For Sale by J. S. TYREE, Druggist, Cor. Ttli & I Sts., 
JY VV. Washington, D. C. 
NOTE ON THE USE OF COCAINE 
IN HAY FEVER, 
EGBERTS BAETHOLOW, M. D., L.L. D., 
Prof, of Materia Medica, General Therapeutics and Hygiene in the Jefferson Medical 
College of Philadelphia. 
The remarkable success which has attended the use of Cocaine in 
cases of Hay Fever, is one of the most interesting developments in the thera- 
peutical history of this surprising remedy. The curative power thus ex- 
hibited, throws a clear light on the pathology of this singular malady. The 
various theories of the pathogeny of Hay Fever may be resolved into two: 
one, that its manifestations are local, and due to the deposit of some irritating 
material; the other, that its real origin is systemic, a peculiar state of the 
nervous system being necessary to its production, and secondary to this, a 
disturbance in the peripheral expansion of the nerves distributed to the 
broncho-pulmonary mucous membrane. There can be little doubt that both 
theories contain a truth, but they do not have the essential requisites of a 
satisfying theory, in that neither one reconciles all the facts. 
Until Blackley came forward with his experimental investigations, the 
theory of a local cause had no other support than vague surmises. When 
he demonstrated that the pollen of certain plants possessed the precise 
irritating qualities to excite the peculiar local disturbance, the case seemed 
to be closed in favor of the local-action theory; but it was soon seen that 
there are other necessary elements in the morbid complexus. We owe, more 
especially, to the late Dr. George M. Beard, the demonstration of these ele- 
ments and the correlation of the phenomena of nervous origin. 
As all persons in any given community are alike reached by foreign 
bodies in the air, it is obvious that those stricken with Hay Fever must pos- 
sess a special susceptibility to the action of the irritating cause. 
To produce Hay Fever, a peculiar type of nervous system is necessary. 
In such subjects, the contact of the pollen of certain grasses, or of certain 
other irritating matters, as for example, powdered ipecacuanha, is necessary. 
These conditions being present, the mechanism of the disease is, as follows: a 
greater or less congestion of the nasal mucous membrane, and implication of 
the terminal filaments—end organs—of the fifth nerve and of the sympathetic, 
ensue; hence, the swollen state of the membrane, the acrid and abundant 
secretion (catarrh) the subjective distress and the formation of “sensitive 
areas.” The sneezing, the asthmatic symptoms, and other nervous phenomena are purely reflex effects, readily explained by the anatomical relations of 
the affected nerves. Vulpian had, long ago, shown that ablation of the 
spheno-palatine ganglion—a centre of the sympathetic nervous system—was 
speedily followed by a profuse catarrh of the nasal mucous membrane. The 
nucleus of the fifth nerve has close physiological relations, if not actual com- 
missural connections, with the nucleus of the pneumogastric nerve. Hence, a 
reflex disturbance originating in the terminals of the fifth, may thus involve 
the terminals of the pneumogastric and its associated nervous connections, 
causing amongst other nervous disturbances, asthmatic symptoms. 
A remedy for Hay Fever to be curative or powerfully palliative, must 
accomplish one or both of two objects: it must arrest the local irritation; 
it must prevent the reflex disturbance. It must so affect the nasal and 
faucial mucous membrane as to remove any special susceptibility that exists, 
and put the individual so affected in the state of the majority of the popula- 
tion who breathe with impunity, air charged with irritating materials. Have 
we such a remedy? We can conceive of a germicide, or antiseptic, sufficiently 
powerful that if efficiently applied in time, the initial disturbance may be 
prevented or arrested. Helmholtz, and a few imitators, have succeeded by a 
happy application to the nares, of a solution of quinine. Unfortunately, the 
numerous agents, so perseveringly employed in this way, have in almost all 
instances failed in any permanent effect. It remains to be seen how far 
cauterisation of the sensitive areas, so admirably advocated by Dr. Sajous, 
will prove curative. This method is widely intended to arrest the transmis- 
sion of irritating impulses originating in the nasal mucous membrane. 
Since preventive measures and the arrest of the initial disturbances 
have hitherto proved migatory, the attention of sufferers has been directed to 
means of relief for the more distressing symptoms. Until the powers of 
Cocaine had been made known, not much of a satisfactory character had 
been achieved, and the one remedy for the great army of sufferers, consisted 
in a complete change of the climatic conditions. At last, a peculiar mode of 
applying Cocaine, seems to have solved the problem. 
Before Dr. Koller, of Vienna, had demonstrated the anaesthetic effect 
of Cocaine, laryngologists had used it to some extent to lessen the sensitive- 
ness of the faucial mucous membrane. Nothing in therapeutics is more won- 
derful than the power of this agent to allay the sensibility of the nerves of 
the mucous membranes generally, and it is this, which Dr. Koller, especially 
showed. It naturally followed on this demonstration, that the agent would 
prove useful in all irritable states of the mucous membranes, and hence, when the annual sufferings from Hay Fever began, the victims, especially when 
physicians, looked to Cocaine to give them relief. Unfortunately, the usual 
solution when applied, was useful chiefly in the milder cases, for the profuse 
discharge in the severer cases, either diluted the agent so far as to make it 
inactive, or washed it away before it could act on the part. Fortunately, 
some of our English colleagues discovered the value of Wyeth’s tablets, or, 
as they prefer to call them, “ tabloids,” and already a mass of testimony has 
been offered, showing their extraordinary value in the relief of this malady. 
This agent thus applied, complies with singular completeness to all the con- 
ditions of the therapeutical problem, set forth above. It relieves that hyper- 
sensitiveness of the mucous membrane, which separates the Hay Fever vic- 
tim from all other normal subjects. It allays the irritability of the end 
organs of the nerves, of aniipal and organic life, and thus, whilst it relieves 
the local distress, removes the congestion, and checks the secretion. It acts 
also, on the next link in the chain of morbid impressions, and arrests the 
wide-spread, reflex disturbances having their common point of transmission 
in the nuclei of the fifth, and pneumogastric nerves. 
In using Cocaine, a compressed pellet or tablet, containing one-sixth 
of a grain, is inserted into the nares alongside the cartilage of the septum, 
and retained by closing the nostril, until it has time to dissolve and be 
applied to the surface generally. They can be repeated according to necessity, 
each nostril receiving them in turn. The experience thus far is, that very 
prompt relief is obtained, and only the occasional introduction of a tablet is 
necessary. 
Besides the smaller tablets or pellets for nasal use, Messrs. Wyeth have 
prepared a Cocaine Troche, which is an elegant and extremely useful form, for 
the treatment of throat affections, for the relief of one form of Hay Fever, for 
Cough and Asthma, etc. It is an admirable remedy to allay the cough of 
phthisis, especially the dry and harrassing cough with scanty or no expec- 
toration, which prevents sleep, causes regurgitation of food, and rapidly 
exhausts the strength. For this purpose, a troche is laid on the tongue toward 
the base, and allowed to dissolve slowly. Every practical physician will see 
the superiority of this mode of using Cocaine to the throat, over the present 
solution applied by a pencil. These troches may be utilized, also, to induce 
the necessary degree of anaesthesia, for various manipulations on the fauces. 
To illustrate the remarkable efficacy of the tablets of Cocaine, the subjoined 
experiences are selected out of the already numerous published examples. COCAINE TABLETS 
IN 
HAY FEVER. 
CHAS. E. SAJOUS, M. D. 
Instructor of Rhinology and Laryngology, Etc., Jefferson Medical College, Phila. 
At the request of Messrs. Wyeth & Brother, chemists, of this 
city, I have investigated the merits of the Hydrochloride of Cocaine Tablets, 
manufactured by them, each containing | gr. of the drug, as suggested by 
Mr. John Watson, of Westminster Hospital, London. 
This method of application is doubtless the only one in which the 
physiological action of Cocaine can be obtained I had previously tried the 
drug in solution, but could not obtain in any of the cases, sufficiently marked 
effect to warrant further use; in one case, it seemed to produce an unfavor- 
able reaction and to cause aggravation. That it cannot be effective in solution 
is easily explained:—the great amount of secretion present so reduces the 
strength of the solution employed, as to render it comparatively inert. Used 
in tablets, the secretion forms the vehicle for the drug, and the membrane 
is thus thoroughly bathed with a powerful and effective solution. For the 
itching at the eyes, however, the four per cent, solution seemed to be admira- 
bly adapted, a drop now and then, in the inner canthi, not only relieving the 
itching, but reducing markedly the local congestion. 
In the ten cases of hay-fever, (those chosen being of the worst type and all 
subject to asthma) in which the tablets were tried, four were under treatment 
by the galvano-cautery method, while the other six were merely resorting to 
palliative measures. The action of the remedy, however, did not seem to be influenced by the organic alteration of the surface of the membrane, in the 
four cases in which this was being done. In four cases out of the ten, the 
results were most satisfactory; not only did the tablets arrest the nasal symp- 
toms, but they seemed to have the same effect on the asthma. The following 
abstract from a letter will serve to demonstrate these facts: “ They seem to 
have modified very materially the paroxysms of sneezing, and to have stopped 
almost altogether the acrid secretions from the nose. Their effect in relieving 
the asthmatic feature of the disease, was instantaneous.” About the same 
remarks were made by the other three cases. In four other patients the symp- 
toms were relieved, but not arrested. The nasal occlusion was greatly reduced, 
and the sneezing abated. In two of these, the intensity of the asthma was 
greatly diminished, the patients being able to sleep comfortably. In the two 
remaining cases, none of the symptoms were in the least influenced. 
To any physician who has attended many cases of hay-fever, the record 
presented by Cocaine, administered in this manner, is certainly a very satis- 
factory one, and doubtless will lead him to consider this agent as the first on 
the list of palliatives. As to the cases in which the tablets were not beneficial, 
I am inclined to believe that the quantity of Cocaine in them was too smalh 
and that a quarter, a half, or perhaps an entire grain of the drug would have 
operated satisfactorily. I would, therefore, suggest, that tablets of different 
strengths be made. Furthermore, it seems to me that an elongated shape, 
such as that of a bean, would facilitate greatly their manipulation and their 
retention in the nasal cavities. 
In order to obtain the best effects, the tablets should be introduced in the 
nose every two hours, taking care not to use the handkerchief, during at least, 
five minutes after their introduction. Ido not consider the use of cotton 
in the nostrils, necessary to retain the tablet in place ; in fact, it is an objec- 
tionable measure, the cotton acting as an irritant. [Reprint from the London Lancet, July 4th, 1885.] 
COCAINE 
IN THE 
TREATMENT OF HAY FEVER. 
To the Editor of the Lancet: 
Sir :—I am desirous, with your permission, of calling the attention to the 
value of Tabloids of Cocaine in the treatment of hay fever. I feel that I can 
speak with confidence on this point, as I have, for many years, been a 
sufferer from this distressing affection, and the observations were made more- 
over upon myself. The attacks in my case usually commence about the last 
week in May, and continue without intermission until the end of July, the 
discomfort and inconvenience experienced being so great, that, during the 
summer months, lam practically incapacitated for work. The most prominent 
symptom is sneezing, which comes on in paroxysms, and is liable to occur at 
any moment, night or day. The attacks are most severe and persistent, and 
are entirely uncontrollable, so that over and over again, I have been obliged 
to leave the lecture, theatre or a place of amusement, and go home and lie 
down. They are accompanied by great shortness of breath, during the per- 
sistence of which any exertion is impossible; the exhaustion is so great that 
the whole body is bathed in perspiration, and there is generally a feeling 01 
faintness, accompanied by dimness of sight, and often a staggering gait, if any 
immediate attempt is made to walk. Other symptoms are itching and irrita- 
tion of the nose, with smarting and tickling of the mucous membrane of the nares and septum. There is an irresistible desire to violently rub the offend- 
ing member with a coarse pocket-handkerchief, although painful experience 
has taught me that it ultimately intensifies the trouble and irritation, which 
return with redoubled vigor immediately after the application. At the same 
time, there is a copious secretion of acrid mucous, which acts as an irritant, 
and inflames the surface with which it comes into contact. The eyes are usually 
suffused with tears, and there are tickling and itching of the margins of the 
lids, which are pressed tightly together in the vain hope of obtaining relief. 
The hard palate burns and itches so intensely, that the tongue has to be forced 
backward against it in order to allay the irritation. All these symptoms are 
greatly intensified by heat or sunlight, and by dust of all kinds. The pollen 
of hay, either growing or stacked, is perhaps the most powerful exciting 
cause, but minute particles of any kind floating in the air will act in the same 
manner. Even the starch from a freshly washed and ironed handkerchief 
will suffice, unless carefully shaken out before being used. The susceptibility 
is so great that until lately no remedy which was tried—and the last one was 
a long one—appeared in any way to control the course of the disease. A 
fortnight ago, I was induced to use the Tabloids of Cocaine for the first time, 
and the relief they have afforded me has been so marked, that I cannot feel 
sufficiently grateful for the introduction of this remarkable remedy. One 
tablet, containing a sixth of a grain of the hydrochlorate, is slightly moistened 
in the mouth, and is then introduced into each nostril. They adhere without 
the slightest difficulty, and cause no pain nor irritation of any kind ; but the 
relief is immediate and complete. During the last fortnight, I have used 
twenty-four tablets, and have been practically free from my old complaint, 
although I have spent much of the time out of doors and under circumstances, 
which, without my remedy, would have been impossible. lam grateful for 
the relief I have obtained, and am therefore desirous to lay this plain state- 
ment of facts before your readers, in order that it may be brought to the notice 
of my fellow-sufferers. 
I am, sir, yours truly, 
JOHN WATSON, 
Westminster Hospital, S. W., June 29,1885. [Reprint from the London Lancet, July 11th, 1885.] 
COCAINE 
IN THE 
TREATMENT OF HAY FEVER. 
To the Editor of the Lancet; 
Sir:—Having successfully employed Cocaine in some forms of this com- 
plex disorder, I can fully endorse the good report given of Cocaine by your 
correspondent, Mr. Watson, of Westminster Hospital. It is precisely in such 
cases as Mr. Watson graphically describes, from a personal experience, that 
Cocaine presents satisfactory results. But the fact must not be lost sight of, 
that this affection—“ Hay Fever, Hay Asthma, or Summer Catarrh,” as I have 
described it upon the title page of the first edition of my work on the subject 
published in 1864—shows itself sometimes in one form, and sometimes in 
another of a wholly different character. Troublesome as are the symptom* 
of hay fever in its catarrhal form, they are neither so persistent nor so difficult 
of relief, as those of the asthmatic variety of hay fever. In this latter, and 
unfortunately, very common class of cases of hay fever, Cocaine is useless, in- 
deed its administration would imply a waste of time, so that for the prompt 
alleviation of asthmatic complications, we must still look mainly to lobelia and 
chloroform, nitre fumigations, and inhalations of sedative preparations, con- 
joined with appropriate general and dietetic regimen. 
I remain, sir, yours obediently. 
WM. ABBOTTS, M. D. 
Margaret St. W., July 6th, ’B5. Philadelphia, Pa., August 25th, 1885. 
Messrs. John Wyeth & Brother, 
Pear Sirs:— 
care in producing the Tabloids of Cocaine, as recommended by Dr. Watson, 
in the “ Lancet” of July 4th, I depended on this remedy to meet the annual 
Hay Fever trouble, which, in my experience, has always been very severe, and 
much intensified by accompanying asthmatic spasms. My old enemy came 
on, with all its virulence, on the 18th inst., but on the 19th, I was prepared 
with the tabloids. The use of them, in the simple manner, described below, 
produced marvelous relief in a few minutes. The quieting influence remained 
all day. Each day since, I have allowed the attack to come on, and then the 
renewed application has given the same satisfactory results, without the 
slightest unpleasant sensation. My experience fully confirms all that Dr. 
Watson states in favor of this new remedy. My mode of application is by 
inserting a tabloid in each nostril, against the inner bridge wall, retaining in 
position with a little cotton, and then pressing the nostrils together for five 
minutes. In half an hour, I remove the cotton. 
Thanking you for the promptness in supplying and 
I have, also, found the asthmatic spasms wonderfully kept in check, 
and this is not surprising, as, no doubt, the powerful dose of cocaine extends 
to some extent, its soothing influence, to the whole mucous membrane, and I 
think it probable some mode of using cocaine may be discovered, by which 
“pure” spasmodic asthma may be more successfully treated than hitherto. 
I am, yours truly, 
J. HARPER MORRIS. 1417 WALNUT STREET, 
Philadelphia, Pa., August 27th, 1885. 
Messrs. John Wyeth & Brother, 
Dear Sirs:— 
The “ Tabloids ” of Hydrochlorate of Cocaine, so kindly 
handed to me some time ago, have proved a great success. The cases of Hay 
Fever applying to me for treatment earlier in the season, were treated with 
the Cocaine in solution, applied upon Absorbent Cotton to the nasal chambers, 
throat, etc., and later in the form of a spray, owing to the reduction in price 
of the article. Since the advent of the “Tabloids,” I find them much more 
available and convenient. The prompt and great amelioration of the Nasal 
Distress renders the use of Cocaine most satisfactory. It undoubtedly stands 
in the first rank of remedies for Hay Fever. 
I now find cauterization seldom necessary. 
Thanking you for the favor of trying these tabloids, believe me, 
Most sincerely yours, 
ALEXANDER W. MacCOY, M. D. 
Philadelphia, Pa., August 27th, 1885. 
Messrs. John Wyeth & Brother, Philadelphia. 
Gentlemen:— 
In compliance with your request of the 23d inst., I 
have tried your Cocaine Tablets in a number of cases of Hay Fever. Although 
I have had but a very short time to try them, I feel confident that they are a 
very valuable addition to our list of remedies, and without a doubt, are now 
the most effective palliative we possess. I cannot say that they have been 
successful in every case of the seven in which they were used ; but in two, 
the symptoms could be kept in abeyance ; in three, they decreased the inten- 
sity of the paroxysm, markedly, while in the two others, they did not seem to 
produce any effect. In the early stages of an access, they are capable of ar- 
resting the bronchial symptoms, as well as the nasal, but in confirmed asthma, 
palliation, only, was observed. Five pellets nissolved in a tablespoonful of 
water, have furnished valuable assistance in reducing the itching at the eyes. 
At some future time, I shall be able to furnish you more satisfactory 
data, as I shall then have tried the tablets in a larger number of cases. 
Yours, very truly, 
CHARLES E. SAJOUS. M. D.