[Reprinted from The Medical News, December 17, 1892.] 
THE TREATMENT OF HAY-FEVER BY MEANS 
OF COCAINE PHENATE. 
By D. BRADEN KYLE, 'M.D., 
OF PHILADELPHIA. 
The subject of hay-fever has been so thoroughly 
studied as to its etiology, pathology, and treatment, 
that one hesitates, even in the line of treatment, to 
bring forward anything new on the subject. The 
existence of many theories as to the cause, the 
pathology, and also of the various plans of treat- 
ment, points to the unsatisfactoriness of our treat- 
ment of this troublesome affection. 
The theory advanced by Dr. Sajous appears to me 
to be the correct one—i. <?., that there are three 
essential features in the production of hay-fever: 
i. An external irritant. 2. A predisposition on 
the part of the system to become influenced by 
this irritant. 3. A sensitive area through which the 
system becomes influenced by the irritant. 
The best plan of treatment, both upon theoretic 
and practical grounds, is at once suggested—remove 
the sensitive area. Many patients object to the use 
of the cautery, and the physician has to resort to 
less radical treatment, the object of which should be 
to diminish the irritability of the sensitive areas. 
The chemical combination of carbolic acid and 2 
cocaine would appear to form an admirable drug for 
this purpose. 
Having used with success the aqueous extract of 
witch-hazel (selected on account of its astringent 
properties), I combined cocaine phenate with this 
drug. As the cocaine is insoluble in the witch-hazel, 
I first dissolved the former in alcohol, and then 
added it in the desired proportion to the witch- 
hazel. The solutions used varied in strength from 
i to io per cent. The cases in which this com- 
bination was used were those that refused treatment 
by cauterization of the sensitive areas. They were 
all characterized by the common symptoms of the 
disease, which are too well known to justify repeti- 
tion. Three were cases in which the attacks were 
recent, that is, the disease appeared during the past 
year for the first time; and five cases varied from 
three to seven years in duration. In two there was 
hypertrophy of the middle turbinated, with marked 
thickening of the mucous membrane. In one there 
was slight deviation of the septum to the right; 
and in two cases there were marked asthmatic 
symptoms. 
The plan of treatment was as follows: First, 
I cleansed the nasal mucous membrane with an 
alkaline solution. I then applied to the sensitive 
areas by means of cotton pledgets the 8 per cent, 
cocaine-solution, keeping this in contact with the 
parts for at least ten minutes, followed by a spray of 
a solution of the same strength. The result was a 
diminution of the hyperesthesia, lessened conges- 
tion, and relief of the constant coryza and sneezing 
that are so annoying in these cases. The treatment 3 
failed to benefit the cases in which there was marked 
hypertrophy. I then removed the thickened mem- 
brane, and the result was a partial relief. 
In the cases in which the solution was injected into 
the sensitive areas the results were more rapid. This 
accorded with the theory that has been advanced 
that the drug coagulates the albumin in the tissues, 
thereby rendering absorption slow, and leaving the 
cocaine in contact with the tissues for a longer 
time, with lessening of the danger of systemic 
action. 
The effect was most marked in the cases charac- 
terized by reflex asthmatic symptoms. In these a 
spray of the 8 per cent, solution was used. In one 
patient, who for three years had suffered for from 
four to six weeks during the attack, the treatment 
began with the first appearance of the trouble, and 
in five days all symptoms disappeared, not to re- 
turn. 
The results in the other case were equally good, 
with a slight return after the patient had taken a long 
drive, and with exposure to the emanations of rag- 
weed. This was relieved by a few applications of the 
solution. This attack was slight, and characterized 
by a sensation of irritation, but by none of the marked 
symptoms that usually accompany this disease. 
Knowing how uncertain as to permanent results the 
treatment of hay-fever has been, we dare not draw 
too positive conclusions from these few cases. Pos- 
sibly this treatment will only prove palliative, and 
the next season may be marked by a return of the 
disease, but even temporary relief is a source of 
great satisfaction. We are aware of the experience 4 
of others, who, after having used a certain plan of 
treatment successfully in many cases, were doomed 
to disappointment by their sure cure failing in the 
next case, and by their permanent cure being fol- 
lowed by a prompt return of the disease the next 
year. 
1632 Chhstnut Street.