PROPHYLAXIS 
IN 
Rhinitis Sympathetica. 
S. O. RICHEY, M. D. 
THE CLARK <fc LONGLEV CO., PUBLISHERS, CHICAGO. [Reprint from the Chicago Medical Journal and Examiner for December, 1886.] 
Prophylaxis in Rhinitis Sympathetica.* By S. O. Richey, 
M.D. 
In the evolution of medicine, gradual progress has been 
made to the present development of preventive measures in the 
management of disease, the practice of which; in its perfection, 
will be the science of the future. Prevention of disease, and 
the structural changes consequent, will, when we have the 
necessary knowledge, be more conservative, more simple, 
and more agreeable than our efforts to meet the disease in 
human bodies, disguised often by a complexity of symptoms, 
and to limit or prevent pathological metamorphoses. 
Any rational being will prefer the proverbial preventive 
“ ounce ” rather than the “ pound,” later, and not upon the 
basis of quantity alone,—though even that might be deemed 
sufficient,—but upon that of the disagreeable environment and 
consequences of the disease. 
There appear in medical journals from time to time elaborate 
discussions upon the most efficient means of relief of the local 
symptoms of hay-fever, or rhinitis sympathetica, by thera- 
peutic measures or surgical procedures after structural changes 
have taken place in the nares ; but very little is said in regard 
to prophylaxis, except the suggestion of change of climate— 
an offspring of the “ pollen ” dogma. 
It is important that we get the idea of pollen out of our 
minds and accept the rational explanation, as will be done by 
all sooner or later, that rhinitis Sympathetica is a reflex affec- 
tion, or a peripheral expression of a more central disturbance, 
the impairment of the balance of circulation in the cervical 
plexus. Thus we have the influenza: the cause being slight, 
* McKenzie—Transactions of the Medical and Chirurgical Faculty of the 
State of Maryland, 1S85. Richey—Prophylaxis in Rhinitis Sympathetica. 
2 
and acting interruptedly, the effect is a number of slight influ- 
enzas. The same cause acting persistently and gravel)' for a 
greater or less time produces what is called “a severe cold.” 
What is the cause of so distressing an affection ? If it were 
pollen would it not be found among herbivora, and as much 
so during the winter season as in the summer among those 
domestic animals which are stabled jpid fed upon cured grass, 
from which the pollen is more likely to escape, and in greater 
abundance, than when it is green ? 
Insufficient protection of the body, and especially the spinal 
region, from decided and quickly repeated alternations of tem- 
perature is the initial cause. 
In 1880-81 my attention was fixed by finding myself a 
sufferer from this affection. At that time the tone of my 
nervous system was very low, but not for the first time. 
I was also alternating between the city and the country, 
my days being spent in the city and my nights in the country, 
and in this I saw no sufficient cause for the disease, for others 
did the same without suffering, and I recovered with both 
these alleged causes persisting. Writers on the subject claim 
both as predisposing influences, the first of which I accept, 
and the latter I repudiate; With the dread of its direful con- 
sequences I naturally watched its course closely, in my own 
case, and studied the symptoms of the approaching crises 
until they became familiar to me. I looked up my books 
again for a hope of relief, but found it always resolved itself 
into seeking another climate for the season, and this my work 
would not allow. I found, too, .that a change to the same 
place did not relieve all persons so affected, and that some- 
times the same person would not be relieved at the same 
place, twice: These facts induced me to doubt whether any 
one would be safe from the supposed cause of the affection Richey—Prophylaxis in Rhinitis Sympathetica. 
3 
anywhere, until I met a young man who told me that he 
always found relief by spending the day in a boat on the lake, 
fishing, for there the pollen could not reach him. I then 
asked him if he wore the same clothes while fishing as at 
other times, and found that he replaced his cotton-gauze under- 
shirt with a woolen shirt. 
As I was then wearing the cotton-gauze undershirt, and 
remembering the slight creeping chills up my spine and at the 
nape of my neck prodromic of an attack, I put on a flannel 
undershirt, and with the exception of one or two attacks, im- 
mediately afterward, I have been well ever since. 
The flannel being too warm for comfort in this climate 
during July, August and September, in looking through the 
furnishing establishments, I found an undershirt resembling in 
texture a fish-net, called in the shops “ French netted goods,” 
which I substituted with success and with perfect comfort. 
It does not, in its continuity, lie close to the body and rapidly 
absorb moisture, like the gauze; if it becomes damp, it does 
not dry out so rapidly, and thus by rapid and frequent evapo- 
ration, cause alternations of temperature and disturb the 
circulation of the spinal region with the reflex symptoms 
called rose-cold. 
Those who change their abode in search of relief, go to a 
higher altitude or a more northern latitude, and while they do 
not thus escape “pollen,” they find it comfortable and often 
necessary to wear more protective clothing next the skin, and 
in this fact, I believe, is to be found the cause of their relief. 
Any kind of material next the skin which will, like gauze, 
absorb sweat and dry out quickly, would produce the same 
consequences. One does not have this affection in the winter 
season, when well clad, unless from force of habit or an asso- 
ciation of ideas in an impressionable individual. The affection 4 
Richey—Prophylaxis in Rhinitis Sympathetica. 
is less frequent among women, because they perspire less and 
less frequently. 
In the usual course of things my opportunities for obser- 
vation of this affection are very limited as compared with 
those of others, being confined to those in whom it has 
caused tubal catarrh, whose impaired hearing could not be 
properly improved without removing the cause—the imme- 
diate cause being the rhinitis, producing congestion of the 
lining membrane by extension to the tube; the mediate cause 
being a disturbance of the spinal circulation. Laborers, 
especially in the country, in the midst of pollen, are less liable 
to have this trouble, for, being accustomed to constant 
healthful exercise, they have a more stable circulation, which 
is not so easily thrown out of balance. 
While eight or ten cases are too limited a number to 
establish a theory, yet when taken with the fact that no one 
of them has failed in getting relief by counsel in the item of 
dress, they make this subject worthy of consideration. 
It is not my object to discuss the treatment of symptoms, 
or the surgical management of nasal structural changes 
resulting from the persistence of this affection. 
Let me ask, only, if it is best to suppress these peripheral 
manifestations by the use of cocaine, or the thermo-cautery? 
May not the affection, in such event, indicate its presence in 
some other and more serious way: in petit mal, for instance? 
Is it not more exact and more scientific to find and remove 
such basal cause? 
Washington, I). C.