Thomas L. Shearer, M.B., C.M., Edinburgh, Baltimore, Md.

      It is only fair to the members of this society to state that, in this short paper, I have no intention of inflicting upon them an enumeration of all the various remedies, with indications, that may be employed in the treatment of catarrhal troubles; but I merely wish to bring to their notice a few medicines whose action is almost specific in certain conditions of the air passages. Nowadays so much time and space are devoted to these on the surgical treatment of nasopharyngeal disease and so little thought apparently given to the medicinal part of the subject that it seems only proper that we roam a bit in the latter field. Naturally where one encounters adenoids, nasal growths, pronounced septal deviation – with or without spurs – that obstruct nasal respiration, or any of the other pathologic states that require surgical interference, that treatment should be carried out; but one should protest against wholesale removal of little spurs whose only offense is that they exist in a breath way without causing any obstruction to respiration, and against a dozen other minor conditions of a trivial nature which are detected by the searchlight eye of the most enthusiastic rhinologist. Had nature intended us to cut all of these trifles away we would have been born with a saw tied to our necks for the purpose. This state of affairs is a crying evil, and is well named by Sir Felix Semon, of London “the lust for operation.” Excluding, however, the cases that really require operative interference, one encounters occasionally instances in which a simple catarrhal process exists, in which thee patient complains of an obstinate postnasal discharge of clear mucus, or of a discharge – either bland or offensive – from the nostrils, and which can not be traced to any particular sinus; it is to a remedy for such conditions that your attention is first asked. It is a curious plant and is obtained from a strange locality, it bears the name of

Lemna minor

      Dr. Robert C. Cooper, of London, in 1894 was the first one to experiment with it and to describe its sphere of action; strange to say it has not become as well known as it deserves. The plant is a form of the lowest phenogamous vegetation. It consists of lenticular floating fronds composed of stem and leaf together and bearing thee flowers in slits in the edge. It forms the green scum found on stagnant ponds and dykes. It is found in two varieties, the lemna minor and the lemna gibba. The special action of the plant is upon the nostrils – the Schneiderian membrane. Its most striking indications for use are either a putrid smell in the nose or a loss of all sense of smell or taste, and a putrid taste in the mouth, especially on rising in the morning, with a general foulness in the mouth, due apparently to the dropping down of impure material from the postnasal region. “Along with this there may prevail a disposition to noisy diarrhoea.” The patients have their symptoms aggravated in damp and rainy weather. At times pain in thee eyes during heavy, rainy weather, with drowsiness during the daytime and restless sleep at night exists, and the pallid, dullish, sickly look in the face so often associated with long standing infection from nasal catarrh is also present. Lemna will relieve both of these symptoms. In atrophic rhinitis, where the crusts and muco-purulent discharge are abundant with fetor, its action is very marked. It modifies the secretions to such an extent that we can the more readily improve the condition of the nasal chambers with the aid of local measures. Whether the remedy has the power to either prevent or even retard the process of atrophy itself remains to be seen. In another class of cases in which general turgescence due to swollen, relaxed turbinates blocks the nostrils completely, Lemna surpasses the action of any other remedy. Again, we have all encountered instances of nasal polypi that, in spite of the most thorough repeated surgical removal, insisted upon fresh formation. That most characteristic feature of nasal polypi – the tendency to swell up in damp weather and thus further hinder nasal respiration – is relieved in a wonderful way by Lemna minor. It does not either kill, cure or in any way get rid of the growths, but it diminishes their succulence and thus reduces their volume and also lessens the influence of wet weather to which such subjects are prone, and this is no small boon, as most of us know after repeated failures with remedies like calcarea carbonica and teucrium marum verum – so highly recommended for this condition. In cases suffering from simple, glairy mucoid postnasal discharge, and where no surgical treatment is indicated, Lemna is invaluable. Again, after operation on the nose and throat, where some discharge still persists, this remedy should be given a trial. This latter remark also applies to sinus disease, in which, as in the antral form, the fetor is so annoying. In acute coryza Lemna often acts very well by reducing the swollen turbinates, but its sphere of action is essentially in sub acute and chronic conditions. An important point concerning this plant is the question of size and the frequency of dose. Cooper prescribed the tincture, while Burnett preferred the 3x dilution. From considerable experience with it I am inclined to recommend either the 1x or 3x dilution; preferably the 1x dilution if it does not produce twisting intestinal pain and diarrhoea. Where such secondary effects do follow its use or where the pharynx is already too dry, the 3x dilution is best. Five drops in a spoonful of water night and morning is the usual method of administration. In very profuse discharges – nasal or postnasal – the remedy can be taken three times daily great care must be taken to insure reliability of the preparation.

Apocynum Cannabinum

      This remedy – Commonly known as Indian hemp – is an excellent agent in cases of chronic nasal catarrh with a tendency to acute stuffiness, complained of especially at the bridge of the nose, with thin, watery or thick, yellow discharge, and where the memory is dull and sluggish. The discharge seems to be derived from the nasal mucous membrane itself, and is not, apparently, of sinus origin. Dull headache is often present. It acts well in people whose nostrils become congested and blocked up easily, who take cold readily. The dose is five drops of 1x dilution twice daily in sub acute rhinitis, or only once daily where the medicine is taken for months in order to overcome the tendency to attacks.