Thursday, October 31, 2013

1862: Phoebus writes symptoms of 'summer catarrh'

Since Dr. John Bostock defined hay-fever for the medical community in 1819 and 1828, there was little mention of the ailment until Dr. Philipp Phoebus published a book titled "On the Typical Catarrh of Early Summer, or the so called Hay-fever or Hay-asthma" in 1862.  (1)

Dr. Phoebus was professor of medicine at the University Giessen in Germany. He describes six groups of symptoms, of which may vary from one case to another.

1.  Nostrils.  Severe catarrh (inflammation).  This results in "severe sneezing, which is very and frequent and recurs in paroxysms of ten, twenty, or more sneezing in rapid succession, coming on at short intervals; so that the sufferer may sneeze as often as several hundred times in the course of a day."

2.  Eyes.  Catarrh and increased secretions. The eye feels full, itchy and irritating.  The eye looks red and swollen.  Eyesight is weakened, and there is an intolerance to light. Both eyes are usually affected simultaneously.

3.  Throat. Pharynx is red, and swollen; there is intense itching of the fauces (back of the mouth behind the tongue) and posterior part of the soft palate; and this unpleasant sensation is aggravated by the ineffectual efforts which the patient makes to relieve it by moving the tongue about the mouth.  Sometimes there is difficulty swallowing. 

4.  Head.  Headache.  "Some more slight, but more frequently severe, and situated either at the forehead, which is hot and burning, at he occiput (back part), or over the whole of the head. The pain is often brought on and increased by the paroxysms of sneezing, and, assuming a neuralgic character, may extend along the course of the facial nerve, or into the external auditory passage. The patient complains of a constant feeling of irritation and itching about the forehead, the nose, the chin, and the ears."

5.  Lungs.  Mucus membrane of larynx to bronchi. Bronchial catarrh. Asthma. Dyspnea (shortness of breath). Cough may be insignificant or severe and loud. Expectoration may occur with this cough.  Irritation of larynx and trachea, and "feeling of weight and pressure within the chest; the patient's voice becomes muffled and coarse... The difficulty of breathing is occasionally very distressing, and wheezing, sibilant sounds may then be heard throughout the greater parts of the lungs. The attacks of dyspnea are more strongly marked towards evening, and continue through the whole of the night. It is in this class of cases that the patient's sufferings are the most severe.Generally, after having been asleep for one or two hours, or a longer period, the patient wakes up suddenly, gasping and struggling for breath, as if every moment would be his last; his eyes are protruded, his lips and face become livid, and ho eagerly throws open the doors and windows of his room in his ineffectual efforts to get more air, until at last he sinks down completely exhausted. When he falls asleep, his slumber is short and restless, and he is again aroused, after a brief interval of repose, by the same painful constriction across the chest, and difficulty of breathing. When the asthmatic symptoms are well-marked the dyspnoeal paroxysms come on earlier at night, or in the evening, and continue until the next morning."  These are thus called asthma attacks, or hay asthma, or periodic asthma.

6.  Nervous disturbance.  This is coupled with catarrhal fever. Shivering and cold perspirations with sneezing and coughing. "The patient is uncomfortable, restless, , and unfit to attend to his ordinary avocation, and complains of weariness, defective memory, inability to fix his attention upon what he is doing, and heightened susceptibility to external impressions. There is a sense of general irritability, and the least noise, draughts of cold air, and various trifling inconveniences, which at other times would pass unheeded, disturb and distress the patient very much; and his sufferings are too frequently increased by the want of sympathy and apparent disbelief of the severity of his ailment, shown by persons about him, who, enjoying perfect immunity themselves, cannot form any adequate idea of the extent of the patient's sufferings."

These symptoms generally "make their appearance suddenly, and remain for some weeks, or even, in severe cases, months." 

What brings on the attack?
  • Flowering of the grass
  • In the fields where a late crop of hay is grown
  • Emanations given out by decomposing leaves and other vegetable matter
  • Operation in low-lying localities, near stagnant water
Just think for a moment of suffering from the above mentioned symptoms in 1862 when there was absolutely nothing you could do for it.  I mean, there were remedies, but nothing even remotely as effective as what we have at our disposal today.  In the worse cases, modern medicines only take the edge off.

I can honestly say there have been many times I have suffered from the above.  I have experienced the burning, itchy eyes that I can't help but to rub, and this rubbing merely exacerbates the problem.  I remember the itchy throat, and scratching it by rubbing my upper palate to the lower, and sometimes by making a grunting noise that my family and friends teased me about. And this just made the itching worse. 

When I was a kid in the 1970s there was a warning on the package of antihistamines that said don't use if you have asthma.  My parents and doctors took this seriously, and so I often had to suffer much as a hay-fever sufferer would have in 1862.  There were many agonizing days and nights. 

As a sufferer myself, I can't help but to have empathy for these sufferers.  I can't help but to see them, and feel their agony.

 "Unless the length of the attack is abridged by medical means, the patient often remains for many weeks, at least, in deplorable condition, and is incapacitated from following his ordinary occupation."

References:
  1. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw, pages 17-24.  The quotations are from Smith's descriptions of Phoebus's ideas. 

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