Thursday, October 24, 2013

1873: Blackley studies hay fever

Dr. John Bostock defined hay-fever for the medical industry in 1819, and by 1840 physicians in England and the United States were diagnosing patients with the disease.  The quest was on to better understand the condition, and the person up to the task was Dr. Charles Harrison Blackley, a surgeon from Manchester, England. 

He was born in 1820, and worked as a printer and engraver until he was 35.  He studied at Royal Manchester School of Medicine, and he qualified as a doctor in 1838.  Yet he did not receive his M.D. until 1854 in Brussels.

References:

  1. "Charles Harrison Blackley, 1820-1900," The University of Manchester: The John Ryland University Library: Manchester Medical Collection, http://archives.li.man.ac.uk/ead/search?operation=full&rsid=dc.title%20any%2Frelevant%2Fproxinfo%20%22William%20Charles%20Henry%22&firstrec=1621&numreq=20&highlight=1&hitposition=1638, accessed 9/13/14
  2. Blackley, Charles Harrison, "




and by the time he was 28, in 1848, he was diagnosed with the newly defined disease called hay-fever.  He wanted to learn as much as he could about his disease, and he "carefully read over most of the scanty bits of literature of the disease then existing," Blackley explained in his 1873 book "Hay-fever: its causes, treatment, and effective prevention." (2, page 8)

His quest frustrated him, as he wasn't able to generate any knowledge about the "nature of the cause," he writes.  "I was inclined to regard heat as the principle exciting cause, but my experiences did not quite coincide with the opinions of those who had written on the disorder, and this experience had, unfortunately, compelled me to come to the conclusion that until something more was known than I had learned from the writings of others, or from my own previous observations, there was no chance of escape from the annual torment. I had thus a personal interest in getting a more thorough knowledge than I then possessed of all the phenomena of hay-fever." (2, page 8)

So he decided to do experiments.  At first he tried to find subjects to experiment on, yet only a few volunteered.  So this basically forced him to resort to experimenting on himself, which he started doing in the year 1859.  Surely there were some who criticised him for this, although his experiments were so well founded that they were readily accepted by the medical community.  (2, page x)

John Fry, in his 1963 article "The Natural History of Hay Fever," which appeared in the Journal of the College of General practice, wrote that hay fever was usually diagnosed "in patients who presented with characteristic bouts of sneezing with dry nose and running eyes during the 'hay fever season' between the end of May and the end of July." (1, page 260)

Fry explains that by the mid 19th century many studies were performed on the reproduction of plants, and it was determined that plants reproduce sexually, and pollen was discovered.  It was learned that some plants were pollinated by bees and others by wind. (1)

Also at this time there were many new ideas to explain diseases.  One of the greatest scientists of the 19th century was Louis Pasteur (1822-1895).  He performed many studies and became among the first physicians to believe -- and prove -- that diseases were caused by tiny microbes. (1)

Pasteur proved that by injecting small amounts of proteins from harmful microbes into a person you could protect people from certain diseases, and even cure some diseases (such as rabies).  This type of therapy was referred to as prophylaxis, which means protection from. (1)

So other doctors soon picked up on Pasteur's ideas. Fry explains that Dr. Blackley believed his own hay-fever was the result of exposure to grass pollen not hay.  So he decided to perform tests on himself to prove his theory.  In 1873 he published his work in a book called "Experimental Researches on the Cause and Nature on Catarrhus Aesivus (Hay-Fever, or Hay-Asthma)." (1)(2)

Blackley made two significant observations about hay fever:
  1. It was caused by grass pollen, not hay
  2. It was a disease of the educated, upper class and wealthy, including physicians and clergy
Terry Allen Hicks, in his book "Allergies," (2006, China, page 40) describes how Blackely saved some grass pollen in a jar until winter.  When all the grass was dead he opened the jar, inhaled, and almost immediately started sneezing.  He thus proved that allergy symptoms were not caused by hay but pollen.  Yet despite this evidence, the term 'hay fever' stuck. (3)

Blackley performed another test on himself where he "inserted pollen into a small cut on his skin and a rash developed within 20 minutes.  He later determined that this test proved he was allergic to pollen, and his experiment became the first ever allergy skin test.  Today's allergy testing is similar to what Blackely used," wrote Paul Ehrlich and Shimer Bowers in their 2008 book "Living with Allergies."  (5)

Bostock believed hay fever was a condition of the upper and middle classes.  Philipp Phoebus came to the same conclusion.  William Abbotts Smith considered this theory, although he writes that he witnessed "many well-marked cases of Hay-fever amongst the poorest classes."  (7, page 36)

Blackley tended to agree more with Bostock and Phoebus.  He said he experienced only two cases of working class people with hay fever, and therefore concluded the disease to be an "aristrocratic disease." (2, page 6)

Gregg Mitman, in his 2007 book "Breathing Space," explains Blackley's thinking on this subject.  He writes that...
 "before the industrial revolution... a large portion of the population in England was exposed to the atmospheric conditions of country life, either through the cultivation of the soil or the production of woolen, linen, and cotton goods, largely in rural villages and towns.  As England's population increased, large numbers of people moved from the 'country to the workshops and mills of towns.'  In doing so, they removed themselves from pollen and other exacerbating factors to which agricultural laborers were continually exposed.  At the same time, the influx of population into cities, where greater educational opportunities, wealth, and luxury prevailed, created circumstances 'favorable to the development of the pre-disposition to hay fever.'  The frenzied pace of urban life, the mental demands of modern business, and the removal from nature, which could fortify the body and calm the hurried mind, had strained the nervous system of the city's educated and well-to-do classes.  'As population increases and as civilization and education advance,' Blackey warned, hay fever 'will become more common'" (2, page 14)
So Charles Blackley was a significant contributor to the knowledge of hay fever.  Of interest is that his theory about hay fever being a disorder of the upper class is an idea that still emulates in the medical community.  A new theory is that it's a disease that develops because the immune system isn't exposed to enough germs, and therefore the immune system doesn't develop properly, and hay fever (allergies) and asthma develop. A theory now is that it's a disease associated with modern civilization. He passed away in the year 1900.
References:
  1. Fry, John, "The Natural History of Hay Fever," Journal of the College of General Practice, 1963, 6, page 260
  2. Blackely, Charles Harrison, "Hay-fever: its causes, treatment, and effective prevention," 1873, 1880 2nd edition, London, Bailliere
  3. Hicks, Terry Allen, "Allergies," 2006, China, page 40
  4. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press
  5. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
  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, reference from "Experimental Researches on the Cause and Nature on Catarrhus Aesivus (Hay-Fever, or Hay-Asthma), by Dr. Charles Blackly, London, 1873
  7. 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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