26 
JOURNAL OF THE 
[January, 
HAY-FEVER: ITS TREATMENT PHYSIOLOGICALLY 
AND PATHOLOGICALLY CONSIDERED. 
BY DR. N. C. HUSTED. 
(Read December 7th, 1888.) 
That Hay-Fever belongs to the Neuroses, has become an 
established fact; and, when the most eminent of our recent 
writers on this subject have brought forward such overwhelm- 
ing proofs to show, that it is an affection of the nervous system, 
it seems folly to entertain any theories or ideas appertaining to 
its pathology, etiology or treatment, which are not based on a 
neurotic hypothesis. To the layman’s mind it may seem 
strange that eminent writers should not come to any agreement 
concerning this troublesome affection ; but, notwithstanding the 
fact that the nerve-theory has placed Hay-Fever on a new 
foundation, from which we may feel assured many bright super- 
structures will arise, yet many questions come before us, which 
will give rise to much future discussion. 
In recognizing Hay-Fever as a nervous affection, certain 
questions naturally arise from such an hypothesis : 
I. Is Hay-Fever of Neurotic origin ? 
II. If so, does it begin primarily, (a) in the central nervous 
cells, (£) in the nerve-trunks, or (c) in the terminal organs ? 
III. Are pathological lesions present ? 
IV. Is there an inflammation of the mucous membranes, giving 
rise to nervous hyperesthesia ? 
In the New York Medical Record of July 14th, 1888, Dr. B. 
O. Kinnear, of Boston, gives an interesting paper, in which he 
states, and endeavors to prove, that Hay-Fever is a disease of 
central cell origin. His argument shows deep study and a logical 
train of thought, and, although believing his premises to be 
faulty, I think the article adds greatly to our literature of the 
subject. 
Explanation of Plate 15. 
Human nerves and mucous membrane as related to Hay-Fever.—mm, mm, mucous 
membrane ; sc, spinal cord; eg, Casserian ganglion; oph, ophthalmic 
nerve; f, frontal branch ; n, nasal branch; l, lachrymal branch; srn, 
superior maxillary nerve ; gp, glosso-pharyngeal nerve ; p, pneumogastric 
nerve ; sp, superior pharyngeal branch ; si, superior laryngeal branch ; b, 
bronchial branch. JOURN.N.Y. M IC.SOC., Jan. 1889. 
PLATE 15. 
HUSTED ON HAY-FEVER. 1889.] 
NEW-YORK MICROSCOPICAL SOCIETY. 
27 
In support of his hypothesis, Dr. Kinnear makes use sub- 
stantially of the following facts : Grief causes the tears to flow, 
the muscles of the face to contort, and induces rapid failure of 
muscular strength. Mental excitement acts on the secretions of 
the kidneys. Nausea and vomiting are often caused by a dis- 
gusting sight or smell. Joy and anger flush the face. Sneezing 
is an effort of Nature to throw off the foreign body from the 
mucous membrane of the nose, &c. 
These are reflex acts giving rise to hyperactivity and hyper- 
secretion. He reasons from this, that abnormal nerve-force, 
due to disease of the central cells, will give rise to abnormal 
effects on the system ; i. e., disease of the central ganglion, con- 
nected with the nerves supplying the mucous membrane of the 
nose and throat, causing what he calls abnormal nervous force, 
produces abnormal secretions from these parts. At the same 
time he declares Hay-Fever paroxysms to be reflex acts. Which 
is very true ; thus showing the fallacy of his theory, that the 
disease originates in the central nerve-cells. Now a reflex act 
is due to the stimulation and irritation of a sensory nerve, over 
which the impulse travels ; the central cells acting only to 
receive this impulse, and transmit it to the motor nerves. By 
this it will be seen, that a reflex act cannot take place, unless 
the impulse be first carried along a sensory nerve to the cell. 
And therefore Dr. Kinnear’s assumption, that a diseased con- 
dition of the cells originates the reflex act, and its subsequent 
phenomena, seems to me to be false. In fact, he must deny the 
existence of all the well-known etiological factors, when he 
assumes that the disease is of central nervous origin. 
After a careful study of this affection, and believing it to be 
a disease of the nervous system, I have arrived at the following 
conclusions, which seem at least to be based on physiological, 
pathological and common-sense principles. Hay-Fever is a 
periodic, Neurotic disease, occurring in persons having a 
peculiar idiosyncrasy, or constitutional diathesis, and character- 
ized by a hypersecretion of the nasal and pharyngeal mucous 
membranes. The paroxysms are reflex acts, due to an irritation 
of the terminal fibres of the nerves, supplying the nasal and 
pharyngeal mucous membranes. The impulse is carried along 
the sensory nerves to the central cells in the medulla, which, on 
receiving the impulse, transmits it to the vaso-motor system, 28 
JOURNAL OF THE 
[January, 
producing a congestion of the parts, from which the impulse 
originates. This abnormal blood supply increases the nutrition 
of the mucous membrane, giving rise to a hypersecretion of the 
mucous glands. 
The blood-supply of the body is regulated by the great sym- 
pathetic nervous system, which surrounds the arteries, and the 
sympathetic nerve-endings are supposed to terminate in the 
muscular coats of the arteries. Any thing, which affects this 
system of nerves, will cause either contraction or dilatation of 
the vessels, thus diminishing or increasing the blood-supply of 
the part. A common illustration of this fact is shown when, on 
approaching a hot fire, the skin becomes red, and the action of 
the heat on the nerves of the skin causes the capillary blood- 
vessels to dilate, and thus increasing the action of the sweat 
glands, the surface becomes moist. In the same manner the 
application of cold to the surface causes contraction of the 
capillaries. Stimulation of certain nerves, connected with any 
organ or tissue of the body, will cause a determination of blood 
to those parts, and a hyperactivity. 
The amount and continuance of a congestion, or hyperaemia, 
depends on the duration, rather than on the amount of irritation 
present. A severe cut on the surface of the body, with some 
sharp instrument, causes local hyperaemia of the surface incised, 
while it is comparatively of short duration ; while the prolonged 
presence of a splinter, or other foreign body, will cause severe 
inflammation, which may ultimately end in gangrene. Such 
illustrations show the influence of the nerves over the arterial 
system, and demonstrate to us that the nerve-theory of Hay- 
Fever is not altogether unfounded. 
It may easily be seen from the above facts, how certain sub- 
stances, coming in contact with the mucous surfaces of the nose 
and throat, will set up an irritation in the terminal nerve-fibres ; 
and how this irritation, in the form of nerve-impulses, keeps 
flashing along the sensory nerves to the switch-men in the 
medulla, who, in the form of nerve-centres, having no action of 
their own, irrespective of events taking place elsewhere in the 
body, receive their elective despatches, and faithfully transmit 
them down the cervical spine, and, by means of the cervical 
sympathetic system, dilate the nasal and pharyngeal capillaries, 
thus causing the familiar discharges from the nose and throat. 1889.] 
NEW-YORK MICROSCOPICAL SOCIETY. 
29 
Physiologists have time and again proven for us these reflex 
acts ; we are constantly seeing them illustrated in our every-day 
life ; and surely their connection with this disease is not beyond 
the range of possibility. 
There is another factor, which enables us to regard Hay- 
Fever in the light of a Neurosis. This is its almost exclusive 
confinement to patients in the higher walks of life. As the 
human race advances to higher degrees of civilization and 
refinement, in direct proportion do the Neuroses multiply among 
our aristocracy, and each successive generation shows us the 
increase. The Anglo-Saxon race appears to be alone liable, 
English and Americans being those who are almost exclusively 
affected. As to Temperament,—it almost always occurs in the 
nervous and energetic. 
Sir Morell Mackenzie, in his work on Hay-Fever, quotes a 
case, in which a young lady, who was a victim of Hay-Fever, on 
visiting the Royal Academy, was so struck with the realistic 
representation of Hay-Fever, that she was at once seized with a 
severe paroxysm of her complaint, from which she was at the 
time free. Dr. Mackenzie thinks she must have passed a hay- 
cart on her way to the academy. It seems probable that in a 
person of highly sensitive nervous organization, such a sight 
would act reflexly on the nerves, already in a state of hyperses- 
thesia, and produce the paroxysm. The sight or thought of 
anything sour will cause an increase in the salivary secretion ; and 
so this case seems to bind us still closer to the nerve-theory of 
Hay-Fever. Why is it that some of us suffer, while others enjoy 
immunity ? For the same reason that, on exposure to some 
contagious disease, one man will contract it, and the others 
escape. We give it that very convenient but unfortunate term, 
“ idiosyncrasy,”—that peculiar liability, some of us have, to con- 
tract certain diseases, which we can not as yet explain, and 
which is often hereditary. 
The active cause of the irritation causing Hay-Fever still 
remains unsettled, to a certain extent; but the majority cling to 
the pollen theory. I would raise the following questions : 
I. The pollen from vegetable life acts as a direct irritant to 
the nerve-endings in the mucous membrane. 
II. The pollen, or atmosphere', contains bacilli, which act as a 
ferment, on entering the blood. 30 
JOURNAL OF THE 
[January, 
III. The nasal membrane is kept moist by the secretion from 
the mucous glands. 
The mucous membrane is covered with ciliated epithelium, 
the cilia being continually in a state of motion. Now if, from 
any cause, these cilia are in a state of hyperactivity, it can be 
seen how the mucous, instead of accumulating and keeping the 
membranes moist, will be thrown off, as it accumulates, and the 
membrane, becoming dry, is easily irritated by the presence of 
foreign bodies. This, seems to me to be a possible explanation 
of the fact, that Hay-Fever attacks only the favored few ; the 
hyperactivity of the cilia depending on the Neurotic diathesis 
of the patient. It is well known that the atmosphere is filled 
with bacilli of different species, which are innoxious until they 
find a mucous membrane favorable to their growth. The Hay- 
Fever bacillus has not yet been captured ; and it is possibly 
lurking in the air we breathe, waiting to pounce down on the 
mucous membrane of those of us, who present a favorable pre- 
disposition. The ideas presented are merely suggestive, there 
being no space for their discussion in this paper. 
On starting this paper, I had determined to make no mention 
of symptomatology. The symptoms are well known to most of 
you here present. But certain circumstances have determined 
me to speak of a very distressing one. The difficulty of breath- 
ing, and tightness about the chest, and cough, are regarded by 
many as the extension of the pharyngeal inflammation to the 
air-cells of the lungs. When the cellular tissue of the lungs 
becomes inflamed, something more serious than an asthmatic 
attack is going to happen. In fact I do not consider Hay- 
Fever to be accompanied by inflammation ; for inflammation 
always leads to proliferation, and destruction of tissue. I 
regard it merely as a congestion, which does not get as far as 
inflammation. These chest symptoms are plainly due to irrita- 
tion of branches of the pneumogastric nerve. As we know, 
branches of this nerve are distributed to the lungs ; it has also 
branches which form a part of the pharyngeal plexus. There 
can be no question that stimulation of this plexus will excite the 
branches which supply the lungs. 
The Treatment.—Numerous remedies are proposed every 
year, but none of them do more than give partial or temporary 
relief. A gentleman, visiting a suburban town, had occasion to 1889. J 
NEW-YORK MICROSCOPICAL SOCIETY. 
31 
call a physician in the night to prescribe for a severe paroxysm 
of this disease. The good old country doctor came, felt of his 
pulse, and enquired if he had tried any remedies. “ Yes,” he 
replied, “ I have been trying retnedies all my life, and now I 
want something to cure me.” 
Any treatment of Hay-Fever, to be effectual, must be based 
on a correct theory of its causation. Recall the fact, that the 
nasal and pharyngeal capillaries are in a state of engorgement, 
caused by the action of the nerve-impulses, which start in the 
plexuses of those parts, on the central cells of the sympathetic 
system, whose duty is to keep these vessels in a state of contrac- 
tility. It seems evident from this, that anything, which will 
cause the sympathetic nerves-to regain their normal condition, 
will relieve this congestion in the capillaries. This is done by 
the use of Chapman’s ice-bags. They must be applied to the 
spine, and remain there from ten to fifteen minutes, and even as 
long as an hour, at each attack. After three or four applica- 
tions, it will be found that the attacks will be warded off, or I 
may say the disease will be arrested. During the past year, 
some half dozen cases came under my care. I found the ice- 
bag to invariably arrest the attacks, and, in one particular case, 
the attacks have not recurred. Thus far I consider it a cure.