R E V I E W O F 
Hay Fever, its Etiology and Treatment, 
with an Appendix on Rose Cold. 
]JY 
MORELL MACKENZIE, M. D., London. 
FROM 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES. 
October, 1885. Extracted from the 
American Journal of the Medical Sciences for October, 1885. 
REVIEW. 
Hay Fever, its Etiology and Treatment, with an Appen- 
dix on Rose Cold. By Morell Mackenzie, M.D., pp. 54. 
London: J. & A. Churchill, 1885. 
There are many positions encountered in the writings of medical men 
which by virtue of their common acceptance have come to be regarded in 
the light of axiomatic truths either from slavish adherence to authority or 
indifference to inquiry into their claims to scientific recognition. In this 
way transmission of error is often encouraged by those who, bowing with 
reverence before the dignity of age and established usage, unconsciously 
receive the fallacies taught in school and text-book as primal or funda- 
mental principles of their medical knowledge. The emancipation of the 
professional understanding from the error of first impressions derived 
from the dogmatism of teacher and writer is a process of tardy evolution, 
and it is therefore easy to see how false doctrine universally received and 
taught by medical men should, when announced by them to the laity, find 
ready access to the unprofessional mind and influence the popular judg- 
ment. The general popularity of the pollen theory of the disease falsely 
called “ hay fever” affords a striking illustration of the truth conveyed in 
the above reflections. It has been universally taught for years that this 
affection is due to some mysterious agency contained in the granules of 
pollen, and the laity have been disciplined by their medical advisers into 
the belief that the curious ensemble of its phenomena is in some inexpli- 
cable manner produced by the emanations from grasses and flowers There 
is a certain charm about this superstition which commends it at once to 
the fancy. It is seemingly so natural and plausible to connect the phe- 
nomena of the disease with the flowering of certain plants, and the mind 
so naturally gravitates toward the easiest and most poetical explanation, 
that it is not surprising that this view should have obtained such univer- 
sal dominion over the thoughts of the profession and laity. Even those who 
have in recent years partially forsaken the beaten track into which it has 
led them are still to a great extent under the influence of its power, and 
it is therefore not unnatural that not only the profession, but the laity, 
dominated by the precepts of a doctrine of almost universal acceptance, 
should receive the alleged relation of the pollen granule to the phenomena 
of “ hay fever” as a fundamental truth, and rest content with the lazy ex- 
planation of the affection which it affords. 
During the past few years this theory has been slowly driven to the 
wall chiefly through the investigations of American observers, and new 
conceptions of the disease have arisen, which, if they have not reached 2 
the solution of its pathology, have at least placed this hitherto incurable 
complaint on the list of curable affections. 
The essay before us is an apology for the pollen theory, and challenges 
attention, not on account of originality in the subject-matter, for the line 
of reasoning is essentially the stereotyped one so long employed by the 
advocates of this view, but because a representative man, like Dr. Mac- 
kenzie, has undertaken to lead the forlorn hope of a dying hypothesis 
against the host of facts which are daily marshalling themselves against it. 
In view of its many inconsistencies and contradictions, and in the light 
of recent observation, the refutation of the pollen theory seems a work of 
supererogation, but, in justice to our distinguished author, we will call 
attention to a few of the many unanswerable objections which bear 
directly on his contention. 
The orthodox articles of Dr. Mackenzie’s accepted faith are embraced 
in the following fundamental propositions: (1) That, the disease is pro- 
duced by the pollen of grasses and flowers, the granules of which are en- 
dowed with a peculiar vitalized principle which possesses “ exceptional 
qualities ... as a living organism capable of undergoing some degree of 
development when deposited on mucous membranes more or less exposed 
to the air;” (2) that, as the pollen granules containing this vital principle 
are only one-tenth the size of the blood-corpuscles, it is highly probable that 
they enter the bloodvessels by actual penetration of their walls, and it is 
not improbable that the malaise experienced in hay fever is due to the 
presence of this granular matter in the general circulation. In accord- 
ance with this view, he has selected as the motto for his essay the well- 
known Virgilian proverb “ latet anguis in lierbd.” At the same time, he 
confesses, with those he follows, that the persons liable to be thus affected 
by pollen are possessed of a peculiar idiosyncrasy, although upon what the 
latter depends is “ quite unknown.” In other words, Dr. Mackenzie ad- 
vocates the theory which derives its popularity mainly from the writings 
and experiments of Blackley, in whose footsteps he closely treads. 
Let us consider these positions in detail, and in the first place inquire, 
“ Is there anything in pollen to produce the disease in question ?” 
Dr. Mackenzie makes the unqualified assertion that “ Blackley’s experi- 
ments leave no doubt that the cause of hay fever is the action of pollen 
on the mucous membrane.” To this statement we must respectfully, but 
emphatically demur. While due credit should be given for the painstak- 
ing way in which Mr. Blackley conducted his experiments, it must be at 
the same time acknowledged that they fell far short of the accomplishment 
of the object for which they were carried out. They prove one thing, 
and one only, that in an isolated case, and that his own, at least pollen 
may act as an exciting cause of the paroxysms of the disease. They by 
no means show, as Dr. Mackenzie and others wrongly infer, that pollen 
is the sole exciting cause of the paroxysm, and that the latter may not be 
produced by heat, light, and other external agencies. The negative effects 
of heat, light, and ozone in his own case are utterly valueless in view of 
the demonstrated fact that these agents excite the paroxysm in many 
other individuals. So far from proving that “ hay fever” is due to the 
action of pollen on mucous membranes, they fail to throw any light what- 
ever upon the true cause of the affection. It is not our object in this re- 
view to expose the many vulnerable sides of Blackley’s work, which is so 
often quoted, but apparently so rarely read. His conclusions have been 
handed down from author to author as ex cathedra utterances from which 3 
there is no appeal. While his experiments were carried out in the first, 
instance presumedly in a strictly scientific spirit, it is suificiently evident, 
from his subsequent publications, that his mind was so swayed by the 
pollen theory as to render it unreceptive to new facts and new discoveries. 
Neither he nor his followers attempt to reconcile the inconsistencies and 
contradictions which are the logical outcome of his hypothesis. As a 
specimen of his line of reasoning, the powerful blow which Beard dealt 
the pollen theory is met with the observation that the gentleman is a 
member of two neurological societies, and that, therefore, the researches 
of this notoriously painstaking and accurate observer are open to serious 
objection. 
While Blackley showed that in his own case pollen acted as an exciting 
cause of the paroxysms, it has, on the other hand, been conclusively 
demonstrated that there are a host of other agencies, external and inter- 
nal, which produce exactly the same result. Our own observations, based 
on the analysis of a large number of cases, teach (1) that there is practi- 
cally an infinite number of causes which may precipitate the attack ; 
(2) that one irritant is of itself insufficient to produce the paroxysm, the 
latter being only possible from abnormal functional activity of the nerve- 
centres, inherited or acquired; (3) that in the majority of cases the 
paroxysms are induced by a variety of agencies differing entirely in 
character and mode of operation; even in those cases in which there is 
apparently only one exciting cause, it will generally be discovered that 
there are conditions which bring about the attack other than the alleged 
solitary exciting cause; (4) that the latter may be operative only during 
certain periods of the year, or may provoke a paroxysm, without regard 
to season, whenever applied ; (5) that it may be said, in general, that the 
exciting cause may produce its effect, by direct or indirect (reflex) irrita- 
tion of the sensitive nerves of the nasal and other mucous membranes ; 
through olfactory impression or through simple association of ideas; or 
the same result may be brought about by physical or mental over-exertion 
or emotional excitement; (6) that typical paroxysms occur in some persons 
at any season of the year, from a variety of causes, but especially from 
sudden changes in the temperature, or from electrical disturbances of the 
atmosphere ; (7) that paroxysms may be produced as reflex phenomena 
from irritation of a distant organ, or from some excitation starting in the 
nerve-centres themselves ; (8), finally that pollen is only one of a host of 
exciting causes, and there is reason to believe that in some cases in which 
it is supposed to be the excitant, it has little or no influence at all. 
As an illustration of the effect of a purely psychical impression in the 
production of the paroxysm, we would call attention to our experiment 
with an artificial flower related at the last meeting of the Laryngological 
Association. Dr. Mackenzie alludes to an exceedingly interesting case 
of his own, which supports the views concerning an occasional psychical 
element in the etiology, although he gives to it an interpretation which, 
in our opinion, is unwarrantable. A victim of “ hay fever,” after a visit 
to the Royal Academy, where she had seen a highly realistic hay-field of 
Mr. Vicat Cole, had a severe attack of the disease. Dr. Mackenzie 
hesitates between the natural explanation afforded by the association of 
ideas, and the possibility of her having passed a hay-cart on her way 
home; “ the latter solution, if more prosaic,” is also, according to him, 
“ more probable.” 
There is another case in literature identical with that mentioned by 
Dr. Mackenzie, and the two open our eyes to the fact that the association 4 
of ideas sometimes plays a more important part in the production of a 
paroxysm than the supposed vital property of the pollen granule. 
There is absolutely nothing in pollen to cause the group of phenomena 
known as “ hay fever.” To urge the existence of some inherent vital 
principle which develops a peculiar power when deposited on a mucous 
membrane is one of those gratuitous assumptions which from the insecure 
foundation upon which the pollen theory rests, and which have no scien- 
tific reason for their acceptance. It is certainly more rational and more 
in accordance with the facts in the case to infer that the influence of local 
irritants is mechanical or chemical, and that their power to excite a 
paroxysm depends upon their physical properties, and the length of their 
sojourn in the nasal chambers. The glutinous character of some sub- 
stances, the irregular surfaces of others, will give rise, for example, to 
more prolonged irritation than substances of smooth contour and less 
tenacious qualities which are readily swept out of the nostrils. As the 
irritation of worms or morsels of undigested food retained for a long while 
in the gastro-intestinal canal give rise to convulsions, cough, and other 
reflex disturbances through the constant irritation of the readily impres- 
sionable nerve-centres of the infant, so the prolonged excitation of the 
hyper-sensitive vaso-motor centres of the “ hay fever” sufferer by the 
external irritant may evoke the vaso-motor disturbances which are the 
leading characteristics of the complaint under consideration. The cause 
of the convulsion is not the worm or the undigested particle of food, but 
the prolonged action of a local irritant upon a naturally excitable nervous 
organization. 
While nearly everybody is exposed to the action of pollen on the 
mucous membranes, comparatively few suffer from the disease, which 
latter is, moreover, most commonly met witli among those least subjected 
to the alleged exciting cause ; for, although confined to no particular class, 
it is a well-known fact that it is most frequently observed in the cities, 
and is comparatively rarely encountered among the agricultural popula- 
tion. The explanation of this consists in the fact that the latter are less 
predisposed to catarrhal affections in general, and disorders of the nervous 
system. At least, this is obviously more satisfactory than the position that 
constant exposure to the exciting cause produces tolerance. The occur- 
rence of the disease in situations and under conditions in which the presence 
of pollen is out of the question strongly militates against the theory that 
pollen is the sole exciting cause. The relief or immunity from the disease 
found by the seashore and on the mountain top is readily explained by 
the well-known beneficial effects of these regions on catarrhal and nervous 
affections. In other words, the influence of locality upon the disorder is 
climatic and tonic, and has little to do with a diminished amount of pollen 
in the atmosphere of a given region. The depressant effect upon the 
nervous apparatus of the heated land breeze is probably more potent in 
the production of a paroxysm than the emanations that may be carried 
along with it. The occurrence of the disease far out at sea has been met 
by the assumption that clouds of pollen must have been wafted thousands 
of miles to the ship that carried the unfortunate victim, or that in the 
unfurling of the sails “a large quantity of pollen collected in their folds 
was set free,” and is illustrative of the form of reasoning by which the 
advocates of the pollen hypothesis seek to escape from their dilemma. 
Indeed, the whole line of defence adopted by the pollen theorists is 
assumptive rather than demonstrative or argumentative, and consists in 5 
an apparent endeavor to involve the logic of facts in a tissue of seemingly 
plausible suppositions. 
Equally unanswerable objections to the pollen theory are those which 
relate to the influence of race, education, modes of life, climatic influ- 
ences, geographical distribution, etc.., while its inconsistency is shown in 
the fact that while the disease is supposed to be due exclusively to the 
emanations from plants, it is at the same time universally contended that 
the affection is one confined to the social and intellectual life of the 
present century. And so we might go on to enumerate many other facts 
fatal to the assumption that the disease is due to pollen, such as its com- 
plete disappearance in some summers, the non-correspondence of the hay 
season in America and the period of the attack (Wyman), the marked 
periodicity of the attack apart from the possible presence of pollen, its 
regular appearance at a certain hour and on a certain day, pointing to 
derangement of the nervous system, etc. etc. The alleged exact corre- 
spondence of the onset of the disease and the flowering of certain plants is 
unfortunately more apparent than real, and, according to our observation, 
the period of attack is related more to moisture or heat, or both combined, 
to rapid temperature changes, and to other thermometrical and baro- 
metrical conditions than to the presence of pollen in the atmosphere. 
It will thus be seen that the influence of pollen is narrowed down to a 
very contracted sphere—that it is simply one of an indefinite number of 
external agencies which are capable of producing a paroxysm, and that 
there are excellent grounds for the belief that in many cases in which it 
is assumed to be the exciting cause, it has little or no influence at all 
except through the association of ideas. 
Let us turn now to that portion of our author’s creed which relates to 
the penetration of the vessel walls by the pollen granules and their 
accumulation as foreign matter in the blood. We cannot contemplate 
this proposition without an involuntary shudder, especially when wre view 
it in the light of a possible destroyer of some of our most pleasant rela- 
tions with the outer world. It is but just to Dr. Mackenzie to say that 
this luminous idea originated in the brain of a Mr. Wright Wilson, who 
some years ago flashed across the literary horizon in that highly instruc- 
tive portion of the London Lancet devoted to notes and queries from 
correspondents. Dr. Mackenzie seems to have been the only mortal wdio 
caught the heavenly vision, and to him therefore belongs whatever credit 
attaches to the discovery of Mr. Wilson and his theory. As far as our 
knowledge goes, Mr. Wilson and Dr. Mackenzie are the only authors, 
living or dead, who have gravely announced their belief in this proposi- 
tion, and we hazard the conviction that, upon reflection, the latter will 
leave to the former the exclusive honor to which he is most justly entitled. 
We even venture to predict that in the coming ages—ay, to the end of time 
—Mr. Wilson will remain the solitary champion of an idea which, for 
fertility of fancy and perfect independence of natural law, shines above 
all other such conceptions. 
“ . . Yelut inter ignes 
Luna minores.” 
Dr. Mackenzie characterizes as “ zealous bacteriomaniacs” those who 
seek in specific organisms the cause of the affection under review. If 
the germ-theorists be in truth “ bacteriomaniacs,” under what variety of 
mania do those fall who attribute such terrible properties to the innocent 
pollen granule ? 6 
While this remarkable theory may be regarded as illustrative of the 
extent to which the pollen advocates allow themselves to be carried by 
their dominant idea, it must nevertheless be confessed that it opens up an 
unending vista of possibilities to the speculative eye of the imagination. 
Through ciliated epithelium, basement membrane, and vessel wall, the 
dreadful vitalized amoeboid pest of the summer months is launched into 
the general circulation. Does it feast on the nuclei of the white cor- 
puscles as its legitimate prey, or does it seek its pabulum in the more 
organized and nutritious protoplasm of their redder and more numerous 
companions ? Is it carried into remote organs on the crest of the serous 
wave, or is it whirled through the circulation on the back of the red blood- 
cell ? Is the dyspnoea of this disorder due to pollen emboli in the lungs 
or to granular invasion of the respiratory centre ? Are we at last-to 
realize the poetic conception of 
. Quick effluvia darting through the brain, 
Die of a rose iu aromatic pain’' ? 
The solution of these and similar problems must be unfortunately 
deferred until a time when the human mind is ready for the conception of 
Mr. Wilson, when the diagnosis of the affection shall be made with the 
microscope, and when the blood-stained pollen granule will rank with the 
tubercle and comma bacillus as a priceless legacy of medicine to man. 
We regard it easy of demonstration that pollen or any other form of 
matter is insufficient of itself to produce the disease or excite its 
paroxysms. The cause of the affection must therefore be sought, not in 
the outer world, but in some personal susceptibility to certain forms of 
irritation—some morbid condition of the system either as a whole or in 
part. While it is undoubtedly true that the inhalation of external irri- 
tants—and pollen is only one of a host of such substances—acts as an 
exciting cause of the paroxysm, it is at the same time beyond question 
that careful inquiry will discover its influence to be purely secondary or 
accidental, to be dependent upon some local or constitutional condition. 
The solution of the question lies then in the direction of some localized 
or systemic derangement of the subject himself. 
That the development of the affection presupposes some morbid condi- 
tion pertaining to the individual seems almost evident to intuition, and it 
is therefore surprising that its essential cause should have been so long 
sought for in objects derived from the external world. Even the most en- 
thusiastic advocates of the theory of external causes are forced to admit 
an essential predisposing influence without which the exciting cause is 
inoperative, and in its admission they unwittingly wreck the theory they 
attempt to defend. Blackley himself acknowledged a special predisposition 
or idiosyncrasy, and Dr. Mackenzie, while in one portion of his essay advo- 
cating the pollen theory, pure and simple, in another announces his belief 
that the affection is an idiosyncrasy, that it is characterized by and leaves 
behind it no structural lesion, and is therefore destitute of a pathology ! 
The confession that the disease is an idiosyncrasy is inconsistent with 
the tenets of the pollen theory as formulated in the two main propositions 
of our author’s contention,—is incompatible with the assumption that the 
disease is produced by the action of a peculiar vitalized principle (resident 
in pollen) upon the mucous membrane. If it be in truth an idiosyncrasy 
or innate peculiarity in the sense used by Dr. Mackenzie, it follows that 
the pollen theory is not only unnecessary, but fallacious. The admission 
of idiosyncrasy as the essential factor is a practical recognition of the in- 7 
adequacy of the pollen speculation and a virtual surrender of the ques- 
tion. The explanation of the disease by the theory of idiosyncrasy and 
its explanation by the pollen theory represent two distinct and opposite 
ideas, two separate and antagonistic hypotheses. We fail to see, there- 
fore, how this view, which may be appropriately termed the botanico- 
psychological theory, and which is formed of two mutually destructive 
propositions, brings us any nearer the solution of the pathology of “ hay 
fever.” 
Idiosyncrasy is a word, not an explanation, which practically conveys 
no definite idea concerning the essential nature of the disease, and is tan- 
tamount to a confession of “learned ignorance.” In a former communi- 
cation, we observed that, when certain morbid phenomena were inexpli- 
cable by known pathological laws or did not come within the range 
of speculation based on experimental research, the term idiosyncrasy 
was sought as a convenient refuge for acknowledged ignorance. Dr. 
Mackenzie objects to this on the ground that the term is, on the contrary, 
“ a convenient word to express certain series of phenomena which have 
not been explained.” Now, as “ idiosyncrasy” stands for a condition of 
which we have no knowledge, and of which we can form no conception, 
it involves the idea of hopeless ignorance. If we have no conception of 
a supposed state, it is idle to attempt its explanation by a mere word—an 
empty term, which, although suggestive in one respect, is at the same 
time a terse, emphatic way of expressing a defect in our knowledge and 
observation, and carries with it the inevitable confession that the matter to 
be explained is inexplicable. We consider, therefore, the use of the term 
employed by us and that cited by Dr. Mackenzie to be practically equiva- 
lent to the terms of an equation which will be found upon analysis to be 
equal to each other. It seems scarcely necessary to linger thus upon a 
matter so self-evident, but we cannot refrain from calling attention to the 
following words of Locke as pertinent to the subject of the present in- 
quiry : “ He that knows not what he himself meant by a learned term, 
cannot make us know anything by his use of it, let us beat our heads 
about it never so long. Whether we are able to comprehend all the ope- 
rations of nature and the manners of them, it matters not to inquire, but 
this is certain, that we can comprehend no more of them than we can dis- 
tinctly conceive, and, therefore, to obtrude terms where we have no 
distinct conceptions, as if they did contain, or rather conceal something, 
is but an artifice of learned vanity to cover a defect in an hypothesis or 
our understanding.” 
Dr. Mackenzie defends the idea of idiosyncrasy by means of illustra- 
tion and comparison, but it should be remembered that the former is not 
explanation, the latter not argument. That Julius Caesar Scaliger turned 
pale at the sign of a water-cress, that some persons are taken with nettle- 
rash after the ingestion of fish and fruit, certainly does not bring us 
nearer the conception of idiosyncrasy, much less the complicated etiolo- 
gical relations of “hay fever.” Neither does the comparison instituted 
by Marsh between the effects of the poison-oak and those of the pollen 
granule throw any light upon the subject, for between the two there is 
neither parallel nor analogy. 
To set aside, therefore, the important internal factor in the etiology of 
the affection, wherein the whole solution of the question lies, under the 
specious terms, special proclivity or predisposition, individual peculiarity 
or idiosyncrasy, is virtually equivalent to saying that we have no suffi- 8 
cient explanation to offer, for, as Dr. Mackenzie himself justly remarks, 
“ it would cease to be an idiosyncrasy if a satisfactory explanation could 
be arrived at.” The more we reason in this direction, the more involved 
the subject becomes, and we are therefore not surprised that Dr. Mackenzie, 
weary of involution and obscurity, finally surrenders the whole ground 
in the following honest sentence : “ Nevertheless, it must be freely ad- 
mitted that no theory explains why pollen should prove a highly exciting 
substance to the mucous membrane of some persons, and not to others.” 
“ Hay fever” is not an idiosyncrasy, but a disease—a definite morbid state, 
the elucidation of whose phenomena must be sought in the study of patho- 
logical law, and not in an inquiry into the process of plant reproduction. 
But, it may be naturally asked, Is there any explanation of the pheno- 
mena of the disease which is better than that of an assumed “ idiosyn- 
crasy” ? 
Let us search for the answer to this question in the literature of the past 
decade. In 1876, Dr. George M. Beard, of New York, wrote a work on 
“ hay fever,” based upon carefully collected statistics, in which he surveyed 
the problem from a standpoint entirely different from that taken by pre- 
vious investigators. As the result of his observations and inquiries, con- 
ducted in an accurate, scientific manner, he pronounced “ hay fever” a 
functional disease of the nervous system, closely allied to sick-headache. 
Its alleged almost invariable appearance in the higher walks of life, and 
notably in those of superior intellectual attainment, together with its 
assumed absence among inferior races, was dexterously wrought by him 
into the conception that the affection is the offspring of a higher civiliza- 
tion, the outcome of a hypersensitive nervous organization, the result of 
the enervating influences of nineteenth century social and intellectual 
life. While he does not explain in what such a neurosis consists, while 
his researches and conclusions are open to fair criticism, they nevertheless 
threw a new light upon the subject, and opened up a broader and more 
scientific pathway of research. WTiatever he failed to do, he established 
the important fact, that an important factor, if not the chief in the disease 
resides in some imperfectly defined condition of the nervous system. Hay 
fever, according to Beard, is the complex resultant of a number of different 
external exciting causes (30) acting upon a nervous system debilitated 
by the injurious influences of modern social and intellectual life. 
Five years later another important fact in connection with the disease 
was brought to light by Dr. Daly, of Pittsburgh, who showed that in a 
fair proportion of cases there is local disease of the nose and nasal pharynx 
(from simple hyperaesthesiato pronounced structural changes, such as hyper- 
trophic catarrh, polypi, etc.), without which the exciting cause (pollen, 
bacteria) is innocuous, and that the cure of the affection may be accom- 
plished through removal of the local intrinsic condition (by cauterization 
with acid, electric cautery, etc.), a position which he established by most 
convincing practical proof. To this observer belongs the credit of formu- 
lating the treatment of the disease by measures addressed to the nasal 
and nasopharyngeal chambers. According to Daly, we are only justified 
in looking upon “hay fever” as a neurosis when the affection persists 
after removal of the local nasal disease. Daly attempted no explanation of 
the mechanism of the disease, but simply announced a clinical fact and 
the treatment based upon it. 
The following year, Dr. Roe, of Rochester, published the successful 
results of his treatment of the disease by the operative method, and 9 
related a number of cases in which a cure had been effected. According 
to him, the affection is due to the action of pollen upon the nasal mucous 
membrane, which in some persons is rendered peculiarly susceptible by 
active or latent disease of the naso-pharynx associated with hypertrophic 
catarrh of the nasal passages. The asthma and other manifestations of 
the paroxysm are due, he believes, to reflex congestion of the mucous 
membranes of the several organs in which their effects are manifested. 
While Ur. Roe believes the exciting cause to be pollen, he at the same 
time contends that, in order to the production of a paroxysm, “ latent or 
active,” nasal disease must be present, that the nervous symptoms are 
secondary to the hyperaesthetic condition of the nostrils, and that the latter 
is not the effect but the cause of the neurotic feature of the disease. 
In the same year we published the results of some experiments made 
by us with reference to the localization of reflex sensitive areas in the 
nasal passages, which, we venture to believe, throw some further light 
upon the subject. These observations led us to the belief that the area 
most sensitive to reflex producing impressions is represented by that 
portion of the mucous membrane which covers the turbinated corpora 
cavernosa, that reflex acts are only exceptionally awakened from irritation 
of other portions of the nasal fossae, and that all parts of the erectile area 
are not equally susceptible to irritation, the most sensitive spots being 
located in the mucous membrane covering the posterior extremity of the 
inferior turbinated body and the septum immediately opposite. These 
views of the sensitive area were opposed by Dr. Hack, of Freiburg, who 
maintained that all reflexes arise from congestion of the cavernous tissue 
of the anterior end of the inferior turbinated bone. The views of Hack 
on “ hay fever” are similar to those of Daly and Roe. According to him, 
two factors are necessary to the paroxysm, a hypersesthetic condition of 
the terminal filaments of the fifth and olfactory nerves and an increased 
irritability of the cavernous tissue, caused, as a rule, by local nasal disease, 
and he inclines to the belief that the neurasthenic symptoms are secondary 
to the nasal affection. 
In 1884, a still more exclusive view was put forth by Dr. Harrison 
Allen, of Philadelphia, who held that the affection depended solely upon 
obstruction or tendency to obstruction in the nasal passages ; he also 
called attention to the fact that (in his experience) in the sufferers from 
this disease, the inferior turbinated bones lie well above the floor of the 
nostril, a condition which subjects the mucous membrane covering them 
to additional irritation from external causes. These observations of 
different physicians, working independently of each other, viewing the 
subject from different standpoints, while not perfectly harmonious, never- 
theless present a singular unanimity in their recognition of the necessity 
of therapeutic measures addressed to the nasal passages as a prime factor 
in the treatment of the disease. AYhile they render it probable that 
certain states of the nasal passages are necessary to its production, they 
do not demonstrate the fact that local nasal disease is the sole excitant of 
the paroxysm. The views given above have been confirmed by the clinical 
experience of a number of physicians, among whom may be prominently 
mentioned Drs. Sajous, of Philadelphia, Bosworth, of New York, and 
Ingals, of Chicago. Several months after the publication of Dr. Allen’s 
views, we endeavored to reconcile the discrepancies met with in the 
results of different observers, and advanced the theory which we give here 
in brief:— 10 
According to our conception, as outlined in several articles published 
during the last few years, the so-called nasal reflex neuroses, whether taken 
singly or collectively, as in the case of the ensemble of phenomena known 
as “ hay fever,” may be regarded as the Protean manifestations of a mor- 
bid condition to which we have given the name Rhinitis Sympathetica, and 
which is characterized by a hyperaesthetic condition of the vaso-motor 
nerve-centres linked to a peculiar excitability of the nasal cavernous tis- 
sue. For, if we inquire what condition or conditions is common to them 
all, and what morbid process is capable of producing them either singly, or in 
combination ; how phenomenaapparently so widely different in character and 
anatomical sphere of operation may be traced to a solitary source, we lind 
the answer in certain more or less clearly defined changes in the nasal ap- 
paratus and in a certain exalted state of the sympathetic nervous system, 
to which latter we instinctively turn as the organ most conspicuously con- 
cerned in the evolution of purely reflex acts. In whatever relation the 
local nasal affection and the condition of the sympathetic stand to each 
other in the matter of cause and effect, they must both be regarded as in- 
separable factors in the production of the phenomena under consideration. 
It matters not to what hypothesis the path of speculation may lead. Of 
this we can be reasonably sure, that in order to the production of the char- 
acteristic symptoms of this disease, a certain excitability of tbe nasal 
passages is necessary, plus an exalted state of the central nervous 
system. 
From our present knowledge of the disease, it seems difficult to escape 
the conclusion that its pathology is intimately interwoven with a morbid 
condition of the vaso-motor sympathetic, and probably a hypersensitive 
state of the nerve-centres themselves. When we recall the fact that in 
the famous section of the sympathetic in the neck by Claude Bernard 
symptoms similar to, or closely allied to the phenomena of hay fever were 
produced ; when we reflect upon the results reached by Prevost in his ex- 
periments on the spheno-palatine ganglion, is there not a clue to lead us 
through the labyrinth of our difficulties to a rational solution of the ques- 
tion ? Whatever be the essential cause of the disorder, do not its phe- 
nomena point directly to a circumscribed disturbance of the vaso-motor 
sympathetic ? What the histological condition of the centres or the nerves 
themselves may be, is in the present state of our knowledge a matter of 
conjecture ; but this much is probable, that their normal impressibility is 
so increased that when subjected to various forms of stimulation an ex- 
plosion of nerve-force takes place which is represented to our senses by 
certain vaso-motor disturbances in the nasal passages and other portions 
of the mucous tract dominated by the cervico-occipital sympathetic. The 
organs which bear the brunt of the attack are the nasal passages, and the 
exalted condition, erethism of the turbinated corpora cavernosa, is there- 
fore the leading, distinguishing and characteristic feature of the paroxysm, 
constituting, as it were, the central symptom around which the other phe- 
nomena of the paroxysm are grouped, and from which many of them proceed, 
either as the result of mechanical causes or from reflex action. The dis- 
comfort and more serious symptoms of the disease commence with the 
swelling of this tissue, and are dissipated with the subsidence of the same. 
W hatever be tbe exciting cause of the paroxysm, the tendency to sec- 
ondary erection of this tissue plays an important role in its mechanism, 
and, just as in an ordinary coryza, the central symptom, the most promi- 
nent condition, is represented by the swelling of the cavernous bodies. 11 
Indeed, whatever the other elements of the paroxysm may be, the phe- 
nomena referable to the cavernous tissue constitute the mainspring of the 
machinery by which it is set in motion. As the distinguishing feature 
of the paroxysm resides in an exalted condition of this tissue, by dimin- 
ishing or abolishing its reflex excitability we eliminate the leading element 
in the complex mechanism of the attack. Now, our experience shows 
that, while all parts of the nasal mucous membrane may be sensitive to 
reflex-producing impressions, the most sensitive area is located in the 
lower posterior portions of the nostrils, a zone corresponding to the dis- 
tribution of the spheno-palatine branches ot the superior maxillary nerve 
as distinguished from the nasal branch of the ophthalmic. The former 
nerve, derived through the spheno-palatine ganglion, probably contains 
therefore the vaso-motor fibres which govern the erection of the turbinated 
tissue, and as the sympathetic filaments which have been traced to the 
nasal passages are found in greater abundance over this area, we may for 
practical purposes speak of a nasal plexus located in the sensitive area 
and intimately associated with the evolution of the nasal reflex. The 
clinical observations of Roe, Sajous, Ingals and others, and our own, 
show that this is precisely the area of greatest turgescence and excit- 
ability during the paroxysms of the disease, and the localization of the 
“ sensitive area” may therefore be looked upon as the key to the mecha- 
nism of the attack. Just here, we would like to call attention to a property 
of erectile tissues which is consonant with the ideas of reflex excitability 
formulated above, and which may possibly in a measure explain the rela- 
tion of erection of the nasal cavernous tissue with the vaso-motor manifes- 
tations of the sympathetic form of rhinitis. In the human body, wherever 
erectile tissue is found, it is intimately related to reflex or sympathetic 
acts; there seems to be connected with it a certain receptivity to reflex- 
producing impressions, a certain power of reflex excitability dependent 
upon its structure and functions. It is thus peculiarly a tissue of sym- 
pathy in which we may most satisfactorily study the mechanism of purely 
reflex or sympathetic acts. Now it seems to us, that, as the nasal corpora 
cavernosa belong to this class of sympathetic tissues, there will be little 
difficulty in explaining the role which they play in the paroxysms of an 
affection which is probably connected with, if not dependent upon, an ex- 
citation of the sympathetic nerve-centres, and in more clearly defining 
the intimate relation which its erection bears to the reflex manifestations 
of the disease under review. 
For practical purposes, then, we may regard the affection as a coryza 
dependent upon some derangement of the nerve-centres as its essential 
cause. The latter may be inherited or acquired ; in the latter case it may 
be brought about in a number of different ways. In the first place it may 
be the result of pathological conditions of the nasal passages themselves, 
generally associated with repeated and prolonged erection of the cavernous 
tissue with subsequent abnormal irritation of the nerve-centres. The 
nasal disease itself may be developed in the first instance from direct or 
indirect (reflex) irritation, begetting a hyperaestlietic condition of the 
nasal passages, and eventually disordered activity of the centres. When 
therefore the former are exposed to undue irritation, either from ab extra 
influences or from internal causes, an explosion of nerve-force takes place 
in the centres which expresses itself as a paroxysm. We might illustrate 
this mechanism by referring to the operation of the aura in epilepsy, and 
the excitation of the spinal nervous system produced by abuse or disease 
of the generative apparatus. 12 
The excessive irritability of the nasal tissues may be brought about, in 
another class of cases, by an exalted state of the central nervous system, 
leading eventually to derangement of the vaso-motor centres, or, finally, a 
hypersesthetic condition of the latter may be occasioned by other patho- 
logical states of the system as a whole, or as the result of reflected irrita- 
tion from its individual parts. Whatever be the avenue through which 
the exciting cause operates, two factors seem to be inseparably associated 
in the production of the paroxysm—a hypenesthetic condition of the nasal 
erectile area, and a derangement of the nerve-centres. 
In calling special attention to the irritability of the nasal erectile—or 
contractile—tissue, we do not by any means seek to overlook the vaso- 
motor manifestations in other portions ot the respiratory apparatus, and 
even in other organs not directly connected with it. On the contrary, the 
explosion of vaso-motor force expends itself upon other portions of the 
tract dominated by the cervico-occipital sympathetic. Just as in a cold 
in the head, we have symptoms referable to the lower respiratory tract, 
aural apparatus, eye, etc., so in this form of sympathetic coryza we have 
disturbances in these and other organs of the body. But the symptoms 
which stand out in conspicuous prominence are those which spring from 
the erection of the turbinated tissues. That the manifestations included 
under the head of asthma, cough, congestion of the conjunctiva, etc. etc., 
may proceed from this source alone, is shown by their immediate dissipa- 
tion upon removing the source of irritation in the nasal passages by topical 
applications, instrumental interference, or by the artificial contraction of 
the swollen tissues. We have been able to illustrate this by the following 
experiment. In the course of our treatment of one of our cases with the 
cautery, we noticed that, when the applications were confined to one nostril, 
the phenomena referable to the corresponding side of the head were com- 
pletely dissipated, whilst those of the opposite persisted and were only 
removed upon cauterization of the mucous membrane of that side. 
During the paroxysm this tissue, in our experience, is invariably con- 
gested and swollen, and exhibits a characteristic irritability entirely out 
of proportion to that found under ordinary circumstances, that is to say, 
in simple inflammation of the passages. Indeed, in a large proportion of 
the class of cases commonly known as “reflex neuroses,” this irritability 
is so exquisite as to render the contact of the blandest applications un- 
bearable to the patient, and this apart from the presence of any of the 
exciting causes of the paroxysm. 
In transferring the point of greatest excitability from the peripheral 
ends of the nerve-filaments to the centres themselves, we are fully aware 
of the want of experimental proof in favor of such a view, but we believe 
that it affords a more comprehensive explanation of the complex phases of 
the disease than that which is based on the assumption of organic changes 
in the terminal filaments of the sensitive nerves. 
In accordance with the views expressed above, we proposed some time 
ago to substitute, for the various names given to this affection, the term 
coryza vasomotoria periodica—a proposition to which Dr. Mackenzie 
objects on the ground that it involves the acceptance of an unproved 
theory, although he employs one himself which involves the resurrection 
of a disproved hypothesis. While we do not claim that the theories 
advanced by American physicians embody the complete and final settle- 
ment of the question, we regard them as less objectionable than those 
heretofore advanced; we believe that, in indicating the line of future 13 
research, they bring the problem one step nearer its solution, and that by 
viewing it from the standpoint they suggest, we may catch a broader 
glimpse of its protean aspects, and be in a securer position to relieve the 
sufferings of our patients than if we follow the narrow pathway along 
which the pollen theorists ride their hobby to an invariably unsatisfactory 
and unsuccessful result. 
To our views on the subject of “ hay fever,” Dr. Mackenzie has two 
objections to offer : (1) that we do not “ realize the true nature of hay fever 
as a periodical disease occurring only during the season when hay or certain 
flowers are in blossom and (2) that “ our views of the sensitive area are 
directly opposed by Dr. Hack, who holds that reflex manifestations do not 
occur until the anterior part of the lower turbinated body has first become 
turgid.” In regard to the first objection we have this to say: first, that 
we distinctly recognize the paroxysmal or periodical nature of the disease, 
both in our definition and in our first communication on the subject; 
secondly, that while it is true that a lax-ge proportion of cases suffer only 
during certain months of the year, our clinical observation teaches us that 
in a certain number typical paroxysms occur at all seasons of the year, 
provided the patients are subjected to the conditions which we have out- 
lined above. Dr. Mackenzie apparently reasons from the assumption 
that the complex etiological relations of the disease have been thoroughly 
investigated and definitely determined, and seems to disregard the tact 
that we are yet on the threshold of inquix-y in this direction, that we ai'e 
just beginning to discover in the many phases of this affection things un- 
dreamt of before in our philosophy, and that the true conception of the 
disease can be reached, not from the exclusive study of external causes, 
not from the hasty generalizations of isolated experience, but from the 
higher vantage-gi-ound which overlooks the subject in all its bearings, 
which bi’ings within our range of vision new facts and new discoveries, 
from which, in fine, we can regal’d more clearly the subject himself, and 
his complex relations to the external and internal forces hy which he is 
influenced and surrounded. As an idiosyncrasy stands for something 
which is inexplicable, and as “ nothing explains why some persons should 
be affected by pollen and not others,” a correct and adequate definition of 
this affection from the standpoint of Dr. Mackenzie is a logical impossi- 
bility. If we have no clear conception of the essence of a thing, it is 
obviously impossible to define it, and it is therefore highly unscientific to 
measure the value of independent observation by the criteria of an arbi- 
trary definition. 
To Dr. Mackenzie’s second objection we would I’eply that our observations 
upon this subject have received the independent support of competent ob- 
servers both in this country and abroad, and that Prof. Hack, in his more 
recent pamphlets, which doubtless had not reached Dr. Mackenzie at the 
time his essay went to press, has retreated from the exclusive views which 
he held in his original publication. It is interesting to remark just here, 
that, while Dr. Mackenzie unhesitatingly approves the result of Prof. Hack’s 
investigations in this direction, he nevertheless, a few pages further on, 
makes the most deprecatory insinuation conceiving the work of his Ger- 
man confrere, who has done so much to throw new light upon this field of 
nasal pathology. The objection which he urges to the contention of Drs. 
Daly, Koe, and Allen, that “ so fewr of the many sufferers from nasal dis- 
ease are affected by the pollen of plants,” assuming that the disease is 
caused by pollen, would be admissible were it contended that the affection 14 
is a simple nasal inflammation, and that there is no other factor at work 
in the mechanism of the paroxysm ; but it obviously does not apply to the 
views outlined above. Applied to the pollen theory, it would carry that 
interesting conception to a depth from which there could be no resurrection. 
Whichever theory be correct, when we come to consider the subject in 
the light of practical results, we find that the pollen theory others no hope 
in the direction of cure; the measures based upon it are simply palliative, and 
in some respects ludicrous in the extreme; while, on the other hand, the 
views formulated above offer a prospect of relief in every case and perma- 
nent cure in a fair proportion. The cure of the disorder by remedies ad- 
dressed to the nervous system, to the nasal passages, or both, amounts to 
the most convincing demonstration, and is a complete and practical answer 
to the pollen assumption. Dr. Mackenzie’s deprecatory remarks on the 
treatment advocated by American physicians can have very little weight, 
as he acknowledges that he has but imperfectly studied the question from 
their standpoint, and has had no practical experience with the improved 
methods they suggest; but it is a significant fact that the only English- 
man who has adopted the American plan, Mr. Lennox Browne, has ob- 
tained from it most satisfactory results. If the dissipation of the disease 
by a given method does not offer “ a sufficiently favorable prospect” to 
justify its adoption, what better criterion of its efficacy, it may be asked, 
would Dr. Mackenzie require in judging of the merits of the operation ? 
There is, perhaps, no more striking commentary on the inadequacy of the 
pollen speculation than the Cimmerian darkness it has thrown around the 
treatment ot the disease, and we are therefore not surprised when Dr. 
Mackenzie informs us that the treatment is “ unsatisfactory,” and that 
“ prevention is better than cure.” But let us turn our eyes for a moment 
from the horrors of the American method to the pleasant prospect of relief 
afforded by the pollen theorists, and reflected in the pages of Dr. Macken- 
zie’s essay. 
It a life on the ocean wave or a home on the rolling deep be imprac- 
ticable, “ dwellers in towns should avoid the country” and those who reside 
in the country should proceed at once to “ the centre of a large town,” 
or, if this be out of the question, “ the patient should remain, if possible, 
within doors during the whole of the hay-fever season.” Active exer- 
cise should be carefully avoided, and if the sufferer ventures out of doors, 
“ he should, if possible, avoid the middle of the day,” or, if obliged to 
sally forth at that inauspicious hour, “should protect his eyes by wearing 
spectacles with large frames accurately adapted to the circumference of 
the orbits ; or he may find some advantage in wearing a hat with a very 
broad brim.” As rapid motion in the open air aggravates the complaint, 
“it may be advantageous to wear a veil over the face whilst driving or 
riding. One made of ‘ three ply’ of fine silk gauze has been recom- 
mended,” but Dr. Mackenzie finds a “ double gossamer,” which can be 
had in several colors, answer the purpose in some cases. “ Plugging the 
lachrymal ducts with glass rods,” “ closing the nostrils with a metal 
clip,” and wearing an apparatus containing carbolic acid and camphor 
within the nostrils, are also suggested to secure comfort to the sufferer. 
“Protected in this way,” says Dr. Mackenzie, “ many people disposed 
to hay fever escape altogether, whilst others contract the disease in a very 
mild form.” To his everlasting credit be it said, however, that he “ can- 
not recommend” the glass rods and metal clip, but he nevertheless adds, 
“ the nostrils may he plugged (italics Dr. Mackenzie’s) with cotton-wool 15 
or wadding by means of one of Gottstein’s screws.” Apart from many 
other inconveniences attendant upon such a line of treatment, imagine the 
tortures of confinement to a closed chamber during the intense heat of 
our summer months ; fancy the spectacle which the victim presents with 
his eyeballs covered with an unsightly apparatus, his lachrymal ducts 
filled with glass rods, and his nostrils plugged with cotton—a form of 
secundum arteni torture which recalls the ingenuity of Torquemada. 
But if this should not suffice, consistence with the pollen idea may demand 
that other avenues be also closed, that the intra- and extra-aural pres- 
sure be equalized by tamponing the auditory meatus, and that, in order to 
avoid the inevitable access of pollen to the respiratory structures which 
must follow the necessary patency of the mouth, that avenue should be 
also peremptorily sealed. The experiments of Blackley show that pollen 
grains may be retained in the clothing for many weeks, and that when 
let loose upon a mucous membrane they are capable of producing unlimited 
havoc, and the suggestion naturally arises, why not apply the glass- 
rod method to the urethra, and the respirator and tampon to the rectum ? 
It has also been proved (to the satisfaction of the pollen theorists) that 
the disease may commence as an irritation of the skin by the ubiquitous 
pollen, and it is even possible, if we follow out Mr. ilson’s idea, that the 
pollen granule may enter the cutaneous capillaries. But, thanks to chem- 
istry, we have an effectual barrier to such intrusion in shellac. As the 
pollen granule is one-tenth the size of the blood-corpuscle, it is readily 
conceivable that the means suggested above may prove ineffectual, and we 
therefore see no escape from inclosing the patient in some form of appa- 
ratus like the diving-bell, to which the air may be conducted from the 
nearest mountain top. But some captious critic may inquire, “ Vi ith the 
primce vice thus hermetically sealed, how is the patient to breathe under 
the conditions you suggest?” This conundrum has been solved by a surgical 
friend of ours, who proposes that, as the lower respiratory tract is proba- 
bly least sensitive to the action of pollen, the operation of tracheotomy 
be performed—a proposition which we cheerfully commend to those who 
follow the treatment of Mr. Blackley. 
Let, then, the patient, prepared according to the directions given above, 
don his broad-brimmed hat, fold about him the three-ply gauze, or double 
gossamer of the rainbow hue, and hie him to the centre of the nearest town 
where the passer-by may recognize the embodiment of the victory which 
science has wTon over disease—“ monumentum aere perennins.” 
In the light of recent discovery, and in accordance with our views in 
regard to the pathology of the disease and the mechanism of its paroxysms, 
we believe that the general principles governing its treatment may be 
briefly defined as follows: It should be remembered, at the outset, that 
the vaso-motor manifestations, of which the erection of the turbinated 
corpora cavernosa is the central and most conspicuous, are secondary 
phenomena dependent upon a direct impression made upon the nasal 
mucous membrane, or on indirect influence conveyed or reflected through 
the vaso-motor centres from a distant organ ; or, finally, from some exci- 
tation starting in the centres themselves. Any treatment, therefore, ad- 
dressed to the nasal chambers, except in the case of the destruction of the 
cavernous tissue, accomplishes thus one result, and one only—it closes 
one door against ab extra irritation of the nerve-centres. In order to 
exclude completely the influence of the latter, careful search should be 
made for any pathological condition, systemic or local, which may be 16 
regarded as a source of direct or indirect irritation, and appropriate treat- 
ment adopted. Recognizing the prime importance of the reflex excita- 
bility of the nerve-centres and the resulting vaso-motor manifestations, 
an endeavor should be made so to alter the nutrition of the central nervous 
system that the centres may not respond so easily to the reflex-producing 
impression. Failing in the above methods, the partial, or if necessary 
complete, destruction of the cavernous tissue corresponding to the sensitive 
area should be undertaken. In the majority of cases it is neither neces- 
sary nor desirable to destroy large areas of tissue, the amount to be 
sacrificed depending upon the exigencies of the particular case. 
The treatment of the disease by cauterization, which has been carried 
out so successfully in this country and Germany, has been criticized in 
England and France, but it is a noteworthy fact that the criticisms have 
emanated from those who have had no personal experience with the 
method. A recent French writer of this class has gone so far as to 
characterize it as an “ audacious” procedure. But it should be remem- 
bered that it was a Frenchman who referred in similar terms to the first 
operation of McDowell, and a representative Englishman who cried 
Credat Judceus Apella at the mention of a procedure which has done so 
much to render the modern surgery of Great Britain illustrious. 
In that highly instructive and philosophical production, Gil Bias, occurs 
the following passage, whose application we leave to those of our trans- 
atlantic friends who positively refuse to make trial of the American 
methods— 
44 ‘ Sir (said I, one evening to Dr. Sangrado), I take Heaven to witness that 
I follow your method with the utmost exactness; yet, every one of my patients 
leaves me in the lurch. Jt looks as if they took a pleasure in dying, merely to 
bring our practice into discredit. This very day 1 met two of them going to 
their long home.’ ‘Why, truly, child,’ answered he, ‘I have reason to make 
pretty much the same observation; I have not often the satisfaction of curing 
those who fall into my hands; and if I was not so sure as I am of the principles 
upon which I proceed, I should think my principles were pernicious in almost 
all the cases that come under my care.’ ‘ If you will take my advice, sir,’ said 
1, 4 we will change our method and give chemical preparations to our patients, 
through curiosity ; the worst that can happen will only be that they produce the 
same effect that follows our bleedings and warm water.’ 4 I would willingly 
make the experiment,’ he replied, ‘provided it would have no bad consequence; 
but I have published a book in which I have extolled the use of frequent bleed- 
ing and aqueous draughts ; and wouldst thou have me go and deny my own work ?’ 
‘Oh, you are certainly in the right!’ said I; ‘you must not give your enemies 
such a triumph over you ; they would say you" are at best disabused, and there- 
fore ruin your reputation; perish rather the nobility, clergy, and people, and let 
us continue in our old path.’ . . . . ‘ We went to work, therefore, afresh, 
and proceeded in such a manner, that, in less than six weeks, we made more 
widows and orphans than the Siege of Troy.’ ” 
We are sorry that we are compelled to speak thus disparagingly of the 
views advocated in the brochure of Dr. Mackenzie, but we cannot allow 
our admiration of the author’s ability to interfere with our duty as re- 
viewer. His work is written in his well-known agreeable style, and he 
has put the pollen theory in as an attractive light as is possible under the 
circumstances. Championing a feeble cause, his defence is naturally weak, 
and if he has not thrown new light upon the subject, it is because he is 
trammelled by the contradictions and many inexplicable questions insepa- 
rably associated with the hypothesis into which he has endeavored to 
breathe new life. He views his subject from the standpoint of Blackley, 17 
and has not sufficiently investigated it in the light of recent revelations. 
We believe that our distinguished author would better employ his powers 
in exposing its fallacies than in apologizing for a theory which represents 
not progress, but retrogression. 
The pollen idea is better adapted to please the imagination than to per- 
suade the reason. Like the fabled Icarus, in attempting to go beyond its 
legitimate sphere, it has failed in the accomplishment of its object. Criti- 
cism is necessary to knowledge, and erroneous doctrine may in this way 
lead to more perfect understanding, and in this sense the pollen theory 
may be said to have accomplished a useful purpose ; but, on the other 
hand, by diverting the mind from more essential etiological conditions, by 
introducing an insuperable element of confusion into the investigation of 
the disease, it has contributed in a large measure to retard the progress of 
therapeutic inquiry. Deliverance from false conceptions based on tradi- 
tional belief is a task difficult of accomplishment. May we not hope for 
the co-operation of Dr. Mackenzie in this direction ? 
Let us, finally, commend to the future historian of this affection the 
exile of the terms “ hay fever” and “ idiosyncrasylet us hope that the 
time is not far distant when the pollen theory shall be relegated to its 
proper historical place as an interesting speculation ; that the next essay 
which treats of it will bear as its motto the eloquent in memoriam, or the 
terse and homely hie jacet. May we not even indulge the belief that the 
next edition of the work before us will be devoted, not to the resurrection 
of a defunct hypothesis, but to the elaboration of its epitaph ? 
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