ON THE 
Inhibitory Arrest of the Act of 
Sneezing, 
AND ITS* 
\ 
THERAPEUTICAL APPLICATIONS. 
BY 
E. C. SEGUIN, M.D., 
LECTURER ON DISEASES OF THE NERVOUS SYSTEM AT THE COLLEGE OF PHYSICIANS 
AND SURGEONS. NEW YORK. 
REPRINTED FROM 
OR, BROWN-SEQUARD'S ARCHIVES OF SCIENTIFIC AND PRACTICAL MEDICINE 
March, 1873. 
J. B. LIP PIN COTT CO., 
25 Bond Street, New York, 
and 
715 & 717 Market Street, Philadelphia. 234 
E. C. SEGUIN. 
IV. 
ON the 
INHIBITORY ARREST OF THE ACT OF SNEEZING, 
AND ITS 
THERAPEUTICAL APPLICATIONS. 
BY 
E. C. SEGUIN, M.D., 
LECTURER ON DISEASES OF THB NERVOUS SYSTEM AT THE COLLEGE OF PHYSICIANS AND 
SURGEONS, NEW YORK. 
In the early summer of 1869, I discovered that sneezing could be 
arrested or prevented by forcibly rubbing the skin below and to either 
side of the nose. I at once communicated this fact to the editor of 
this Journal, and in my letter pointed out the inhibitory nature of the 
phenomenon; classing it with the arrest of the heart’s action in Weber’s 
experiment,* and with the arrest of spinal epilepsy by irritation of the 
great toe.f I was soon made aware that this simple means of stop- 
ping sternutation was known to many outside the profession, and 
that it had been formally recommended by DidayJ in 1843. More 
recent researches have shown me that Haller§ (perhaps Barthoiinus 
before him ||), and Marshall had called attention to the possi- 
bility of arresting sneezing by irritating the skin between the nose 
and the angle of the eye (Haller), or by rubbing the end of the nose 
(M. Hall). 
I venture to treat formally of this small matter, because I was per- 
haps the first to call attention to the correct explanation of the ar- 
rest, and because I have long had in mind certain therapeutical ap- 
plications of this method. Before proceeding to state the circum- 
stances which may indicate the arrest of sneezing, a few words about 
* See Brown-S6quard, Archives of Scient. and Pract. Medicine, No. i, Jan. 1873, p. 89. 
+ Brown-Sequard, Archives de phys. normale et pathologique, I. p. 157, 1868. 
1 Diday, Note sur un moycn simple de prdvenir ou d’arreter la toux dans certaines maladies. 
Gazette Mdd. de Paris, 1843, pp. 103-106. 
§ Haller, Elementa physiologiae, t. Ill, p. 304. Lausansc, 1766. 
|Th. Barthoiinus, cited by Haller in op. cit. [passage not found in B.’s works.] 
1 Marshall Hall, Diseases and Derangements of the Nervous System, p. 99. Lond., 1841. INHIBITORY ARREST OF. THE ACT OF SNEEZING. 
235 
physiological and pathological sternutation may not be out of 
place. / 
1 st. What is the physiology of sneezing? A most distinguished 
physiologist* has said that “ sneezing is a sudden and violent con- 
traction of the expiratory muscles consequent upon the closure of the 
upper part of the air passages. * * * * The diaphragm, contrarily 
to what is taught by many ancient and modern writers, takes no part 
in the act of sneezing; it is not an expiratory muscle, and acts only- 
in the deep inspiration which precedes sneezing.” Austin Flint, jr.f 
defines sneezing as “a, convulsive action of the expiratory muscles 
succeeding a deep inspiration ; the air being violently expelled, with 
a characteristic sound, through the nares.” states that 
the act of sneezing is accomplished by a violent expiratory effort. 
Haller§ speaks of sternutation as consisting of a spasm of the dia- 
phragm, in the first place, causing a deep inspiration, this being fol 
lowed by spasmodic action of the muscles of expiration. Morgagni || 
also considers the act of sneezing as caused principally, if not wholly, 
by spasmodic action of the diaphragm. Many writers mention the 
associated movements of the face, head, neck and limbs, which every 
one must have observed in his own person while sneezing. After the 
deep inspiration, the air is held in the chest by closure of the glottis, 
then escapes principally through the nose, the isthmus of the fauces 
being closed. This is the typical sneeze; but custom has brought 
about the discharge of a part of the air through the mouth, in order 
to prevent the very result for which the act of sneezing seems fitted, 
viz., the expulsion of mucus from the nostrils. I desire particularly 
to call attention to the Hallerian view of the physiology of the act. 
It appears to me that the deep inspiration which we take previous to 
sneezing is really spasmodic, and due to a morbid (unusual) irritation 
of the centre of origin of the phrenic nerves. In support of this an- 
cient view we have the fact, that in cases of excessively prolonged 
sneezing (Brown-Sequard’s and Mosler’s cases) the pain complained 
of is located in the neighborhood of the diaphragmatic insertion. 
Could we prevent this first or preliminary act, we should always be 
able, it strikes me, to avoid sneezing. 
The cause of physiological sneezing usually consists in an irritation 
of the nasal branches of the trifacial nerve by congestion, dust, odors, 
mechanical or chemical contacts. In many persons the spasm is 
* J. Miiller, Manuel de physiologie, (ed. Littre), t. I. p. 278. Paris, 1851. 
t The Physiology of Man, vol. I, p. 395. New York, 1866. 
t Principles of Human Physiology, p. 333. Seventh edition. Lond., 1869. 
§ Albertus Haller, Elementa physiologic, loco cit. 
| Morgagni, De sedibus et causis morb. English ed., by Benjamin Alexander, M.D. Vol. I, p 
341, Letter XIV, art. 26, 27. London, 1769. . - 236 
E.' C. SE?GUIN. 
easily brought about by the action of light upon the conjunctivas (op- 
tic nerve also?). It has been stated that the application of a spirit- 
uous liquor to the anterior part of the palate may act as an excitant.1* 
I have been informed by a well-known medical man that, when a boy 
at college, he was in the habit of exciting sneezing in his own person 
by scratching a certain spot upon his head, near the vertex, and a 
little to one side of the median line ; thereby causing frequent dis- 
turbances in the class-room. Sneezing is spoken of by older writers as 
preceding attacks of epilepsy,f and one states that it is very 
commonly observed just before sexual congress. Romberg § states 
that one of the listeners to his lectures had informed him that he was 
obliged to sneeze whenever a salacious thought suggested itself to 
his mind. 
2d. Under what circumstances can sneezing itself merit the name 
of a disease; when does the act become pathological ? The older 
writers on medicine appear to have had their attention directed to 
this matter. Sauvages, || who recognizes six varieties of sternutation, 
says that epidemic sternutation had before his day proved so violent 
as to cause death. He does not give any reference to his authority 
for this statement, and I have been at some trouble to trace the re- 
port, and have found it attributed to an author named Polydorus 
Virgilius,whose work I have been unable to procure. Morgagni,** 
Bonetus,ff Albrecht,JJ Fabricius Hildanus,§§ and Lancisi|[|| are quo- 
ted as reciting fatal cases. Morgagni’s case is a good one ; an autopsy 
yielding negative results having been made. Bonetus does not speak 
from personal experience, but relies on the statement of a supposed 
eye-witness, Famianus Strada ; the subject sneezed twenty-four times, 
and expired during the twenty-fifth sternutation, it is supposed, from 
rupture of the vessels of the brain. Albrecht’s case is circumstan- 
tially related, and may be accepted. On reading Lancisi’s work 1 
found that he referred to the same case as Bonetus. We are, there- 
fore, willing to admit the existence of only three fatal cases, one of 
these being imperfectly recorded. Hildanus’s work I have not been 
able to consult. observed a case in which a deviation up- 
* De Lens, cited by Rullier, Diet, des sciences t. LIII, p. 578. 
tStalpart van der Wiel, Obs. rarior. med.—anat.—chir. Lugd. Batav., 1688. 
I Amatus Lusitanus, cited by van der Wiel, op. cil. 
§ Romberg, Nervous Diseases of Man, vol. I, p. 349, Syd. Soc. Trans. Lond., 1853. 
| Sauvages, Nosologie t. II. pp. 50-52. Paris, 1771. 
I Polydorus Virgilius, de invent, rerum. Lib. 6, cap. 2. 
** Morgagni, op. cit. Letter XIV. art. 27. 
+t Bonetus, Sepulchretum anat. vol. I. lib. 1. sect. xx. obs. xvii. Genevae, 1700. 
tt Albrecht, in Ephem. naturae curios. Dec. II. obs. xii. p. 38, 1687. 
§§ Fabricius Hildanus. C#it. I. obs. 24. 
IJLancisi, De subitaneis mortibus, p. 45. Romae, 1709. 
II Haller, op. cit. INHIBITORY ARREST OF THE ACT OF SNEEZING. 
237 
Weird of the eyeball was produced by violent sneezing. Erasmus 
Darwin* places sternutation in his Class II. (diseases of sensation), 
Ordo I. (increased sensation), and Genus I. (increased action of the 
muscles); together with diseases which he considers allied species, 
such as asthma, singultus, tenesmus, parturition (!) etc. Rombergf 
records an instance of sneezing extending over a period of four years ; 
and the case of a woman who was seized wnth violent sternutation 
whenever conception occurred—the fit of sneezing usually taking 
place in the morning. Sir Benjamin BrodieJ saw two cases of very 
severe and prolonged sneezing, in both of which profuse secretion 
of serous fluid took place from the nostrils. Among recent writers 
upon diseases of the nervous system Handfield Jones§ and Eulen- 
burg| have considered the subject in a systematic way, and the for- 
mer author has advanced the view that sternutation may sometimes 
be due to a central cause. Dr. Peter communicated a case 
of prolonged sneezing to the Obstetrical Society of Edinburgh oc- 
curring during the middle term of pregnancy, and ultimately causing 
abortion. On becoming pregnant a second time the woman expe- 
rienced similar fits of sneezing, beginning, as before, about the fourth 
month of gestation. A remarkable case has been described by Mos- 
ler,** as occurring in a young girl. The patient, previously rendered 
anaemic by various causes, became affected with an acute inflamma- 
tion of the meatus and deeper parts of the ear, and shortly afterward 
began to sneeze in very frequent paroxysms. The frequently re- 
curring spasm was very violent, and soon reduced the patient to a 
state of alarming prostration. For three days she was able to take 
but very little food, and obtained no rest; she became aphonic, the 
sides of the thorax corresponding with the diaphragmatic insertion 
became the seat of extreme pain, the pulse attained a rate of more 
than 120 beats per minute, the face was flushed, and the nasal and 
buccal mucous membranes dry. The ear was swollen and tender, 
and there existed much pain in the whole of the same side of the 
face. A warm bath, together with cold affusion to the head and 
spine, and two doses of £ gr. morphia put an end to the threatening 
disorder, after it had continued eighty hours, and after the patient 
had sneezed at the least estimate fifty thosuand times. A severe 
case of sneezing lasted over a week, and accompanying a first men- 
* Darwin. Zoonomin, vol. II, p. 222, Am. ed. Phil. 1797. 
+ Loco cit. 
$ Works, Vol. III. p. 173. London, 1865. 
§ C. Handheld Jones. Functional Nervous Disorders, pp. 644-46. Lond., 1870. 
| A. Eulenburg. Lehrbuch der functionellen Nervenkrankheiten, pp. 672-3. Berlin, 1871. 
1 Proceedings of Edinburgh Obstetrical Soc. in Edinb. Medical Journal. Nov. 1861, p. 49a. 
** Mosler, Virchow’s Archiv, Bd. xiv., s. 557-565. 238 
E. C. SEGUIN. 
sfrual period, is reported by Dr. Trautmann, Sr.* Cases of severe 
sneezing are also recorded by many of the older authors, among 
whom may be named Delius,f Lanzoni, J Schubart,§ the two Franks. || 
In the case of Delius the sternutation was allied with hiccough in the 
course of a malignant fever. Finally Dr. Brown-Sequard has told 
me of a case observed by him in which violent sneezing occurred 
during the progress of an inflammatory affection of one-half of the 
medulla oblongata, diagnosed during life, and verified by a post- 
mortem examination. In this patient, the pain caused by the spasm 
was about the base of the thorax, on both sides. 
The causes of pathological sneezing may be classified into local 
(nasal), central, and peripheral. The local cause may be an inflam- 
mation of the mucous membrane of the nose, vibriones irritating the mu- 
cous membrane (in hay-fever, the presence of a foreign 
body in the nostrils, (snuff, various other sternutatories, the larvie of in- 
sects, ** etc.). Concerning the causes of sneezing produced by mor- 
bid states of the nervous centres, we really know nothing. Perhaps 
many of the hysterical cases may be due to this cause. The causes 
acting from a distance are numerous. Uterine,ff intestinal,JJ pul- 
monary (asthma and whooping-cough), conjunctival or retinal irrita- 
tion may produce the spasm. 
In one of Romberg’s cases the§§ third branch of the trigeminus was 
found diseased before its exit from the skull. In Mosler’s |||| extra- 
ordinary case, inflammation of the ear, causing irritation of branches 
of the trigeminus, was undoubtedly the cause of the spasm. Moslei 
attempted to produce sneezing in dogs by direct irritation of the auri- 
cular filaments of the fifth pair, but without success. 
Treatment the most varied and extraordinary has been tried for 
the relief of morbid sneezing. Bartholinus, quoted by Haller, seems 
to have been the first to suggest irritation of a sensitive nerve of the 
face, between the angle of the eye and the nose, as a means of 
arresting the spasm. Haller speaks of the plan as if he had tried it 
himself. Morbid sternutation has been cured by the use of snuff, 
* Schmidt’s Jahrb. Bd. VIII. p. 50,/roni Summarium, Bd. X. Hft. 3. 
+ Delius, in Acta Phy*.—Med. Acad. Caesareae-Leopold-Carol. Vol. VIII. obs. cviii. p. 380, 1748. 
t Lanzoni, in idem. Vol. I. obs. lxiii. p. 117, 1727. 
§ Schubart, in Ephem. naturae curios. Dec. I. obs. cxxxviii. p. an, 1672. 
| J. Frank, Praxeos medicae universae precepta. Vol. II. p. 831. Cited by Romberg, op. cit. 
I Cited by Eulenburg, op. cit. p. 672. 
** Carpi in Harless Jahrbucher, Bd. I. Hft. I. Cited by J. Frank, Praxeos Medicae Uni- 
versae precepta, vol II. pars I. p. 965. 
ft Dr. Peter Young Loco cit. 
Dr. Little, in Obstetrical Soc. of Edinburgh, Edinb. Med. Journal, Nov., 1861, p. 493. 
§J Loco cit. p. 347. 
|| Loco cit. 
II Bauwens, cited in Med. Chir. Review, 1836, vol. II. p. 245. INHIBITORY ARREST OF THE ACT OE SNEEZING. 
239 
and Darwin * asserts that, “ when it is exerted to excess it may be 
cured by snuffing starch up -the nostrils.” Dr. Gairdner f strongly 
advocated the use of blisters to the nape of the neck, not only for the 
arrest of the spasm under consideration, but, also, for the cure of 
convulsive cough and hiccough. This means is perfectly analogous 
to that proposed by Bartholinus, Haller, Diday, and the author: 
an irritation varying in intensity being transmitted to the centres in the 
spinal axis which are about to furnish the motor impulse for the spasm, 
the activity of these motor centres is inhibited or arrested by the 
new (more intense ?) irritation. Romberg J advises the use of 
emetics. Eulenburg § recommends emetics, skin irritation (mustard), 
such tonics as iron, arsenic and quinia. An English bishop, subject to 
very harassing fits of sneezing, is mentioned by Watsonj| as having 
found an effectual remedy in dipping his head into cold water. 
Mosler controlled the case which he reports only by a combination 
of the warm body bath, and cold affusion to the head and back of 
neck ; a means which produced syncope in his weakened patient. 
A number of authors insist upon the necessity of removing the 
peripheral cause, irritation of uterus, etc., if any exist. It would seem 
as if these remedial measures might be properly classed under four 
heads. In the first place, means tending to allay the irritation of the 
nostrils (starch); in the second place, remedies which produce, or 
tend to produce, syncope, and its attendant lowering of nervous ir- 
ritability (emetics, warm baths, narcotics); in the third place, medi- 
cines which, like iron, quinia and arsenic, diminish morbid irritability 
by improving the nutrition of the nervous‘centres; and fourthly, in- 
hibitory means, such as cold to the head and neck, mustard and 
cantharidal irritation to the neck, inhalation of iodine (Eulenburg), 
and pressure upon the branches of distribution of the infra-maxillary 
nerve. This last measure is the one which has surely arrested or 
prevented physiological sneezing in my experience, and in that of 
many persons to whom I have recommended it. The upper lip is 
very convenient for this purpose, and the moderately painful impres- 
sion required is easily excited there by the pressure of the side of the 
index-finger. Whether this simple means would succeed in cases of 
pathological sternutation I will not venture to predict. Should it 
fail, I would suggest as producing a more intpnse irritation of the 
same nerves, the use of faradization of the skin of the same parts 
* Darwin, op. cit 
t J. Gairdner, on Anomalous Affections of the Respiratory Organ*. Ed.'nb. Med. and Surg. J. 
I]. p. 77. 1840. 
t Romberg, op. cit. 
§ Eulenburg, op. cit. p. 673. 
I Watson, Lectures on Physic. Am. ed. p. no. Phil. 1858. 240 
e. C. SEGU1N. 
(lips and cheeks near nose). The wire brush electrode should be 
used in connection with the secondary current, the skin to be thor- 
oughly dried, and even covered with starch-powder. It seems to me 
rational to anticipate good results, also, from the faradization of 
the nape of the neck in morbid sneezing, hiccough, or convulsive- 
cough ; after any existing peripheral cause shall have been removed. 
These irritations of sensitive nerves (pressure, faradic-current) trans- 
mitted centripetally by the filaments of the second branch of the 
fifth pair, or by those of the upper cervical nerves, exert an inhi- 
bitory influence upon the motor centres which are about to become 
active, viz., the spinal centre of the phrenic nerves in the first place, 
and, secondly, the extensive kinetic tract which is connected with 
the muscles of expiration. 
Various therapeutical applications of this method suggested them- 
selves to me at the time. 
a. Certain applications to medicine. In various forms of internal 
haemorrhage, especially that occurring in the nasal and pulmonary 
tract, it is highly desirable to avoid the jar produced by sneezing. 
The same indication exists in the course of development of those an- 
eurisms which fall to the care of the physician; for some days after 
the reduction of prolapsed rectum or uterus; or in the advanced 
stage of hepatic abscess, or hydatid disease. A minor use to which 
this inhibitory action may be put, is the prevention of such pains as 
are produced by shaking of the body, or by deep inspiration. 
b. Certain applications to surgery. Sneezing must be avoided 
after many plastic operations, and operations upon the vagina, uterus, 
or abdominal walls. After many cutting operations about the eye, 
absolute rest is highly desirable ; and is even more required in the 
cure of cleft-palate. Of course, under many circumstances, the 
arrest of hemorrhage may be made surer by the avoidance of sternu- 
tation. , 
The reader may, perhaps, pardon me if I add a non-medical para- 
graph. The custom of invoking a blessing upon persons who sneeze 
is a most interesting one. Several ef the old medical authors above 
referred to state that the custom dates from the time of a severe epi- 
demic (in which sneezing was a bad sign ) during the Pontificate of 
Gregory the Great. Brand,* however, and the author of an article 
in Rees’s Cyclopaedia,f state that the phrase “ God bless you,” as ad- 
dressed to persons having sneezed, is much more ancient, being old in 
the days of Aristotle. The Greeks appear to have traced it back to 
the mythical days of Prometheus, who is reported to have blessed his 
* Brand ; Observations on Popular Antiquities, Vol. Ill, pp. 119—127. Pond. 1849. 
+ Rees’ Cyclopaedia, Vol. XXXIV, art. Sneezing. INHIBITORY ARREST OF THE ACT OF SNEEZING. 
241 
man of clay when he sneezed.* In Brand, the rabbinical account of 
the origin of the phrase is given as originating in the alleged faot that it 
was only through Jacob’s struggle with the Angel that sneezing ceased 
to be an act fatal to man. In many countries sneezing has been the 
subject of congratulations, and of hopeful augury. In Mesopotamia 
and some African towns, the populace are reported to have shouted 
when their monarchs sneezed. 
* Alex. Ross’ Appendix to Arcana Microcosmi, cited by Brand. 
It would be unjust not to state that Diday (op. cit.) had suggested practical applications of his 
method, and that I became aware of this fact only after having matured the original parts of this 
article. 
♦Rullier. Article Sternutation, in Diet, des Sciences med. t. LI1. p. 577, 1831. 
Merlet. Est ne stemutatio naturalis actio ? Paris, 1654. 
Schneider. De osse cribriformi, etc. Wittemb. 1656. 
Schoock. De sternutatione: Amst., 1664. 
Alberti. Diss. de sternutatione. Lips. 1671. 
Birnbaum. Diss. de sternutatione, Lips., 1672. 
Forestus. Diss. de sternutatione, Argent. 1688. 
Forestus. Diss. de sternutatione, Argent. 1688. 
Hoffmann. (Maurice) Diss. ptarmographia physiologico-pathologico-therapeutica. Alt., 1710. 
Eyselius. Diss. de stern, praeternaturali. Erf. 1716. 
Rhanius. Diss. de more sternutantibus salutem apprecandi ejusque origine. Tigur, 1742. 
Unzer. Diss. de sternut. Hal. 1748. 
Porta. Diss. de sternut. Basil, 1755. 
Buuhner (A. L.) De sternut. commodis et incommodis. Hal. 1757. 
Faselius. Diss. de causis sternutationis ejusque effectibus. Jenau, 1765. 
Sidren. Diss. de sternut. Upsal. 1779. 
Van Leempoel. Diss. de sternut. Lovan. 1788. 
Metzger. Diss. de sternutatione. Regiom. 1796. 
Rega H. J. De sympathia, p. 240, Harlemi, 1721. ARCHIVES 
OF - 
Scientific and Practical Medicine. 
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Morbid Influences of the Nervous System on Organic Functions. 
Physiological and Pathological Proofs of Attraction of Blood by Tissues. 
Amaurosis and Deafness in Diseases of the Brain. 
Rational Treatment of Poisoning by Organic Substances. 
On the Various Kinds of Hemiplegia. 
On Counter-Irritation: Its Importance and Rational Use. 
Physiology and Pathology of Epileptiform Affections. 
On Pneumonia and other Lung Affections in Diseases of the Brain. 
On Reflex Paralysis and other Affections produced by a Reflex Influence. 
Analogies and Differences between several Remedies (Belladonna, Digitalis, the 
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Artificial Epilepsy in Animals, and what it Teaches for the Treatment of Epilepsy 
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On Transfusion of Blood : New Methods and Proper Conditions for its Use. 
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