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RHINORRHOEA                                       47

fibres relay while the sympathetic ones do not. The parasympathetic nerves
cause vasodilatation and increased nasal secretion, and the sympathetic
fibres have the opposite effect. Alterations in temperature and humidity of
inspired air may rapidly produce vasodilatation when the temperature falls or
vasoconstriction when it rises, and this is as true of the atmosphere as it is of
central heating. There are certain drugs which have a similar effect. The
sympatheticomirnetic drugs, such as adrenaline, ephedrine, neosynephrine,
2-aminoheptane sulphate, amphetamine and Propadrine produce a vaso-
constriction rapidly or, at least, within 2 hours. They also produce a watery
discharge in the nose and an irritative condition of the mucous membrane
leading to a secondary vasodilatation, called the 'rebound* effect. Of the drugs
named, adrenaline and ephedrine give rise to this most rapidly, which explains
why adrenaline should not be used as a nasal pack for epistaxis. The para-
sympatheticomimetic drugs, such as neostigmine and carbachol, produce
nasal vasodilatation together with excessive secretion and sneezing.

Certain antihypertensive drugs may have the effect of upsetting the vaso-
motor balance. Methyldopa (Aldomet, Dopamet, Hydromet, Medomet)
block the sympathetics, while guanethidine sulphate (Ismelin) blocks the
postganglionic adrenergic neurons. Reserpine (Abicol, Adelphane, Serpasil)
may cause vasomotor instability, as may the psychotropic drugs, e.g. pheno-

The endocrine glands also have an effect on the nasal mucosa, hyper-
thyroidism raising the intranasal temperature to cause vasoconstriction while
hypothyroidism may give rise to pale, boggy nasal mucous membrane.
Hormonal factors, such as puberty, periods, sexual intercourse, pregnancy and
the menopause, may upset the vasomotor balance, as may the contraceptive
pill. Emotionally, fear results in vasoconstriction, while anger, resentment,
frustration, humiliation and anxiety have the reverse effect.

The condition of vasomotor rhinorrhoea is thus commonly found in
individuals of the type prone to anxiety, frustration or humiliation who may
erupt in anger or nurse a resentment. It is common to both sexes, but
particularly women, up to middle age. In men the underlying cause may lie in
their work, while in women it may be due to stresses at home or at work.

SYMPTOMS, The complaints are of nasal stuffiness or of excessive nasal
secretion or postnasal secretion, or both stuffiness and secretion. The affected
side may vary from day to day, or from hour to hour, which adds to their
frustration. The explanation lies in the physiological fact that there is an
alternating vasodilatation and vasoconstriction in each side of the nose, and
that these cycles become exaggerated. Nose blowing is frequent and ineffectual
in improving the airway in spite of the constant use of paper handkerchiefs.
Nasal symptoms worsen on changes of temperature or humidity, and bursts
of sneezing first thing in the morning are commonplace. There may be other
complaints, including facial neuralgias, headaches 'like a vice% and general
malaise or fatigue.

CLINICAL FEATURES. Anterior rhinoscopy reveals large, turgid inferior
conchae, the mucosa being rose-red or a more dusky shade. There may be
hypertrophic fringes on the conchae and nasal polypi are occasionally
found. Radiography of the sinuses is usually unrewarding. Allergy may be
excluded by skin tests, and by the inability to demonstrate eosinophilia in
the blood or nasal secretions.