Men, Research, And The History Of Hay Fever
( Originally Published 1943 )
FROM a maze of unknown and undescribed afflictions besetting mankind, hay fever was extracted and held up to the light. Thus exposed, it was at first ignored, then ridiculed, misnamed, and misunderstood. This mutation among diseases grew by leaps and bounds. It poked its tentacles into the eyes and nose of millions of humans located all over the world.
Spreading like wildfire, hay fever could no longer be ignored. It attracted the attention of great scientists in many fields. Individually and collectively they probed and explored every branch of its being. They sought to determine where and how it originated. They worked to bare its very nature and separate it into its many parts. Specialists in turn have apportioned these parts among themselves for more profound research into its every fiber.
The results of these explorations have not been without success. Although the demise of hay fever is not yet in sight its control is imminent. The story of this struggle between man and disease is extremely interesting. No familiar beaten path existed. The disease was and is a strange one. The imagination had to be stretched to accuse the very plants that man relied upon for food and shelter. The story of the quest for understanding, by examination and experimentation in the face of seemingly fathomless contradictions is the narrative we shall now tell.
The Medical profession came upon the road that was hay fever somewhere in the early stages of its career. In 1819, John Bostock, a learned London doctor, presented to the medical profession the first description of a case of hay fever. This earliest account stands today as one of the best and most completely detailed descriptions of hay fever as it is seen in many a doctor's office. The vividness and accuracy of Bostock's presentation of the symptoms is easily understood. The case was that of the good doctor himself who had suffered with the affliction from the time he was eight years of age. We shall let him tell you of his symptoms in his own words as he related them to the Medical Society of London.
About the beginning or middle of June in every year the following symptoms make their appearance, with a greater or less degree of violence. A sensation of heat and fulness is experienced in the eyes, first along the edges of the lids, and especially in the inner angles, but after some time over all of the ball. At the commencement the external features of the eye are little affected, except that there is a slight degree of redness and a discharge of tears. This state gradually increases, until the sensation becomes converted into what may be characterized as a combination of the most acute itching and smarting, accompanied with a feeling of small points striking upon or darting into the ball, at the same time that the eyes become extremely inflamed and discharge very copiously a thick mucous fluid. This state of the eyes comes on in paroxysms, at uncertain intervals, from about the second week in June to about the middle of July. The eyes are seldom quite well for the whole of this period, but the violent paroxysms never occur more than two or three times daily, lasting an hour or two each time; but with respect to their frequency and duration there is the greatest uncertainty. Generally, but not always, their invasion may be distinctly traced to some exciting cause, of which the most certain is a close, moist heat, also a bright glare of light, dust, or other substances touching the eyes and any circumstance which increases the temperature. After the violent inflammation and discharge have continued for some time, the pain and redness gradually go off, but a degree of stiffness generally remains during the day.
After this state of the eyes has subsided for a week or ten days, a general fulness is experienced in the head, and particularly about the fore part; to this succeeds irritation of the nose, producing sneezing, which occurs in fits of extreme violence, coming on at uncertain intervals. To the sneezings are added a further sensation of tightness of the chest, and a difficulty of breathing, with a general irritation of the fauces and trachea. There is no absolute pain in any part of the chest, but a feeling of want of room to receive the air necessary for respiration, a huskiness of the voice, and an incapacity of speaking aloud for any time without inconvenience. To these local symptoms, are at length added a degree of general indisposition, a great degree of languor, an incapacity for muscular exertion, loss of appetite, emaciation, restless nights, often attended with profuse perspirations, the extremeties, however, being generally cold.
This graphic presentation of a case of early summer or grass hay fever is indeed a landmark. Especially, when we consider that John Bostock was not aware of the role played by grass in the cause of his ailment which he called "A Periodical Affection of the Eyes and Chest."
Until Bostock published another paper in 1828 nothing further had been written about hay fever as an ailment. Nevertheless, during this period the malady had been christened "hay fever" by popular baptism. This is one instance in which the people's choice has been the victor. To this day the name hay fever is the one most employed even by the medical profession. Within the last decade the profession has made a decided effort to convert the name to pollinosis.
The name, hay fever, as explained by Bostock, arose out of the popular belief that the ailment was caused by some invisible emanation from new hay.
In their popular belief the so-called laity were closer to the true cause of the symptoms than Bostock and the many doctors after him who variously ascribed the cause to sunlight, the first summer heat, ozone, and neurotic habit. This non-acceptance of plants and things connected with plants as the cause, continued for about ninety years, even in the face of invincible scientific proof.
FROM RARITY TO FIRST PLACE
In his second paper Bostock claimed that after nine years of study he had seen or heard of only twenty-eight cases whose symptoms indicated them to be possible hay fever sufferers. If we contrast this with the millions of known cases of hay fever in England and the United States today, it becomes indeed difficult to imagine that the forces that spread pollens before 1819 couldn't do better than twenty-eight cases. Strong winds to carry pollens were certainly prevalent before 1819. Animals and birds are known to transport pollens great distances on foot and through the air. And we doubt that they took up this practice only after 1828. We can be reasonably certain that there were many more cases before Bostock's time than the literature indicates. On the other hand we can be even more certain that the prevalence of hay fever has in-creased immeasurably in the United States from the time it was first described until the present. As proof of this we need merely to compare the reliable estimate of 200,000 cases in the United States in 1890 to the present estimate of more than 5,000,000 hay fever sufferers. According to the latest census figures, hay fever ranks first in prevalence among the non-fatal chronic diseases in the United States today.
LOOKING FORWARD AND BACKWARD
After Bostock's second paper, hay fever, hay-asthma or summer catarrh, as it was variously called, received increasing attention in medical literature. Publications on the subject at first appeared intermittently. This was followed by a short lull, a renewal of interest, a gradually increasing volume, and finally a shower of literature commencing in about 1920 and continuing to this day.
At intervals in this forward moving train of investigation the idea arose that hay fever must have existed before Bostock's time. They reasoned that if Bostock suffered for thirty-eight years before 1819 others must have suffered as well. And after the affliction was known to be caused by grasses there was no reason to assume that the ancients were immune. Researches into the literature were made; hints and suggestions of symptoms even remotely resembling hay fever were carefully scrutinized. The search bore fruit Bostock himself found a description published in 1802 by a great clinician named Heberden. In this reference the doctor tells of four persons who annually experienced a return of their nasal symptoms during April, May, June or July which remained severe for one month.
Digging further into the past, chroniclers noted several cases of periodically recurring asthma. These were naturally associated with some of our present day cases of pollen asthma.
The most interesting references found were those of cases discovered in the writings of the 17th century. In this period there was described cases, mostly of men (women weren't considered important enough to write about) who were affected by the odor of roses. The hay fever-like symptoms that they attributed to the odor of roses is at the present thought to have been grass hay fever. Their delusion being similar to our no-less current misconception in the minds of thousands that they have a "rose cold" or "rose fever" which is in some manner associated with the blooming of roses.
Thus far the earliest suggestion of a hay fever-like allusion is credited to Leonhardus Botallus. In 1565 he advised doctors not to use perfumes. He wrote "Sweet per-fumes temperately used are pleasing and likewise useful to doctors and to all men . . . but sometimes it happens that what is pleasing to many persons is injurious to one." Here we see a very early use of what is perhaps the most well known adage among present day allergists, namely as Lucretius said it; "What's one man's food is another man's poison."
An even more illuminating example is one reported in the early 1600's by the learned Professor John Baptist Van Helmont. He gives the following very significant description of one of his cases of seasonal asthma: "He was asthmatic almost the whole summer; the entire winter he was free from this trouble. At whatever time he suffered from Asthma his entire body itched; white blebs were formed which looked like a case of leprosy. He said his mother had suffered from a similar itch and likewise his sister; the latter had even to take to bed. But on the birth of her second child she was entirely freed from this complaint." Had we but known it, here was one of the earliest implications of the role of heredity in allergy. Of equal note is the reference to the now often observed relationship between allergic manifestations and the sexual functions. The stuffy feeling in their nostrils that women experience just prior to the onset of menstruation is considered by some as a further example of the tie-up between allergic-like symptoms and the functions of the sexual organs. These associations as we have previously indicated are as yet not clearly understood by the medical profession.
From such cases we can readily see the value of delving into the historical background of an ailment. Oftentimes these presumably outdated references supply a clue or suggestion which leads to the solution of some part of a medical problem. Who knows but that Van Helmont's case may start some medical student on a successful search of a relationship between the hormones of the endocrine glands and the asthmatic state.
It is not an easy task to gather the hallowed references of strange lands and bygone years. Such references are not always readily available or fruitful. Moreover they are often written in a language unfamiliar to the researcher. Such was the case in most of the early papers pertaining to hay fever. Only through the scholarly and persevering efforts of Dr. August Thomen were the early references made easily available to the modem student. In the gathering and preparation there was a short history in itself. Friends, emissaries, and consuls were prevailed upon. Photostats had to be made of valuable documents located in the archives of the British Museum, the Library of Paris, and the Congressional Library. The kindly efforts of several Professors of Latin at Manhattan College were necessitated for the task of translating the early references. Finally the important lines were extracted by the historian.
Bringing to light as it has, such cases of allergy as we have only recently discovered, who dares to call Latin a dead language.
THE FIRST HINT OF POLLEN
Picking up the trail where we left it with Bostock's second paper we find a lady of importance enters the picture. No ordinary woman was she. Her name unfortunately has not been left for posterity. Keen sighted and outspoken she expressed her theories about the cause of her hay fever to Dr. Elliotson who attended the family. She left enough of an impression on the doctor for him to transmit her beliefs to his students in lectures. In one such lecture he records the following statement by her, "I believe the complaint with me to arise principally if not entirely from the farina (pollen) of the grass." From observing the same hay fever symptoms in her mother, an uncle, some nephews, nieces and cousins she states, "It was decidedly an hereditary matter."
Although he was only luke warm in his acceptance of this lady's theories it must be acknowledged that Dr. Elliotson in 1831 was the first doctor to put into writing his belief in pollen as the cause of hay fever. On this score he says, "I believe certainly that it does not depend upon the hay and therefore ought not to be called hay fever, but upon the flower of the grass, and most probably on the pollen." Had he been more than merely luke warm, Dr. Elliotson could have performed the simplest experiment imaginable to either confirm or deny this lady's belief. He had only to gather these grass flowers or pollens and place them in contact with the eyes and nose of the lady and other sufferers in her family. History relates that he did nothing of the kind.