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Violent morning sneezing-and the paroxysms after rising are generally very severe-once caused a rupture of some capillaries in the caruncula lachrymalis of one of my eyes, with subsequent engorgement of that body and a displacement of the axis of the eye, producing diplopia. These symptoms readily yielded to cold douching.

I now come to the most important part of my paper, that dealing with treatment. In considering during the course of the past eight or nine years-since I first suffered from the disease— from time to time the remedies which I had tried or proposed trying, I have been frequently reminded of that classic cold which gave so much trouble to Mark Twain, and which I cannot but believe belonged to the same class of disease.

My first attack occurred during the progress of an epidemic of measles, and I was convinced that I was about to fall a victim for a second time to that disease and anxiously awaited the appearance of the rash. As this failed to present itself I concluded that it was a cold of more than ordinary proportions, and being rather run down by overwork, I treated myself to a day off and a long walk in the country. I do not suppose that I shall ever forget that walk. I sneezed so frequently and so violently as to become perfectly prostrate, and well remember hanging myself-I can use no other expression--over the gate of a field, in a perfectly limp and wretched condition. Some faint glimmering of the real state of the case shone upon me in my second year, during which I tried a remedy, I believe of homoeopathic origin, and called anthoxanthum, which had no effect at all, and subsequently hazeline. This fluid snuffed up into the nostrils has some slight effect, but it is very painful if used undiluted and nearly useless if mixed with water. I have tried opium alone and in combination with belladonna. The latter combination affords relief whilst one is under its influence, but after a three days' trial of it I concluded that it was better to submit to the disease itself, although that entailed encarceration in one room as far as possible, with closed windows and doors. Quinine in five-grain dose by the mouth has given me slight

relief: used as a snuff or as an ointment with vaseline it has always appeared to aggravate the symptoms. Blackley suggests, I do not know on what grounds, iodide of potassium and perchloride of mercury. I tried it once as a forlorn hope and without any great expectations as to its success, nor was I disappointed. It did nothing but produce a vile taste in my mouth. Another writer proposed pills of valerianate of zinc and assafoetida to be taken thrice daily, commencing about a fortnight before the attack was expected. I followed the directions carefully, but the only result was, as under some similar treatment in Mark Twain's case, to give me the odour of a turkey buzzard. I have tried various treatments for gout in moments of desperation but they afforded me no relief.

Chloroform as an inhalation was for some time my sheet anchor, and I used to cause much mirth to ribald friends by copiously anointing my pocket handkerchief with it from a bottle which I constantly carried about with me. Were there no other remedy this would be a great comfort, but there are many unpleasantnesses connected with it, notably, for instance, its bad effects on one's power for work.

Iodine as an inhalation has some little effect, but not nearly so much as a bottle of strong salts which is a great comfort. During the season I carry one always in my pocket by day and by night it lies in readiness by my bed-head. A good sniff will cut short a paroxysm at once, but it must be remembered that the salts must be as powerful as they can be made.

Cubeb cigarettes are very comforting; indeed if one be smoked in a small room and the door and windows kept closed, tolerably complete immunity for the time being is insured. My friend Dr. Carter I think first recommended Marshall's cubeb cigarettes, which are the best I know, and they have been a great boon to me. I have contemplated at times of great dejection the heroic remedies which from time to time one sees described in the medical journals, but have always shrunk from them, partly from a cowardly dislike to the pain they involve, partly from the fact that on the confession of their inventors they appear to be

by no means uniformly successful, whilst in some cases they give rise to very troublesome and distressing symptoms. I now come at last to the only real palliative I know for hay-fever. I allude, of course, to cocaine. I first tried this remedy two or three years ago, but abandoned it, as its effects appeared to be so extremely transient. Early in last summer, however, in conversation with my friend Mr. Priestley Smith, I learnt from him the greater efficacy of Howard's cocaine and determined to try it. Only those who have personally tried both preparations can justly estimate the immense difference there is between Howard's and the article usually supplied by chemists. My experience briefly is, that so far as its effect upon the nose and eyes goes, the former is a perfect palliative for hay-fever, and will enable the sufferer to pursue his ordinary avocations in comfort. As an instance, I may say, that with the assistance of a small bottle of solution for occasional use, and armed with a pair of light blue "goggles," I have been able this summer to do what I have never succeeded in doing before, that is, enjoy regular tricycling runs without any inconvenience worth speaking of. Without the use of Howard's cocaine this would have been a physical impossibility for me, as, even apart from the constant sneezing, the eyes become, when not under the influence of cocaine, and even when protected by large glasses, so chemosed and suffused by the rapid movement through the air and the dust, as to render one almost blind.

I have tried several methods of using the cocaine—tabloids, so much recommended by some are very handy to carry about, and the salt appears to keep well, but they have one great disadvantage for nasal use, which is that the cocaine does not become sufficiently widely distributed over the mucous membrane to produce complete anesthesia. I have also tried cocaine solution in a small douche. This is subject to the objection that one cannot very well carry it about in one's pocket, still less can one conveniently use it in a crowded thoroughfare as may be necessary. Moreover, it is I think, a rather unpleasant mode of administration and possesses no advantages over that which I always employ.

I use a solution of 4% strength in distilled water, which may require to be increased to 5% towards the end of the season. When necessary I pour five or six drops into the palm of the left hand and sniff it up into the nostrils. By throwing the head slightly backwards and from side to side, the solution may practically be made to reach all parts of the cavity. At the same time moistening with the solution the tip of the little finger, I introduce a drop or two into the inner canthus of either eye. For the first few weeks of the season, immunity is secured by this method, even in a severe case such as mine, for two or three hours. When the effect wears off the remedy must be

re-applied.

If cocaine had only this local effect, there would be very little more to say, than that a palliative is at hand, which is for all practical purposes perfect,

But there is unfortunately another side to the picture. Besides its local effects cocaine is a powerful nerve stimulant. I am not now, it must be understood, alluding to the troublesome effects produced on some individuals by a single dose. I have no experience of any such effect upon myself, and this is a personal narrative. I am now speaking of the effects of its continued use.

During the first fortnight or three weeks of the administration of cocaine, I can scarcely describe the delightful effects which it produces. It removes within a minute or two after its absorption all sensation of fatigue, bodily and mental, and produces a most pleasurable capacity for work apparently. I say apparently, because, I doubt if it would be possible to do anything which required great concentration of mind whilst under its influence. As a matter of fact, I have found it very hard to do original work under these conditions. During this time too there is very little reaction after the use of the drug.

But after a short time conditions change, the drug begins to act less powerfully, requiring a stronger solution and more frequent application, and coupled with this there is experienced a great reaction. It is difficult again to give an idea of the amount of this. I can only say that during the period alluded

to, especially if one has necessarily a good deal of work to do, the prostration, I can use no other word, which follows upon the use of the drug, is most severe. This, however, is not all, for the appetite is decreased and sleeplessness induced. The action of the heart becomes rapid and unsatisfactory and the whole nervous system is brought into a highly-strung, over-wrought condition. I can assure those who hear me that I have not overdrawn this side of the picture. So strongly is it impressed upon me, that in spite of the great annoyance and even suffering produced by hay fever, and the relief afforded by cocaine, I am very doubtful whether I shall venture to run the risk of using it during another season.

I can easily understand from my own experience what is meant by the cocaine habit, and one of my chief reasons for reading this paper is to lay my views before my brethren in the profession as a warning against the rash use of the drug. I have seen it stated that the seat of first inoculation is the inner canthus of the eye, and I believe this to be true in some cases, my own included, though not in all. In these, I think, some hope of relief is afforded by the suggestion which appeared in the columns of the British Medical Journal, that the conjunctiva should be bathed with some solution (a weak preparation of corrosive sublimate was that mentioned) several times a day for some weeks before the hay-fever season. I certainly intend to try the experiment next year, as also that of painting the nostrils with glycerine of carbolic acid during the same period, with a view to deadening the surface of the nasal mucous membrane.

In conclusion, I should say that the lesson which I have learnt is that whilst cocaine as a remedy affords a palliation, perfect for all practical purposes, it is a drug whose use is accompanied by so many collateral disadvantages as to make. very doubtful as to whether its continued exhibition, during five or six weeks, is a line of treatment which it is safe or justifiable to enter upon.

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