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decomposing apples, even so much so he could not live or work without the odor of them." It is claimed that others may have such an acute sense of smell that "recent participants in coitus can be distinguished from the peculiar odor from their bodies." Others can not eat certain articles of diet without producing an urticaria. Idiosyncrasy against certain medicaments is well known to the profession, either administered or applied to the skin. Traumatic eruptions following operations and injuries have been observed. Scarlatina sometimes follows. The operation or injury is said to induce a "favorable receptivity" to the scarlatinal poison. Others claim it is caused by traumatic reflex irritation.
These illustrations of idiosyncrasy evidence the fact of a peculiar nervous organization—the so-called neurotic temperament. Though the disease has only been known for the last seventy years, there have accumulated many facts in proof of the hereditary transmission of the peculiar idiosyncrasy. The replies to the interrogatories of Wyman and Beard in their circulars, as well as to facts obtained from general observation, abundantly attest it. Instances are mentioned where it came down for two or three generations. The idiosyncrasy may be present at all ages, but it especially belongs to adult life. Mackenzie reports two cases of children, two and three years old, respectively; the parents of both cases had suffered from the disease. Dr. H. Moulton, of Stuart, Iowa, reports a typical case in a child of eight years, which had existed since she was three years of age. The disease was hereditary. It appears, also, that the people of different countries are peculiarly susceptible. It prevails most in England and America. They are either especially predisposed or suffer the greatest exposure to the cause. Possibly both. In the countries of Asia and Africa it is stated that the English are the only sufferers. Different races are also exempt in the same country, and the same race in different portions of the same country. The Germans of the United States. are seldom afflicted. Beard never saw a case in the Indian or negro. Other observers have not seen a case in hospital practice among the patients from the lower walks of life, but have met it frequently among the educated and higher classes of society. The disease is seldom seen in Norway, Sweden, Denmark, Germany, Italy, Prussia and Spain. It would appear, therefore, that race,
nationality and the habits of the people have much to do with the development of the peculiar disposition of mind and body common to the disease. It is probable that the English and Americans are the most nervous of all peoples. They operate under a higher degree of nervous tension than any other, while also the peculiarity of climate and variable temperature develops the peculiar organization attending the hay fever sufferer. The universal prevalence of the exciting cause in these countries must also be remembered..
In the two hundred cases reported by Beard, only seven patients. engaged in agricultural pursuits are mentioned. The fact that they are exposed to the causes more than any other class might be considered as opposing the view of pollen as a general factor in causation. It is apparent that farmers do not labor under as high mental excitement as do men in most other pursuits. They are not, as a rule, of delicate, nervous organizations, while the excitement and bustle of city life, the vicissitudes of business, the rancor of rivals, the necessary combat against opposing forces in the city "often makes life a burden even where envy marks it a great success," and develops in the inhabitants of the city a susceptibility to nervous impressions, a predisposition of the nerve centers not so liable to be formed in the quiet pursuit of farming. In support of this fact it might further be mentioned that the disease occurs more frequently in males than in females. May this not be due to the restless energy with which men carry on their occupations?" It is well known that in city life the pastime of the ladies among the rich cultured classes is one of pleasure and excitement, while men are in hot pursuit of fame or fortune. Mental overwork is producing its ill effects in the production of nervous diseases of different kinds. Hence, the more frequent occurrence of the diseases now under discussion.
It has been claimed that heat and sunshine are elements in etiology. The popular verdict of those who suffer is fortified by statistics in opposition to this assumption. The evidence of personal experience is always valuable. No writer will now claim that heat or sunshine does more than cause the exaggeration of general sympThe fact that the disease occurs from April until September, continuing often into the winter, is sufficient evidence against high temperature as the original cause. To the extent that heat
and sunshine bring vegetable growth and dust which indirectly act as exciting causes by the production of pollen and dust, which saturate the inspired air, may they be considered causes. Moreover, warm weather produces relaxation and enervation, with corresponding depression, which promotes the sensitive habit and intensifies the disease. The disease may be more acute in warm days and in bright sunshine. The most serious result of hay fever is the nervous exhaustion which it produces. The perverted functional activity of the nervous centers invite it. With most sufferers a mental effort at this time is especially fatiguing and seems like a herculean task and that it would be impossible to accomplish it. This neurasthenia is favored and prolonged by the extreme heat and bright sunshine which obtains during the hay fever season, and in so far may be considered an aggravating cause, but not the cause per se. Again, if heat and light are direct causes we would expect to note that the disease especially prevailed in the southern States of America and in very warm countries, as in India and Africa, under equatorial sun and in the excessive heat and sunshine of desert lands, where heat is almost beyond the power of endurance, or that the "brilliant dazzling glare of sunlight at sea" or the continuous six months sunshine of northern countries are exciting causes. But facts submitted in statistics prove it not the case. In the countries and places just mentioned the disease is as rare as the heat and sunshine is lasting. If the pollen or other emanation is absent, if the individual with his idiosyncrasy and sensitive nostrils is not there, there is no hay fever present. Just as there must be an ear to hear before there is sound or an eye to see before there is light, must there be the requisites, pollen, idiosyncrasy and hyperesthesia to produce hay fever.
It is claimed that other aggravating causes than pollen do not exist, but the frequency of the disease during the flowering season is nearly absolute proof of their agency in causation. Phoebus reports a case in which the disease was "excited, even, by looking at a highly realistic figure of a hay field." The statistics of Beard, before referred to, show that out of two hundred cases, no less than one hundred and four attributed the affection to dust, and of them all, one hundred and forty-two occurred between May and September-the season of flowering plants and grass emanations. The
most common cause of the autumnal variety is the Ambrosia Artemesifolia, generally known as rag-weed, which is common throughout the United States. It belongs to the order Compositæ and to those susceptible to its pollen it produces the most aggravated form of the disease. The dried leaves gathered in its flowering season will produce the affection in some subjects when inhaled at any season of the year. Drs. Wyman and Giddings report cases in point, and the author has observed the same. Sufferers are plentiful wherever ambrosia abounds. The prevalence of hay fever in August and September in this country, and the infrequency of it at this season in England is here found, as rag-weed is of rare growth in European countries.
Sufferers will hardly agree with the old Greek authors who denominated ambrosia the special plant that should bestow immortality and furnish food for the gods. Dust is the common carrier of pollen in the atmosphere. For this reason sufferers attribute the cause entirely to dust, as was observed in Beard's statistics, not knowing that it may be heavily freighted with the pollen of many different plants, and the statement that the dust in "railway cars is the most potent form" in causing the disease, I believe, from observation, to be true, because in the constant change of air from one locality to another, through fields and forests, a great variety of pollen and dust unavoidably attacks the sensitive nasal structures. The writer believes, however, that dust and other emanations, in the absence of pollen, is an aggravating cause in persons who have the highly vascular sensitive nasal tract and essential predisposition. Personal observation of cases caused by the emanations from feathers, animals, drugs and chemicals, sudden exposures of skin to draughts, and cases reported from reliable authority in which other substances aggravated an attack, leave no room for denial. The remarkable distribution of pollen, and its diffusible and migratory nature, must be remembered in such cases before attributing it to other causes. Instances are recorded in which the pollen of pine forests was carried four hundred miles. May not the pollen of herbs be as nomadic in character? In all cases, whatever the exciting cause, it is interesting to note that the individual susceptibility, the predisposing cause, must be present for an attack to follow. The theory that pollen is the most potent
and frequent cause receives its best support in the fact of the disease being so common during the season of flowers and grasses, and in emanations from dried plants at any season of the year, causing an attack, and in the manifold genera and species of the flora indigenous to our country flowering from May until September, the seasons in which hay fever prevails.
PATHOLOGY:-What are the existing lesions? We have stated its frequency among the nervous and educated. In proof may be mentioned such distinguished personages as Helmholtz, Wyman, Flint and Blackley, of our own profession; Broussias, the great botanist, who was impeded in his botanical studies because of it; Beecher, the great pulpit orator; Webster, the illustrious statesman, and Chief Justice Shaw, the eminent jurist, who were affected. The prevalence among the devotees of fashion and society has been remarked where extraordinary demands are made upon the nervous system. The conditions of our climate, the demands of business, producing worry and exhaustion, have, as a consequence, made us a peculiar, nervous people. A climate with such extremes of temperature exposes not only the respiratory nasal tract to frequent irritations, but imposes special strain upon the nervous system, as statistics of insanity will show. The nasal tract being exposed to variable conditions of atmosphere, a highly sensitive and vascular condition of the nasal mucus frequently results. Its function, to warm the inspired air, is one of exposure. Hence, frequent oscillations of warm and cold air develops the hyperesthetic areas of McKenzie, Hack and Sajous, which, from their nerve supply, are highly reflex.
The extreme of heat and cold is an irritant which by frequent congestions induces the hyperesthesia. The claim that a chronic catarrh is the lesion, constantly present, is untrue. It is rather a concomitant or sequel, and if present will greatly aggravate the symptoms. The pathology may be better understood by a brief review of the nerve supply. The fifth cranial nerve, "the great sensitive nerve of the cranium and face," through its divisions, supply the parts involved. The nasal branch of the opthalmic portion supplies the anterior nasal fossa. The lachrymal branch supplies the lachrymal gland, conjunctiva and integument of the upper eyelid. Now the fifth nerve receives filaments from the