Tuesday, May 14, 2013

1820-1870: An ailment called Hay Fever

By the 19th century there were enough people suffering from seasonal sniffling and sneezing that certain physicians started taking a closer look at these symptoms, often referred to as hay-fever or rose-fever, especially if the physician himself was a sufferer.

This is exactly what happened on March 16,  1819 when Dr. John Bostock described his own "condition of catarrhal inflammation of the eyes and chest that appeared regularly each year during the early summer season," according to Gregg Mittman in his book "Breathing Space." (1, page 12) (also see 8, page 3)

Catarrh (catarrhal) is a 19th century term that refers to inflammation of the respiratory passages, particularly the nose, that results in a runny nose.

Bostock described his condition to the Medico-Chirgical Society, along with twenty-eight cases where patients suffered from a similar condition.  By 1828 he came up with a name for this ailment: "'Catarrhus Aestivus,' or 'Summer Catarrh.'" (1, page 12)(5, page 11)(8, page 3)

Yet despite Bostock's definition, hay-fever "still was not recognized as a distinct disease by the profession," writes William Clarence Hollopeter in his 1898 book "Hay-fever and it's successful treatment." And Bostock rejected to the term hay fever because he believed "hay-fever" not caused by hay but(10, page 19):
  • Moist heat
  • Dust
  • Sunshine
  • Fatigue 
Regardless, Hollopeter notes that he finds it "remarkable that the profession in England were unfamiliar with hay-fever when their king, George IV, was a sufferer from it." (10, page 19)

Dr. George Beard, in his 1876 book "Hay-Fever; or Summer Catarrh: It's Nature and Treatment," said that in 1828 Dr. MacCulloch wrote an essay called "An Essay on the Remittent and Intermittent Diseases," where MacCulloch described hay fever as being caused by "hot houses and green houses," and that it was "caused by hay-fields."  (5, page 11)(also see 8, page 4)  Although Hollopeter notes MacCulloch advocated nothing new of the disease. (10, page 19)

Bostock tended to agree that heat had something to do with hay fever, but he doubted that hay had anything to do with it.  Beard said that Bostock "cited a number of facts from his own experience which went to show that, in his case at least, heat and direct rays of the sun had more to do with the disease than any other traceable exciting cause. He states that one season he walked out frequently among acres of hay-grass, and suffered less than usual, except when it was very hot. Dr. Bostock, however, admits that in some persons the disease was apparently brought on by hay; but he was sufficiently skeptical on the subject to suggest that possibly they might be exposed to hay and heat at the same time, and confound the effects." (5, page 12)

In 1829 Dr. W. Gordon wrote a paper where he "took the view that hay-fever was caused by the aroma of the flowers of grass, and especially of the Anthoxanthum odoratum. This writer had observed that the disease usually comes on as soon as this plant flowers, and disappeared about the time that this plant disappeared; and he stated that after the death of this plant patients could go through meadows without suffering. He believed that grass, and not hay, was the cause, and that the disease should be called grass-asthma.
 (6)

In 1831 Dr. Elliotson of England described hay-fever, and two years later and agreed with Dr. Bostock that the disease was not caused by hay, but opposed Dr. Bostock's claim the disease was caused by heat.  He believed grass was the main cause, according to Hollopeter. In 1841 Dr. Ramadge believed it was caused from "effluvia from flowers," Hollopeter adds.  (10, page 19)

Other physicians described patients with this ailment.  Many physicians reported this as being associated with wheezing and asthma.  Some physicians noted that asthma was worse during the dog days of summer.  (1, page 12) (5, page 11)

In 1837, any patient seeing Dr. J.J. Cazenave of Bordeaux, and who complained of hay-fever symptoms, were encouraged to wear goggles to protect their eyes from irritating matter.  As far as Morell Mackenzie is concerned, this was probably the first time a physician recommended protection to prevent hay fever. (11, page 15)

Mackenzie explains that Cazenave also "attempted to prepare the nasal mucous membrane for the enemy's attack by hardening it with nitrate of silver.  Cazenave attributed the complaint to the effect of light, and does not seem to have known that it had been described before." (11, page 15, 16)

In 1850 Dr. Gream "observed the symptoms of asthma were releaved after a fall of rain, and he argues that the laying of dust was the explanation; and, further, he maintained that the malady was peculiar to the summer, because at this season there was more dusts of various kinds in the air," writes Beard.  Gream believed indoor dust was just as much as an exciting factor as outdoor dust, and may have been the first to postulate this theory, notes Beard.(7)

The first to notice the difference between summer and fall hay fever was Dr. Swell from New York in 1852.  (11, page 15)

In 1859 Dr. Henry Hyde Salter, the formost asthma expert of the 19th century, refers to hay asthma as periodic asthma, in that it comes and goes with the hay season, which usually lasts 4-6 weeks.  Like other experts, he believed the exciting factor was "bright, hot, dusty sunshine."  He also blamed laughter, eating too much and hay. (5, page 14)

Also in 1859 Laforque of Tououse defined two cases of hay fever, and he described the condition as neurotic, a conclusion many of his contemporaries would also come to.  He described it as "neurotic in its origin and as being directly excited by heat."   In 1860 Dechambere was convinced "'an occult atmospheric influence' was the cause of the disease." (11, page 15)

So there were various physicians with varying oppinons on what caused hay fever.  It was heat.  It was hay. It was flowers.  It was grass. It was dust.  Some studies were perfomed, but mostly these physicians used their own experiences and observations with their own asthma, or that of their patients.  Still, the wisdom shared was mostly based on the best data available at the time. 

By the 1860s, Mittman writes, Hay Fever or Hay Asthma became a common terms used by the medical community,  (1, page 12) although some continued to use hay asthma.  In 1862, Mackenzie writes, Dr. Phoebus of Giessen, who formed opinions on hay fever from witnessing only one case, sent out flyers to various patients and obtained organized statistics about hay fever and came up with "a complete theory about the disease. I write further about phoebus here.  (11, page 17)

Another thing to note about Dr. Phoebus is that he was probably the first person to write about the link between air pollution and hay-asthma.  He referred to the substance in the air that is naturally occurring (and also a pollutant) as ozone.  Although Charles Blackley breathed the substance in his office for six hours with no effect on his hay fever. He was also among the first to note that dust might cause hay fever. (11, page 35)(8, page 79-90, 91))(I will write about this experiment in another post: See What causes Hay Fever)

Dr. Smith Abbots, Pirrie, and Moore also pulished pamphlets describing various theories about hay fever, "all, more or less, showing a disposition to limit the cause of its development to emanations from plants," Mackenzie writes.  (11, page 17)

Beard explains there's no way to know where the term "Hay Fever" originated from, although "probably it first became known among the people, who observed that the symptoms were brought on or made worse during the hay-making season." (5, page 12)

Other names used to describe related symptoms were: June cold, July cold, and rose cold.  (5, page ii)  Generally the symptoms were the same, and the diagnosis was based on the season.  Yet the most common term associated with them all, regardless of the season, was Hay Fever.

Much like asthma, hay fever left no scars inside the body, other than inflammation (catarrh) that went away in time.  So the condition, like asthma, was soon theorized to be a nervous affection. (5, page iii)

References:
  1. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press
  2. Taylor, C.F., editor, "The Medical World," volume 16, 1898, Philadelphia, 
  3. Fry, John, "The Natural History of Hay Fever," J. Coll. Gen. Practi1, 1963, 6, page 260
  4. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
  5. Beard, George, "Hay-Fever; or Summer Catarrh: It's Nature And Treatment," 1876, New York, Harper & Brothers
  6. Beard, ibid, pages 12 and 13, referenced by Beard from Dr. Mr. W. Gordon's paper "Observations on the Nature, Cause, and Treatment of Hay-Asthma," London Medical Gazette, 1829, vol. iv, page p. 266
  7. Beard, ibid, pages 13 and 14, referenced from "On the use of Nux Vomica as a Remedy in Hay Fever, Lancet, 1850, vol. 1, page 692
  8. Blackely, Charles Harrison, "Hay-fever: its causes, treatment, and effective prevention," 1873, 1880 2nd edition, London, Bailliere
  9. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw
  10. Hollopeter, William Clarence, "Hay-fever and it's successful treatment," 1898, Philadelphia, Blakiston's Sons & Co.
  11. Mackenzie, Morel, "Hay fever and paroxysmal sneezing," 5th ed., 1889, London, J&A Churchill

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