21. SOBRE A CULTURA DA BELEZA,
GRAÇA E SAÚDE NA JUVENTUDE – VI
MY DEAR SIBYL, – I promised to give you to-day some general instructions for the treatment of hay-fever. Two of your family, I believe, suffer from this inconvenient and distressing complaint, Mabel and Constance. If I remember rightly, the form, which the malady assumes in Mabel’s case is that of asthma, while Constance is usually afflicted with the symptoms of influenza. Hay-fever has, in fact, three or four varieties, the two commonest being those just mentioned. In some instances it developes a very persistent and uncomfortable rash on the skin, resembling measles, and accompanied with much heat and a quick pulse. In other cases, again, it causes, on the contrary, a sensation of extreme chilliness, and I have seen patients under its influence wrap themselves in warm shawls or even furs, and sit shivering over a cup of hot negus on a blazing July day.
As for the origin and etiology of hay-fever, nothing in the annals of medicine has afforded more food for discussion, disquisition, and difference of opinion. Some medical authors are of opinion that the disorder has no immediate relation to vegetation, but that strong solar light and heat, whether in town or country, are quite sufficient to produce it in predisposed organisms. But my own observation and experience are decidedly adverse
to this view, for I have repeatedly cured bad attacks of the malady by removing my patient either to a city or to the coast, away from the vicinity of meadows and foliage, and it is well known that a sea voyage is an almost certain remedy even in the most aggravated cases of the complaint. Yet the brilliancy of solar light and excess of solar heat are certainly liable to be greater at sea than on land. Moreover, persons subject to hay-fever have frequently informed me that a simple drive through country lanes during hay harvest is quite enough to induce a severe attack of the complaint, which does not show itself at all so long as they remain in a town, confining their walks or drives to the streets. I know a lady, now resident in Paris, who, on account of her liability to this malady, never visits the Bois de Boulogne during the summer season, knowing by painful experience that even an hour’s ride through its shady alleys and delightful woods would entail on her several days of more or less acute suffering.
Again, some physicians regard hay-fever as a form of nervous disease, the idiosyncrasy of which is developed only in persons of a specially sensitive temperament. It is true, I think, that nervous people are more often found to be susceptible to this malady than others, but such a fact merely proves the greater impressionability or irritability of their physical constitution. External causes, which pass harmlessly by less acutely sensitive systems, are potent agents in the case of highly nervous persons. It is not, therefore, at all wonderful that hay-fever, in common with hysteria, epilepsy, neuralgia, melancholia, chorea, and other recognised disorders of the nervous system, is far more prevalent in our time than it was half a century ago. Indeed, it is only since the year 1828 that the complaint appears to have
attracted medical attention, and it was in that year that the term “hay-fever” was first applied to it. It cannot be doubted that the tendency of the “high pressure,” mental and physical, at which we now live, the continual forcing process undergone by the cerebral centres, and the strain to which the nervous system is in the present day subjected, from childhood upwards, entail as one of their most salient results a condition of heightened sensibility which shows itself in the present predominance of types of disease specially affecting the nerves. It is usually in the “better” and more cultured classes that such diseases are commonest, and hay-fever is no exception to the rule of its kind. Passing over several minor and less important theories respecting the etiology of hay-fever, I need only observe here that the malady is, in all its forms, undoubtedly due, according to my own opinion, to the presence in the atmosphere at certain times of the year of emanations and organic particles liberated by grass, flowers, and foliage; – agents which, although perfectly harmless to a majority of persons, are toxic to others having irritable surfaces of the mucous membrane, whether of the nose, mouth, eyes, throat or digestive canal. Consequently, such persons, breathing the air in which these particles and vapours are contained, speedily suffer from congestion and exaggerated secretions of all these different organs, itching of the nostrils, running of eyes and nose, as in severe cold, incessant sneezing, swelling of the eyelids, tickling of the throat, diarrhaea, slight fever; and, where the form assumed by the disease is asthmatic, wheezing and difficulty of breathing, which, in some cases, may become extremely severe and obstinate. Whether these very disagreeable effects be caused by minute corpuscles of pollen, subtle aromatic exhalations, or invisible bacteria, matters little from a
therapeutic point of view. For each hypothesis the indication is clearly the same, – to suppress or to neutralise the active cause of the complaint.
Let us first take Mabel’s case. Of course, both for her and for Constance, the main thing is to quit the country during hay-harvest, and indeed during the whole reaping season, for the seaside, and to frequent the shore and the town as much as possible, avoiding drives or rides inland, picnics, and other similar temptations. Possibly these simple precautions may suffice; but if not, tiny should be supplemented by one or more of the following remedies.
Every morning, before leaving the bedroom, drink slowly, in sips, a small cupful of black coffee, very hot, and, while sipping it, smoke a stramonium cigarette. Cigarettes of datura stramonium, such as those which I find most efficacious in this complaint, are sold in shilling boxes by Messrs. Roberts, chemists of New Bond-street, London, and Place Vendôme, Paris. They must be smoked slowly, the fumes must be well drawn into the air passages, and, now and then, expelled through the nostrils, a trick which is soon learnt by practice. I have found stramonium smoking a sovereign remedy in many bad cases, where quinine, belladonna, and other specifics entirely fail.
Later in the day, and, indeed, whenever the asthmatic attack becomes violent, the dose of hot coffee and the cigarette may be repeated. Dr. Carter Moffat’s Ammoniaphone is also a valuable remedial agent in hay-asthma. It should be inhaled slowly and thoroughly two or three times a day during a minute or two. Champagne iced, especially if taken fasting in the morning, will frequently cut short a distressing paroxysm of difficult breathing, as I have many times had occasion to
observe. Whenever possible, the patient should also have recourse to hydrotherapy – cold spinal douches and douches on the head and chest being especially serviceable.
As for Constance, she will need a somewhat different method of treatment. In her case the disorder shows itself as a catarrh, accompanied with frontal headache, sneezing, and all the usual symptoms of a severe cold. Sea-bathing and cold water douching will do much for her, no doubt, but to these remedies she must add the use of a lotion of sulphate of zinc, two grains to an ounce of distilled water, applied freely to the eyes several times a day. Twenty minims of tincture of opium added to this lotion will render it still more efficacious. If the irritation of the eyes is intense and burning I recommend the following: –
Acetate of lead ................................................ 2 grains.
Dilute acetic acid ............................................. 1 minim.
Distilled water .................................................. 1 ounce.
This lotion may also be used in the form of spray for injection into the nostrils.
On going to bed at night the inside of the nostrils may be smeared with a small quantity of Calvert’s carbolic camphorated ointment, a remedy which in some cases suffices without other aid to remove unpleasant symptoms. The edges of the eyelids, if sore, may also be gently rubbed with this ointment. In the morning the use of the ointment may be replaced advantageously by a nasal douche thus compounded: –
Carbolate of zinc ............................................. 2 grains.
Distilled water .................................................. 1 ounce.
Nasal douches are best administered by means of spray-producers, sold by all perfumers and chemists in
different sizes and at various prices. By means of one of these little instruments the lotion can be introduced well into each nostril and scattered in small particles on the mucous membrane lining it.
Relief is afforded also by the occasional use in the daytime of ordinary tobacco snuff, or of a powder composed of one-sixteenth of a grain of morphia and one grain of bismuth, applied as snuff, by sniffing it up into the nostrils. The vapour of compound tincture of benzoin, one drachm to a pint or half a pint of very hot water, inhaled two or three times daily, constitutes a most valuable sedative in acute irritation of the back of the throat and the larynx. In the same way, carbolic vapour may be inhaled; twenty grains of carbolic acid to a pint of hot water; or as spray, in cold distilled water, twenty grains to ten ounces of water.
Both Mabel and Constance must avoid walking in the glare of the sun unless well protected with large shady hats and blue gauze veils, or veils as nearly approaching that colour as possible. Small cotton-wool plugs steeped in a camphorated or carbolised solution and inserted into the nostrils, will also be found of great use in neutralising the evil effects of country air when it is impossible to wholly avoid it. A drop or two of spirits of camphor attenuated with a little alcohol or water is enough to impregnate a sufficient quantity of wool for one nostril. If a carbolic plug is preferred, the prescription already given for a nasal douche can be utilised, or Calvert’s ointment, smeared on the surface of the wadding.
Indoors, both girls should sit in shaded rooms, and avoid decorating their tables or their persons with flowers. If any further remedy is requisite than those already recommended, sulphate of zinc and assafoetida may be taken internally in the form of pills. A recent writer
on hay-fever prefers valerianate of zinc to the sulphate, and gives the following formula: –
Valerianate of zinc ............................................. 1 grain.
Compound assafoetida pill .............................. 2 grains.
These pills may be taken once or twice a day, but not more frequently, and only in severe cases which do not yield to external treatment.