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- thiazine. 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.