sympathetic, in the ganglion of Gasser, from the carotid plexus. These filaments establish a connection with the parts of the face and cranium affected, with those of the pharynx, trachea and bronchii, through the medium of the pneumogastric, which also receives filaments from the sympathetic. The lachrymation, photophobia, headache, facial and palpebral pruritus, comes from the sensitive nerve supply from the opthalmic and lachrymal branch of the fifth. (The points of hyperesthesia of the anterior nasal fossa and the inferior turbinated bones, before alluded to in all the manifest series of symptoms.) The nerve supply of these points has anastomosing filaments from the sympathetic. The cough and asthma present is a reflex action through the filaments, from the sympathetic to the fifth and pneumogastric which form the nerve supply to the trachea and bronchii and sensitive areas of the nose. There is constant intercommunication between the nerve centers, the respiratory nasal tract and the sensitive areas of the nose. The latter takes cognizance of foreign bodies in contact with them and conveys the intelligence to the susceptible nerve center. When the irritant is pollen the moist secretion causes them to swell and burst, discharging their contents, which irritates the sensitive reflex areas. Equilibrium of nervous action is disturbed, producing functional derangement of the vaso-motor nerves which preside over the blood supply of the erectile tissue covering the hyperesthetic areas, and also to parts supplied by sympathetic filaments in the nose and eyes, and lower respiratory tract. The disturbance amounts to a vaso-motor paresis of the vaso-constrictor nerves which regulate the calibre of the arterioles supplying these structures, and congestion and catarrhal inflammation is established. Local vascular tone is governed by vaso-motor nerve supply. Before the catarrhal inflammation of nose, eyes, etc., is established in hay fever, the vaso-motor nerves are in this way temporarily paralyzed and the hyperemia, which is a true congestion of irritation, results and causes paroxysmal occlusion of the nostrils, as if they were stuffed with some foreign substance. When the temporary paralysis of the vaso-motor constrictor nerves subsides, the circulation is equalized and breathing is easy.

To conclude, the author believes the true pathology of hay fever consists of local hyperesthetic reflex areas in the nose, which

acted on by pollen or other emanations through the medium of the sensory branches of the fifth nerve and its anastomosing filaments from the sympathitic and through the pneumogastric, establishes a chain of reflex phenomena in the individual primarily affected with an idiosyncrasy.

TREATMENT :-The question of most interest to the sufferer is that of radical cure. Can this be effected? The advances in treatfent in the last five years enables us to answer this question in the affirmative. Any complicating disease of the nose such as simple chronic catarrh, hypertrophies, polypus, must first be removed, which often will greatly moderate the symptoms. Subsequently the hyperesthetic areas are hunted out and their destruction accomplished by means of galvano-cautery or caustic acids. Each sensitive spot is cauterized at successive intervals. (The instrument and details of procedure need not be described, as it can not be undertaken by the sufferer. The operation needs one skilled in the application to undertake it.) The tissues covering the reflex sensitive areas are destroyed by the cauterization. The cicatrix remaining after resolution is possessed of only ordinary sensibility. These applications are beneficial in all cases, and if thorough will entirely prevent the disease. If not thorough, they will greatly ameliorate the paroxysms. In timid individuals partial cauterization be effected by insufflation of nitrate of silver. To Dr. Emery H. Leyman, of Huntington, Indiana, himself a sufferer, I am under obligations for the following combination of silver, sugar of milk and bismuth:

may

"R Argent. nit. grs. iiss, bismuth subnitrate, sacchar. lactis āā 3 iiss. Mix and triturate thoroughly. Solution to be used once or twice a day as indicated by the irritation produced.

"Care must be taken not to throw the powder into the upper sinuses as it will produce intense suffering. As the tissues become tolerant I gradually increase the silver. Its use must be painstaking, careful and persistent, extending over a long period. I would suggest its use at least three months before the annual attack and each season for two or three years. While I do not expect the malady to entirely disappear under this treatment, I believe, as in my case, it will become milder and bearable. The sensitive tissues become in part oblivious to external irritating influences.”

To sufferers who enjoy a competency, complete immunity may be secured by removal to some locality where shelter may be obtained from the exciting cause. In Pepper's System of Medi

cine, Vol. III, pages 222 and 223, resorts are pointed out as follows: "The White Mountains of New Hampshire; not the whole, but a certain portion which is bounded on the west by a line drawn from Littleton to Lancaster (but not including the former place, which is not wholly exempt), on the north by Canada and on the south by Franconia, Crawford House and Jackson, while on the east it extends as far as Bethel, in Maine. Of the various places contained within the territory, Bethlehem and Jefferson, Whitefield, White Mountain House, Fabians, Twin Mountain House, Crawford House, Glen, Gorham and Mount Washington may be regarded as entirely exempt; Franconia Notch almost equally so; while Dalton, Lancaster and Bethel must be ranked as uncertain. Another exempt region extends to the north and east and comprises the lake regions of Maine. Petoskey, in Northern Michigan, is said to afford almost entire relief. There are also several places in Vermont which offer more or less immunity, such as Mount Mansfield and Stow. Canada, with the exception of a few cases reported at Toronto, St. Catherines, and a few places near the southern border, appears to be exempt. The same may be said. of the Adirondack Mountains and Pottersville, on Schroon Lake, and Marquette. The Catskill Mountains and several places high up on the Alleghanies, such as Cresson, Pa.; Oakland and Deer Park, in Maryland, afford relief in many cases. Colorado is said to be exempt, but several patients who have gone there failed to find relief. California is free from the disease, and many hay fever patients have escaped their attacks by removal to that State. The disease is rare in Florida." Immunity may be enjoyed from the spring form at the seashore, except when the wind is off the land. The Isle of Shoals, off the coast of New Hampshire; Fire Island, off the coast of New York, and Mount Desert and Nantucket are islands of resort for those who suffer with the disease in early summer. The ocean is completely exempt, therefore a sea voyage to Europe is a promising means of freedom; as, also, a voyage to California by water would be. After the patient arrives in these places, or makes a trip at sea, all symptoms promptly disappear.

At the resorts in the mountains, when the wind is from the southwest, and so long as it continues from that direction, some symptoms may be present. As the wind turns to the north the suffering is reduced to the minimum. There are no symptoms at sea unless. near enough the shore for pollen to be carried to the ship by the breezes from off the land.

To

To many sufferers the question of palliation is one of greatest interest. When the curative procedure by cauterization is rejected and a sea voyage or a visit to some resort can not be taken, what can be done at home to mollify the symptoms? The sufferers must be exposed the least possible during the attack to the exciting and aggravating causes-pollen dust, heat and sunshine. The residence should be arranged to exclude these to the utmost possible. Let the doors and windows have dark screens, made from some dark, porous material that will sift the air and exclude sunshine. The eyes should be protected by closely-fitting smoked. glasses. Plugging the nostrils with cotton wool, to prevent the entrance of dust and pollen, in some cases proves beneficial. allay the itching, frequent application of carbolized vaseline should be made to the nose and margins of the eyelids. The occlusion of the nostrils can be relieved by the application of a four per cent. solution of muriate of cocaine by means of an eye-dropper or in the form of spray. To apply the cocaine, the patient lies down in recumbent position, the head is lowered and thrown back, and the solution dropped into the nostrils by the patient or nurse. The solution is then snuffed into the posterior nares. Repeat as often as necessary to relieve the swelling. The remedy is thus applied to the entire diseased surface. It never fails, when sufficient is used, to relieve the stuffed feeling in the nose. The general functions should be carefully guarded. Pepsine and lactopeptine for the digestion after meals. If the bowels are confined, a laxative pill, preferably one containing aloine, belladonna and strychnia, should be prescribed; or Carlsbad salines.

R Sodium sulphate 3 v, sodium bi-carbonate 3 ii, sodium chloride 3 i. Mix. S. From one-half to two teaspoonsful dissolved in water an hour before. the morning meal.

Bromides given especially from two to six P. M. for headache and to produce rest at night. From five to fifteen grains of sul

phate of quinine on retiring for the night. Regulate the dose by age, sex and temperament. The violence of the symptoms during the following day will be greatly lessened by it. As the asthmatic stage approaches this is the more important. The quinia should be given in small doses during the day for its supporting effect. Two to four grains every four hours. I have observed excellent results from bromo-caffeine and wine of coca. They relieve the headache and quiet the irritability of the nervous system. The greatest immunity attained at home from lachrymation, sneezing and itching of nose and eyes is obtained from Jewel's powder, which is the following combination of morphia and atropia with sugar of milk, for which I am indebted to Drs. Smith and Blount, of Wabash, Indiana :

R Morphia sulphate grs. xix, atropia sulphate gr. i, sacchar. lactis 3 ii. Mix and thoroughly triturate.

One-half grain of this powder represents 10 grain of atropia and grain morphia. Commence with half grain dose and increase to two grains if required to allay the watery discharge from the nose and eyes. Repeat as often as necessary to control these symptoms. From one to twelve doses a day may be required. Jewel's powder increases the breathing power by stimulating the pneumogastric nerve. It often overcomes the asthma and is a great support to the nervous system. It is invaluable during the attack. For bronchial irritation and asthma, a prescription like the following does valuable service :

R Ammonia muriat 3 iv-vi, pulv. ext. glycyerhiza 3 iv, aqua cinnamonii 3 i., fld. ext., grindelia robusta 3 i, syrup prun. virginiana 3 ii, syr. yerba santa aromatic q. s. 3 viii. Tablespoonful every two to six hours. Frequently enough to control cough and asthmatic irritation.

To this prescription may be added, with advantage often, iodide potassium, wine of pine tar, quebracho in proper proportion. Relief is obtained also from cataplasms of mustard, etc. Nerve tonics for the support of the nervous system before and after the attack. Niemeyer's pill of carbonate of iron and potassa. The trip. valerinates of iron, quinia and zinc:

R Ferri valerinate,'quinia valerinate, zinc valerinate aa. gr. xxx. Mix. ft pill No. xxx. S. One three times a day.