characterized by a catarrhal inflammation of the post-nasal and respiratory passages, with extreme hyperesthesia of the mucous membranes.
Etiology:—The disease depends upon a peculiar susceptibility of the patient to the irritating influence of the pollen of certain autumn flowers. This susceptibility is hereditarily transmitted in some cases. This nasal hyperesthesia may be "selective"—influenced by the pollen of a single plant and not apparent at any time from other influences. In other cases the hyperesthesia is influenced by a great variety of irritating substances. It may be induced by an abormal condition of the nasal passages or by the presence of tumors or by a deflected septum. It is more common among the so-called "upper classes," is entirely absent in the mountainous regions and in the northern lake regions of the United States, and on the sea. It is not readily acquired by people living in the rural districts, but is especially liable to occur among sensitive people, who have long inhaled the dust and irritating atmosphere of the city streets. It occurs in the male sex more often than in the female, and in young adults, rather than in the aged. Children are seldom affected by it.
Symptomatology:—As stated, the occurrence of the disease is usually anticipated by the patient, as due at a certain given time, and usually the patient is not disappointed. Up to that time he may be in perfect health, when, with no premonitory symptoms, there is a pronounced cold in the head, with the accompanying sneezing, obstruction of the nasal passages, discharge of a thin watery mucous, with increased redness of the mucous membrane of the nares, and marked redness of the eyes, with free lachrymation and itching of the lids. This sometimes develops slowly, but usually it reaches an extreme point, within forty-eight hours. The nasal discharge irritates the nares and the upper lip, and there is constant blowing of the nose and sneezing. The asthmatic symptoms may be so slight as not to be spoken of. In other cases, the irritation develops first in the bronchial passages, with extreme asthmatic breathing and bronchial irritation.
Fulness of the head, and supra-orbital or frontal headache, are very common. There is tinnitus, deafness and loss of the sense of smell and taste. The patient becomes listless, and there is lassitude, despondency, and some debility. There may be some exacerbations, in the course of the disease, depending largely upon the exposure of the patient or upon the conditions of the weather. Feverishness and chills are not uncommon, with loss of appetite and disturbed sleep. The symptoms usually abate with the first appearance of frost and the following steady cool weather is often a great relief to the patient. As the condition does not usually appear until late in the summer, or in the early fall, the course is thus limited to from six to eight weeks. However, the local irritation sometimes induces a condition of reflex asthma, or asthmatic bronchitis, which remains after the specific disease has abated.
It is not impossible for idiopathic cases, depending upon other causes of irritation, to occur at any time during the year.
Diagnosis:—A patient who has suffered from a disease at a given period, will look for its return, at same period, the next year. It often returns with surprising regularity and promptness. The sudden onset of severe nasal symptoms, strikingly similar to those of an acute cold, with the watery nasal discharge and usually asthmatic breathing, the patient having been previously in good health, readily determine the character of the disease.
Treatment:—As yet no specific cure for this disease has been found. Homeopathic physicians in compliance with their law of similars, have used rag-weed in the treatment, and they claim with good results; quite a number have used an infusion of rag-weed internally and externally, and claim an amelioration of the symptoms. Dr. Horm an, of Chicago, uses an infusion of the smart-weed and claims invariable benefit. It is used principally as a douche. He has observed many hundred cases and claims that a very small percentage, only, fail to get marked benefit from the first. With this agent the susceptibility is reduced and subsequent attacks are much lighter.
Patients who anticipate an attack of this disorder should place themselves in the hands of a physician, for the removal of any rheumatic or gouty conditions that may be present, and that the condition of the stomach, liver, intestinal canal and excretory and secretory organs may be put in the best possible condition, the excretion of an excess of uric acid must be corrected and normal secretion must be insured. If this condition has not been overcome the patient should take about a dram of the phosphate of sodium in a cup of hot water before meals, until a slight laxative effect is obtained, then the quantity may be reduced to thirty or forty grains three times a day.
With the first appearance of the disease, the patient should receive the following mixture: Gelsemium, one dram; euphrasia, two drams; macrotys, twenty minims; lobelia, ten minims; syrup of tolu, q. s. to make four ounces. Of this a teaspoonful should be given every two hours.
As in acute coryza fifteen grains of the sodium salicylate should be given at the onset of the attack and repeated twice with intervals of two hours, subsequently, five grains may be given regularly every three hours with good results. When the watery discharge is extreme the use of belladonna to produce its physiological influence will be found valuable. In some cases better results are obtained by using atropin in doses of the one three hundredth of a grain, hypodermically, every three or four hours. Thorough irrigation of the nasal passages with a solution of the peroxide of hydrogen in water, or in the normal salt solution, one part of the peroxide to eight or ten of the fluid, will be very beneficial. The internal use of sticta pulmonaria is advised as serviceable in the treatment of this disease.
Rhinologists are using solutions of cocaine and of adrenalin chlorid as irrigating fluids with good results in some cases. There are objections to the use of either of these remedies which must always be considered.
