vascular enlargement at Hack's area, two of these having considerable hypertrophy. In two of the cases, there was also hypertrophy at the posterior extremity of the turbinated bone. These two cases had attacks of asthma, confirming the views of Sajou, who believes that the posterior part of the nasal cavity is affected in the production of asthma and that the anterior part of the cavity is affected in the production of nasal and ocular symptoms.

At present there is a difference of opinion as to the cause of hayfever. Some authors maintain that it is a purely neurotic affection; others, that it is simply an irritation of the nasal mucous membrane; others, that it is a Laixture of the two conditions. The method of treat

ment, which has been successful, has been by applications of acids or the use of the snare. Cocaine is first applied. A small probe, the end of which is covered with cotton, saturated with acetic acid, is pressed upon the swelling or sensitive area. The applications are made every day for a week until the enlargements are reduced. They may be repeated after a few days of rest, if much swelling exists or the patient is not relieved.

Usually from three to twenty applications are necessary to effect a cure. If only sensitive areas are found, but few applications are required. Some authors recommend the use of the acid every four or five days, but in these cases that has not been sufficiently often to control the symptoms.

In some cases, nitric acid was used, the enlargements not being removed by acetic acid, possibly due to the poor quality of the acid. More care is necessary in the use of nitric acid, as other parts of the cavity might be touched, producing a slough or a purulent inflammation.

In one case, 'such an inflammation followed, which was very troublesome and lasted about one week. No disagreeable symptoms ever followed the application of acetic acid or the use of the snare. The best plan is to remove all enlargements with the snare, without waiting for the slow action of acids. In this way, the patient is immediately and permanently relieved.

Vascular enlargements must be operated upon without the use of cocaine. In hypertrophy, it may be applied to alleviate the pain.

Hæmorrhage can easily be controlled by applying the powdered subsulphate of iron or plugging the anterior nares. The cases can be treated more readily during the attack, as the portion of membrane involved is more sensitive and enlargements are increased in size.

I have frequently seen the conjunctiva become clear, the intolerance of light and excess of tears cease, as soon as fifteen minutes after applying acid to the affected areas.

In only one case was there anything abnormal to be seen in the nasal cavity previous to the attack. In this case, a month before the nasal paroxysm, a large hypertrophy existed in Hack's area, each side,

The attacks had not failed to make their appearance for twelve years, varying but a few days from the third of August each year. In one case, only one nasal cavity was affected, the symptoms being confined to the right side of the nose and right eye. In one case there was a vascular growth in only one cavity, yet both nasal cavities and both eyes were affected. In the remaining seven cases, both sides of the nose were similarly diseased.

Of the nine cases, one has remained without an attack five years. One four years, with the exception of a few days the second summer after treatment, when two applications of acid cut short the attack. One case has been three years without symptoms; one case two years. One case has passed one summer without a paroxysm.

In four cases that were treated last summer, the symptoms were immediately checked and have not returned. In ten of these cases the areas were not thoroughly cauterized and I have no doubt symptoms will recur.

REPORT OF CASES.

Case 1. June, 1885. Miss G. P., 21 years of age. In good health, with the exception of hay-fever from which she has suffered for the past nine years. The attacks commenced about the first of June, lasting three months. Was never entirely free from symptoms during that time. The ocular symptoms were very severe, the patient being obliged to remain in a dark room from one to six weeks each summer. Never had asthma. Had not received any benefit from the usual remedies. A week previous to the expected attack, acetic acid was applied daily to Hack's area, which seemed to be sensitive. Slight symptoms appeared the usual time. Swelling existed at Hack's point. Sajou's spots were sensitive. About twenty applications were made during the summer. The symptoms were checked and the patient has not had an attack to the present time, a period of five years.

Case 2. June, 1886. W. D. S., farmer, 24 years of age. Had hayfever for the past four summers. The attacks commenced in May. Was never able to handle hay without producing violent sneezing, watery discharge from the nose, injection of the conjunctiva, photophobia and lachrymation. These symptoms disappeared in a few days. During the attack of hay-fever often had asthma, especially troublesome at night, compelling him to sit up in bed. There was a vascular hypertrophy in each cavity at Hack's and Mackenzie's area. Vision was 2020. P. P. 5 in.; P. R. 18 ins. Had slight hypermetropia, but never wore glasses. Symptoms were checked in three or four days, after commencing treatment. At the end of a week could pitch hay in his barn without exciting symptoms. He was treated three weeks. Since that time he has been free from hay-fever or asthma with the exception of a few

days in the summer of 1887. Slight symptoms appeared and two applications were made.

Case 3. October, 1887. Miss M. D. W., housekeeper, 46 years of age. Has hypermetropia and wears the correcting glasses. In September, 1885, suffered from what she called "a cold in the head." After two or three weeks was suddenly seized with hay-fever, compelling her to stay in a dark room, and keep the lids constantly bathed in hot water to obtain relief. Since then she has never been free from an attack longer than one month at a time. The duration of an attack was from three days to five weeks. The right eye and right nasal cavity alone were affected. She suffered as much in winter as in summer. The watery discharge from the nose was very profuse, saturating fifteen or twenty handkerchiefs in the course of the day. The attacks were sometimes provoked by riding in the cars, driving in the dust, the odor of perfumery or plants. At other times the paroxysm appeared without any exciting cause, even when sitting in church. There was a vascular growth in the right nasal cavity at Hack's area. The treatment began in October, 1887 and after four weeks she remained free from symptoms. Case 4. July, 1889. Mrs. A., 38 years of age. Always lived on a farm. Had hay-fever for the past twelve years, the symptoms appearing regularly on the third day of August. Never varied three days from that date. The duration of the attack was from six weeks to two months. During that time was unable to attend to her work. About one month before the expected attack, the nasal cavity was examined. Hack's swelling was found in each cavity. Cocaine removed nearly ail the swelling, showing that it was composed chiefly of blood-vessels. These hypertrophies were removed with the snare. No symptoms appeared that season.

Case 5. Sept. 1889. Mr. M., 40 years of age. Said he had had catarrh seven or eight years. At times, had hay-fever lasting from a few days to three weeks.

Was examined during a paroxysm. Hack's swelling in each cavity prevented nasal respiration. Symptoms were checked by one application. The areas were cauterized five times. After the swelling subsided, five or six polypi were discovered springing from the middle turbinated bone and posterior extremity of the inferior turbinated bone. These were removed with the snare. Symptoms have not returned. Case 6. August, 1889. Mrs. L., of Boston, 55 years of age. Came to this village to escape the usual attack of hay-fever and asthma from which she has been a sufferer for the past fifteen years. A change of climate lessened the severity of the attack and shortened the duration. This was the only relief ever obtained. At this time she had an attack of hay-fever and asthma. The anterior area in each cavity showed a vascular enlargement. After using the acid a few times the

symptoms disappeared. There was no return during her visit of four weeks. The usual exciting causes could not be made to produce an attack.

Case 7. August, 1889. Miss L., 24 years of age. Came from Boston to escape a paroxysm, but received no benefit from the change. Had attacks at intervals for eight or nine years. Resided nearly all of this time in New York State to avoid the disease. When I first saw this patient, she was confined to her room with asthma, which had lasted about one week. Temperature was 102° F.; respiration 30; pulse 120 per minute. Was unable to sleep and sat up a greater part of the night. Slight hay-fever symptoms were present. Hack's and Sajous areas were both sensitive. About the middle of the right inferior turbinated bone, was a vascular growth, touching the septum. This growth was removed with the snare without the use of cocaine, and the sensitive spots were cauterized. The symptoms disappeared so quickly after the removal of the growth that I cannot help feeling that this was the exciting cause.

Case 8. April, 1889. Miss S., 32 years of age. Had attacks of hay-fever the past two years. The last two months the symptoms have been constant. Nasal symptoms have been very severe; ocular symptoms slight. There was enlargement at the anterior extremity of the inferior turbinated bone. Nose was occluded at times. Acetic acid failed to reduce the swelling or prevent the attack. Nitric acid was applied, increasing the symptoms for several days. At the end of a week the symptoms disappeared and did not return.

Case 9. September, 1889. Mrs. J. T., 42 years of age. Had hayfever for the past six summers. Duration of the attack was about six weeks, unless relieved by a change of climate. When she called at my office, the attack had been in progress about one week. Nasal symptoms were most marked. Ocular symptoms were mild. There was vascular enlargement at each anterior area. Acid was applied to these spots three or four times. No symptoms were seen after the first application. There was no recurrence.

2

NATURE'S REMEDIES.

BY DR. EDW. R. CAMPBELL, BELLOWS FALLS.

While perhaps it would be eminently proper to term all drugs of whatever character "nature's remedies," for the purposes of this paper I prefer to call by this name such universally diffused substances as air, water, sunshine, diet, etc., while we regard drugs as, in part at least, the product of the chemist's hand.

It would probably be impossible to rely on either alone in some cases, but is it not possible that in these days of polypharmacy and vaunted specifics we are in danger of relying too much on drugs and too little on the so called vis medicatrix naturæ "? I am also inclined to think that both our habits and prejudices, as well as perhaps self-interest, in some cases, incline us sometimes to pay too little heed to nature's forces and to exagerate the importance of drugs. We are all well aware that many diseases are self-limited, and as such can neither be absorbed or shortened by medicine. It has been well said by that eminent Boston physician and teacher of a former generation, Dr. James Jackson, "that it is a very narrow and unjust view of the practice of medicine to suppose it to consist altogether in the use of powerful drugs, or of drugs of any kind. Far from it," he adds, "the enlightened physician first considers whether his patient shall take anything. He considers what other modes of relief there are besides pills and draughts. He looks to quiet, diet and regimen."

Dr. Jackson also draws such a vivid word picture between the true physician and quack that I quote his words: "Let it be remembered— and we may address this particularly to the scoffer—that the true physician takes care of his patient without claiming to control the disease in all cases. He does not regard himself as making an exhibition before a company to show his skill: he makes no boast of what he can do. I wish I could say that this is never done by any of our own profession.

"There are those who, directly or indirectly, trumpet forth their skill and success, attributing the recovery of their patients to the remedies they have prescribed and never to the spontaneous efforts of nature. These, whatever titles may be appended to their names, are true quacks. They quack, quack, that they may attract the attention of the passer-by and, while they extol their remedies for the sick and suffering, they are seeking only their own profit and their own glory. The true physician, on the other hand, cannot fail to be modest in his pretensions, for he is aware how his knowledge and power are limited while he feels the magnitude of his task,"