Thursday, November 28, 2013

1876: The nervous theory of hay fever x

Hay-fever sufferers, much like asthmatics, look like normal, healthy people between episodes.  So once the disease was defined by John Bostock in 1819, physicians were quick to conclude that hay-fever, like asthma, was a nervous disorder.  Yes, your hay fever is all in your head.

Well, surely your symptoms weren't all in your head.  The itchy eyes, nose and throat, the watery eyes, the sniffling, sneezing and wheezing are real.  But the cause of your symptoms is indubitably caused by a  a nervous temperament.  Surely you can get the condition without being nervous, but this was more the exception than the rule.

It appears that the champion for the nervous theory of allergies is our good friend, the physician George Miller Beard, the standing head of the United States Hay Fever Association. He explains that: (1, page 77)
"In order to induce an attack, there is necessary first of all a predisposition, frequently hereditary, to special and excessive sensibility of the nerves supplying the affected parts.
"The debilitating influence of heat and the external irritation of a large number of vegetable and other substances are exciting causes merely, widely varying in their effects with different individuals, and of themselves are powerless to induce, or at least to sustain, an attack. As the disease depends mainly on the individual predisposition, no two cases will be precisely alike, but all will differ as individuals differ."
Now, it is important to note here that by implying that hay fever sufferers are "nervous" in no way am I implying that people who have hay fever are goofy in the head, or mad or insane.  This is farthest from the truth.  Dr. Beard explains: (1, page 85)
"Skepticism of this sort comes from an entire misconception of the meaning of the term nervous. Nervousness is assumed to signify debility—of body or of mind, or of both; and to show itself by paleness, emaciation, and incapacity for muscular or cerebral toil. Of all popular delusions, none are more baseless than this. The nervous temperament—even the nervous diathesis, and various manifestations of that diathesis—may coexist with an imposing physique, and with both the appearance and the reality of high health. Physiology and pathology may thus go hand in hand; few people are wholly sick or wholly well; in certain directions we maybe diseased or liable to disease—in all other directions we may be almost absolutely strong."
So the underlying disposition among hay fever sufferers is a nervous temperament, and this predisposes them to the effects of a variety of causes, such as dust, ozone, plants, flowers, grasses, hay, animals, and of course pollen.

Evidence?  Yes, you want evidence.  Dr. Beard provides the following:
  1. It's hereditary character:  Because it runs in families makes it nervous.  "From this we justly conclude that the disorder is of a constitutional character, in the sense that a tendency to it is innate in the organization.  Since dust and pollen don't trigger hay fever in most people, they are thus deemed tetriary or secondary causes.  The primary cause must be something inert, like the nerves.  The descendents of those who suffer from it are the ones most likely to also suffer from it.  "Parents who are of the nervous diathesis, and who illustrate this diathesis by sickheadache or hysteria, may have children and grandchildren among whom prevail many nervous symptoms, of which hayfever is but one."(1, page 79-81)
  2. It prevails mostly among those who have nervous diathesis:  People most likely to have it have stressful brain jobs, are educated, upper class, and have an "active emotional nature," and it seems to "develop with the progress of civilization...As would logically be expected, it is oftener met with in cities than in the country, is more marked and more frequent at the desk, the pulpit, and the counting-room than in the shop or on the farm."  It is more likely to be prevalent in those who "overwork" the brain (brain or desk job) as compared to overworking the muscles (outdoor job, farming). It is more prevalent in the nervous melancholy person (the thinker) as compared to the relaxed phlegmatic person (the relaxer).  (1, page 81-87)
  3. It is peculiar to modern civilization, and most prevails in most climates and countries where other functional nervous diseases prevail:  "We have seen already that hay-fever is a disease of the nineteenth century; it has arisen side by side with neuralgia,with nervous dyspepsia, and allied disorders, of which the eighteenth century knew little or nothing.* There are physicians who can recall the time when neuralgia, now the heir-loom of all well-to:do families, was an unknown word, and when nervous dyspepsia, now so common as to excite no comment, was unheard of."  Hay fever is also seen more in the U.S. and Britain, countries that are more civilized.  Some in Europe call it the English disease, considering it's more prevalent there than in other less civilized countries of Europe. (1, 87-89)
  4. The symptoms of the disease, from first to last, through all the stages, are largely of a nervous character, and are made better or worse by mental influences: Consider the following nervous symptoms prevalent in most, but not all, hay fever victims: (1, page 90)
    • Lassitude
    • Sleeplessness
    • Poor appetite
    • Depression
  5. It sometimes appears to take the place of other diseases, and to be replaced by them:  Physicians have noted that patients with upset stomach, for example, noted their symptoms of that ailment went away as soon as the hay fever struck, and returned when hay fever symptoms disappeared.  Ironically, I have noted this same thing.  I once remember telling my mom I have never been nauseated and short of breath at the same time.  It's an interesting observation and I can see by my own personal experience how it might be thought of.  (1, page 92)
  6. It is affected for better or for worse largely by those influences that operate through the nervous system:   The remedies of the symptoms prove the illness is "under the influence of the mind.  Symptoms come on during periods of overwork and emotion, and remedies to relax the patinet seem to make the symptoms go away.  Likewise, "the remedies that thus far have been of the highest service for the relief of the symptoms, as quinine, arsenic, electricity, stramonium, alcohol, opium, ether, are pre-eminently nerve remedies, and in all the diseases for which they are used accomplish their results directly through the nervous system. Hygienically it is found that cold, of any kind or from what ever source—cool land-breezes, cool sea-breezes, the coolness of elevations or high latitudes, or a cellar or dark room —never fails to relieve; and for a large number of nervous states cold is one of the most potent of tonics."  (1, page 92-94)
  7. Three factors are needed for hay fever symptoms to be present:  Symptoms are only present when all three of the following are present (removal of any one makes the symptoms go away, or not appear): (1, page 94)
    • Predisposition
    • Heat
    • External irritant (dust, pollen, etc.)
  8. Like other functional nervous diseases, hay-fever appears to be excited more by heat following cold than by continuous heat:  Geographic regions where the weather changes around the year, as it does in the tropics, the poles, and northern U.S., have a greater incidence of hay fever sufferers.  Such changes in temperature cause exhaustion, and this stimulates the nervous system.  Geographic regions that are consistently warm have lower rates of hay fever, such as the northern parts of U.S., the tropics and the poles.  So "warm climates are the best resorts for nervous people."  (1, page 95) 
Usually, attacks of hay fever only come about when you are exposed to these causes, animals or vegetable.  In most regards, this therefore makes hay fever more or less a seasonal disease, as most of the predisposed matter are only present at specific seasons of the year, such as the summer or fall, hence the terms "summer catarrh" or "fall catarrh."

Therefore, "as the disease is not due to any single specific cause, animal or vegetable, as has been supposed, no specific will ever be found for it," states Dr. Beard.  "As with ordinary asthma, sick-headache, and other neuroses, to which it is in some respects analogous, the attacks may be prevented and relieved, and some remedies will act specifically for individuals; but no one remedy will ever be found to relieve all cases." (1, page 78)

Considering there is no proven cure, the following have been tried with some success (1, page 78):
  • Avoidance of exciting causes (heat, light, dust, worry, animal irritants)
  • Fortifying the system by tonics before and during the attack, and relieving the symptoms by those sedatives and anodyne, locally or generally administered, which are found by eperience to be bet adapted for each individual cae
  • Spending the season of the attack:
    • At sea; preferably in high altitudes, here the air is always cool, invigorating, and entirely free from vegetable and animal irritants
    • In elevated mountainous regions, where in all latitudes the air is cooler and more invigorating than at low elevations, and some at least of the vegetable irritants are less abundant.
    • In high latitudes, at any elevation where the air is sufficiently cool.
    • At the sea-shore, or on islands near the coast.
    • For those who can not leave their home, keeping quiet in cool, closed, darkened rooms.
When the above remedies don't work, or for those who cannot afford to take such a vacation, the following are remedies that can be tried before and during the attack: (1, page 78)
  • Local applications:
    • Quinine 
    • Arsenic
    • Iron
    • Electricity
  • Atomization:  
    • Quinine
    • Camphor 
    • Palliatives (Remedies that experiment shows to be most useful for each individual.
One may also use just about any remedy that proves to have palliative effects on the symptoms of the disease, notes Beard.

Beard also makes a bold prediction about the future of hay fever:
These facts relating to the transmissibility of hay-fever are the more astonishing when taken in connection with the fact that the disease is so recent. There has scarcely been time as yet for the malady, so to speak, to get intrenched in families, for our grandfathers never heard of this trouble, except, perhaps, as a distant and doubtful wonder, while at the present time it is increasing with such rapidity that in twenty-five years, it is safe to say, there will be thousands of families who have more than one representative in the hayfever army. (1, page 80)
It's interesting anyway.  While Beard and other experts of his era were wrong about hay fever being nervous, Beard was correct when he predicted a steady rise of hay fever sufferers in the future. 

Yet, it is true, writes Beard, that "hay fever is, then, a disease of the fashionable and the thoughtful -- the price of wealth and culture, a part of the penalty of a fine organization and an in-door life." (1, page 87)

References:
  1. Beard, George Miller, "Hay-fever; or catarrh: it's nature and treatment," 1876, New York, Harper and Brothers

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