From my experience with patients I doubt whether many of them would submit to the intra-nasal spark. A theoretical objection to using any form of high frequency or diathermia on the outside of the nose is that, in some skins, frequent application of these currents causes a permanent dilatation of the capillaries of the skin, resulting in permanent redness. I tremble to think of the wrath of the fair lady whom you should cure of the hay fever by endowing her with a permanently red nose. I know that these currents are used on the face freely by dermatologists and have often made a few applications to break up a catarrhal cold; but I have seen cases enough of capillary dilatation and its intractability to make me pause and choose for the nose and face the surely safe faradic current rather than the more spectacular but risky high-frequency. CHAPTER VI _HAY FEVER AS URTICARIA_ The fundamental error in all the literature on hay fever is the teaching that the lesion is a peculiar kind of catarrhal inflammation; whereas it is not an inflammation at all, catarrhal or any other kind. The symptoms of hay fever _resemble_ those of catarrhal inflammation, but the resemblance is only superficial. The resemblance is striking and must be so to have deceived so many skilled observers, but it is only superficial, nevertheless. When you see a patient with eyes red and swollen, overflowing with tears and mucus, burning and sensitive to light, you say at once, catarrhal conjunctivitis. In the nose the sneezing, the discharge, the obstructive swelling suggest at once catarrhal rhinitis. But stop a moment. Did you ever cure a catarrhal conjunctivitis or rhinitis in three minutes by moving the patient from one room to another? You can do that with hay fever. If you can remove the patient from the irritating atmosphere, the swelling and redness will subside rapidly, the discharge cease, and in five or ten minutes you would scarcely know by examining the patient that there was anything the matter with his eyes and nose. By returning him to the irritating atmosphere the symptoms will return instantly. By removing him again, they will rapidly subside. I have watched this many times in my own eyes. It was in watching the changes in my own eyes and nose that I realized that this was no catarrhal inflammation but a much more superficial lesion. Did you ever see a catarrhal conjunctivitis that acted in this way or a cold in the head in which the patient could be cured and catch a fresh cold twenty times a day? I think you never did. A true inflammation requires time, a few hours, for its development, and when an inflammatory exudate oozes into the meshes of the tissue, it requires some days or at least some hours to be absorbed. This one point of rapid appearance and rapid disappearance would forbid our calling the lesion of hay fever a catarrhal inflammation.