Hay-fever, or, Summer catarrh : its nature and treatment Including the early form, or "rose cold"; the later form, or "autumnal catarrh"; and a middle form, or July cold, hitherto undescribed

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I

OR,

Preface

The subject of hay-fever was first forced on my attention in the autumn of 1873, while spending a portion of a vacation in Bethlehem, White Mountains. At that place of resort there were gathered, as usual in recent years, a number of hay-fever refugees, whom the necessities of the disease compelled to remain for some time after the press of summer travel was over. Among these was the late Professor Jeffries Wyman — the mention of whose name suggests all that is most excellent and noble in scientific and personal character — with whom this malady was a family inheritance, and who had therefore enjoyed unusual opportunities for general observation of its peculiarities. From him I learned many facts— then quite new to me — relating to the history and symptoms of hay-fever, and, as an expert in that department of science, he pointed out the fallacies in the infusorial theory of Helmholtz, then becoming popular. '

The perusal of the excellent work of Dr. Morrell Wyman on "Autumnal Catarrh," then recently issued, and in connection with it a careful study of many victims of the disease, some of whom suft-ered slightly from the symptoms even in the mountains,.

A ii

PREFACE.

impressed on me the fact that the whole subject needed to be thoroughly investigated in all its relations, and that until such an investigation was made it would be impossible to establish any theory whatever. All the questions relating to the disease appeared to be open questions ; save the general character of the symptoms, and their periodicity, nothing seemed to be settled.

While preparing the first edition of the circular, which was the starting-point of the researches contained in this volume, I gave a provisional acceptance to the idea advanced by Dr. Wyman— namely, that what he terms autumnal catarrh and what is known as " June " or " rose cold " are distinct diseases. In view of the large number of facts afterward obtained, and which are recorded in this work, it was found necessary to abandon this theory, and to admit the substantial identity of "autumnal catarrh" and "June cold." The probability of this view was enforced by the identity of the symptoms, and was further strengthened by the discovery of a middle form of hay-fever, or " July cold," hitherto undescribed, and which serves to link together the early and later forms.

The conclusions which will be most likely to excite surprise are those which show the relation of this disease to the nervous system. To those who have given the subject no more thought than is suggested by general observation of cases, and who have been witnesses of the unquestioned fact that the malady numbers among its subjects some who are otherwise unusually strong, it seems beyond belief that hay-fever is more markedly hereditary than any disease of which

PREFACE. in statistics have been gathered ; and that the majority of its victims are of the nervous diathesis, and suffer otherwise from an indefinite number of nervous symptoms.

In regard to the nerve theory of hay-fever there prevail two popular misconceptions, which, it is to be hoped, this work may assist in correcting.

First, that nervous susceptibility implies debility and emaciation. Many suppose nervous diseases are imaginary diseases, and get their idea of the nervous temperament from those in whom it predominates, and especially from the hysterical and hypochondriacal, who are always ailing, and who fancy themselves much worse than they really are. The nervous temperament is really consistent with great strength and power of endurance, especially when combined with the bilious and sanguine temperaments ; one may be fleshy and full-blooded, and yet be exceedingly sensitive.

Secondly, that the theory dispenses entirely with the influence of the exciting causes— as heat, dust, pollen, and other irritants. On the contrary, by the facts here collated the potency of these irritants is absolutely demonstrated, and their number is far greater than has been supposed. Individuals vary widely, however, in their susceptibility to different forms of irritation, and not one of these exciting causes nor all combined can avail to produce the disease, except when acting on a predisposed organization.

The theory taught in this book, that this disease is a complex resultant of a nervous system especially sensitive in this direction, acted upon by the enervatmg influence of heat, and by any one or several of a iv PREFACE.

large number of vegetable and other irritants, has the advantage over other theories that it accounts for all the phenomena exhibited by the disease in this or in any other country.

The transmissibility of the disease from parents to children; the temperaments of the subjects; the capricious interchanging of the early, the middle, and the later forms ; the periodicity and persistence of the attacks and their paroxysmal character ; the points of resemblance between the symptoms and those of ordinary asthma ; the strange idiosyncrasies of different individuals in relation to the different irritants ; the fact that it is a modern disease, peculiar to civilization ; the fact that it most abounds where functional nervous disorders are most frequent, and is apparently on the increase pari passu with other nervous diseases; and, finally, the fact that it is best relieved by those remedies that act on the nervous system— all these otherwise opposing and inconsistent phenomena are by this hypothesis fully harmonized.

Those, however, who are unwilling to accept this interpretation will in this work find a resum^ that is meant to be both impartial and exhaustive of other theories, and of all known facts relating to this affection, wherever observed.

The somewhat arbitrary divisions between catarrhal and non-catarrhal regions, as suggested by Dr. Wyman, do not appear to be sustained by the cases herein detailed, for in nearly every state of the Union the disease occasionally appears, though it dimmishes in frequency as we go south, and regions which msure exemption for some are for others of no value.

PREFACE.

V

It is a gratification to know that although from the nature of the disease no specific ever can be found for it, yet remedies almost approaching specifics have already been found for individual cases, and there are few cases that can not obtain more or less relief from some one of the many remedies that have been tested.

The sources from which I have received assistance in gaining information are quite numerous. The physicians, not only of New York and Brooklyn, and vicinity, but of all parts of the country, have co-operated in this attempt to learn the laws of this strange affection to an extent that I can never repay. The publicity given by the leading journals of the country to the fact that these researches were being made has been an indispensable aid, especially in determining the geographical relations of the disease. For the large army of sufferers who have taken the pains to fill out in detail replies to the queries contained in my circular I may express the hope that, without reference to any theory of the disease, the facts herein contained, and which they have helped to accumulate, may prove a substantial reward.

To Frank B. Fay, Esq., Secretary of the United States Hay-Fever Association, I am indebted for the use of much valuable correspondence obtained from the members of that flourishing organization, and also for kindly replies to my queries in regard to the comparative immunity of Bethlehem and other White Mountain resorts. For some of the references to the European literature of the subject, I am under obligation to the work of Mr. Blackley.

The inappropriateness, or, rather, the insufficiency vi

PREFACE.

of the term hay-fever is now quite generally admitted ; for even where the predisposition exists, hay of any kind, fresh or dried, acts as an exciting cause in but a minority of the cases, and rarely, if ever, is it the only irritant that gives rise to the paroxysms. But in this respect hay-fever is no worse than hysteria and other terms that still hold their ground even in scientific circles.

Bearing in mind that this work will find its readers mostly among the laity, and chiefly among the sufferers from the disease, the aim has been to avoid, so far as might be, purely technical words and phrases ; and, while keeping strictly within the limits of science, to bring every point within the comprehension of those who know little or nothing of medicine, save what has been wrought into them by their own painful experiences with this distressing malady.

G. M. B.

New York, Jttne, 1876. ) 45 West 29th St. }

Chapter I. History Of Hay-fever

Literature of the Subject— Writings of Bostock, MacCulloch, Gordon, Praeter, Elliotson, Ramadge, Gream, Walshe, Watson, Salter, Phoebus, Laforgue, Cornaz, Labosse, Smith, Pirrie, Binz, Helmholtz, Moore, Wyman, and Blackley. — Views of Wyman. — Experiments of Blackley. — Defects in all these Methods of Investigation. — More Facts needed. — Necessary to Study the Subject in all its Bearings Pages 11-30

CHAPTER II. author's method of investigation.

Impossible to Solve the Problem of Hay-Fever from a Study only of the Cases that happen to come under the Observation of any one Physician. — Circular of Inquiry. — Facts, not Opinions, sought for. — Means adopted for Distributing the Circular. — Thoroughness of the Investigation.— List of Fifty-five Questions in the Second Circular of Inquiry 31-39

CHAPTER III. statistics of two hundred cases.

Residences of Correspondents.— Geographical Relations of the Disease.— Most Frequent in the Male Sex.— Age and Occupation of the Sufferers. — Inheritance.-Temperament.— Relative Frequencyof different Symptoms.—Dates of Appearance of Attacks.— A Middle Form, or July Cold, discovered.— Intermissions.— Relative Frequency of Cough and Asthma.—Exciting Causes.— Dates of Disappearance of Attacks.— Relation of Frost to Disappearance of Symptoms.— Relation of Symptoms to Mental Influence.— Symptoms of Depression preceding Attacks.— State of Health at the Close of Attacks.— Relation of Hay-Fever to " Cold in the Head."-Mild Attacks in the Winter and Spring.-Capacity for Labor as affected by Attacks.-Other Nervous Symptoms of Sufferers. -Effects of Food, Alcohol, and Tobacco.— Effects of Menstruation, vm

CONTENTS.

Pregnancy, Nursing, and Change of Life. — Effect of Wind and Weather.— Effect of Treatment. — Errors to be Guarded against in Estimating the Value of Remedies. — Helmholtz's Method of Using Quinine. — Electricity. — City and Country compared. — Where Relief is Found. — Effect of Visiting Exempt Regions. — Effects of Ocean Voyages ; of Trips to Europe; of a Residence South. — Use of Tonic Treatment before an Attack. . Pages 40-76

CHAPTER IV.

GENERAL CONCLUSIONS.

Hay-Fever a Neurosis, a Functional Disease of the Nervous System. — This is Proved by its Hereditary Character.— The Nervous Diathesis.— The Nervous Temperament does not imply Debility.— A Modern Disease, and Peculiar to Civilization. — Most Common among the Cultivated and Well-to-do Classes.— Very Rare among the Poor.— The Symptoms of a Nervous Character.— Takes the Place of other Diseases.— Affected by Nerve Remedies.— The Predisposition Essential to the Disease.— Excited by Heat following Cold.— Relative Influence of the various Exciting Causes.— Compared with Ordinary Asthma.— Compared with Sick-Headache. — Pathology. — Idiosyncrasies. — Unity of the Early, Middle, and Later Forms.— Relative Frequency of Cough and Asthma in the different Forms. — Different Forms run into each other.— All Transmissible and Interchangeable.— All Occur in the same Climates, Races, and Temperaments, and are Relieved by the same Remedies.— Why the Later Form, or "Autumnal Catarrh," is Peculiar to the United States 77-116

CHAPTER V.

SYMPTOMS AND COURSE.

Itching.— Sneezing.— Discharge from Nose and Eyes.— Swelling and Obstruction, and Pain of the Affected Parts.— Sensitiveness of the Skin.— Cough and Asthma.— Constitutional Symptoms.— Premonitory Stage. —Characteristics of the Attacks.— Suddenness of Onset.— Paroxysms. —Remissions —Circumstances of First Attack.— Permanent or After Effects "7-132

CHAPTER VL

DIAGNOSIS AND PROGNOSIS.

Hay-Fever distinguished from a Common Cold by the Nervous Character and Greater Severity of the Symptoms ; by its Periodicity ; by the Fact that it is Influenced by Dust and other Irritants ; is less Susceptible to Treatment, and is Relieved at Sea and on the Mountains.— Distinguished

CONTENTS.

ix from Ordinary Asthma by Nasal and other Symptoms, and by Periodicity.— Distinguished from Acute Bronchitis. — Practically little Difficulty in the Diagnosis.

Prognosis. — Variations in the Severity of the Disease. — Longevity of Sufferers from Hay- Fever ; Pages 133-138

CHAPTER VII.

PREVENTION AND TREATMENT.

Three Errors to be Corrected.— No Specific for all Cases will ever be Found, but Individuals will Find Specifics for Themselves. — The Disease much more Relievable than has been Supposed. —The Progress in the Treatment has been Retarded by False Theories.— Prevention better than <Z\ixz.— Sea -Voyage rarely or never fails, and why.

— Travel in Europe. — Cool and Elevated Regions.— Monniains.

Characteristics of Mountain Air.— Why it is Favorable for Hay-Fever Subjects.— Vegetation in the Mountains.— Atmospheric Electricity and Ozone.— Mountains not as good as the Sea.— Diff-erent Mountainous Resorts compared. — White Mountains. — Catskills. —Letter of Mr Fay in regard to Bethlehem.— Colorado.— 77/^ Sea-shore.— L?,nd. and Sea Breezes.— Fire Island. — Ceo/ Regions without regard to Eleva- Mackinaw.— Canada.— Nova Scotia.

Large 0//Vj.— Manner in which Symptoms are Relieved in E.xempt Regions.— Residence in Warm Climates.— California.

Medical Treatment. — \\o\!a. General and Local. — Every one can find Relief — Sedatives and Tonics required.

Constitutional 7>va/wz^«A — Quinine, Arsenic, Electricity — Strvchmne, Iron.-Phosphorus, Cod-liver Oil.-Turkish Baths.-Opiates - Bromide of Potassium, Hydrate of Chloral.-Belladonna.-Iodide of Potassium -Aconite, Digitalis, Veratrum Viride, and Gelsemin - Guarana.-Cafreine.-Muriate of Ammonia.-Prussic Acid.-Nitrite of Amyl -Iodoform.-Ergot.-Ipecac.-Ether and Chloroform, Apocynum Andromifolium.— Grindelia Robusta.

Local Treatment.-^o^ properly Conducted.-Causes of Failure in the Use of Remedies -Atomizers-Letter from Dr. Lincoln.-Quimne.-Camphor.-Iodine.-Glycerin.-Common Salt.-Tannic Acid -Carbolic Acid -Explanation of the Beneficial Effect of Local Appli! cations of Qu,nine.-Salicylic Acid.-Pinus Canadensis.-Sub^t'i l!r.^K-'^."-'?' "^"^-^-Th^ the Mouth and Nose -

EfficK P°'='^h.-Sulphur.-Dry Camphor.-Chloroform for Local

Hygienic 7>v«/,;,.„/. -Diet. -Exercise. -Clothing -Sleeo Ab staining from Shaving ^'otmng. Sleep. —A b-

A 2

X

CONTENTS.

CHAPTER VIII.

ILLUSTRATIVE CASES OF THE DIFFERENT FORMS AND PHASES

OF HAY-FEVER.

Sources whence the Cases are derived. — Cases of the Early Form, or "June Cold."— Cases of the Middle Form, or "July Cold."— Combined Forms. — Cases of the Later Form, or " Autumnal Catarrh."— Southern and Western Cases.— California.— Cape Cod. — Elmira.— Philadelphia.— Cincinnati.— Inheritance.— Maine Lakes.— Pittsburgh. —Case of Daniel Webster.— Case of Henry Ward Beecher.— Special Experiences of the Members of the United States Hay-Fever Association.—Colorado. —Bethlehem vs. Adirondacks. — Mackinac— At Home in a Closed Room. — Cresson, Pa.— Whitefield, N. H. — English Cases.— Mr. Blackley Pages 183-266 t

ITS NATURE, PREVENTION, AND TREATMENT.

CHAPTER L

HISTORY OF HAY-FEVER.

Attention seem^ to have been first directed to hay-fever in England, where the first formal description of the disease was given by Dr. Bostock in 1819, in a paper presented to the London Medico-Chirurgical Society. In this paper Dr. Bostock described his own case, under the title, "Case of a Periodical Affection of the Eyes and Chest."* Nine years later, Dr. Bostock read a second paper on the same subject before the same society, going more into detail, and giving a distinct name to the disease, as " Catarrhus ^stivus," or " Summer Catarrh."! It is noteworthy that the name then given to this disorder is the one which, in the light of the researches presented in this volume, seems to be the most appropriate.

Prior to the time of Bostock, Cullen had observed that some persons are more troubled with asthma in summer, and particularly in dog-days, than at any other season ; and Heberden, in his " Commentary on the History and Cure of Diseases," t had referred in a general way to what is now sup-

* " Medico-Chirurgical Transactions," vol. x, part i, p. 161. London, ^^N- I-.- , t Ibid., vol. .xii, p. 437. 1828.

t Is inth edition, chapter " Destillatio," p. 1 13. London, i8i6.

HAY-FEVER.

posed to have been hay-fever. In his second paper, Dr. Bostock spoke of twenty-eight cases, eighteen of which were fully reported, and the remainder in less detail.

The disease was spoken of by Dr. MacCulloch, in 1828, in "An Essay on the Remittent and Intermittent Diseases." He spoke of the disease as being caused by hot-houses and greenhouses, and said that, in the estimation of the public, it was especially excited by hay-fields. Just when and where the term "Hay-Fever" or " Hay-Asthma" arose, it is impossible to say ; probably it first became known among the people, who observed that the symptoms were brought on or made worse during the hay-making season.

Writers on this subject early began to theorize in regard to the nature of the aff"ection. Bostock supposed that heat was the great cause, and he opposed the notion which arose among the laity that hay had any thing to do with it. He cited a number of facts from his own experience which went to show that, in his case at least, heat and the 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.

In 1829 Mr. W. Gordon published a paper entitled "Observations on the Nature, Cause, and Treatment of Hay-Asthma "* Gordon 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 * London Medical Gazette, xo\M.^. 266. 1829.

HISTORY OF HAY-FEVER.

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-ast/wia.

Mr. Augustus Praeter, in 1830, published notes of a case that he had once seen in Paiis; and in 1831, and again in 1833, the famous Dr. Elliotson referred to the disease, and published a paper upon it.* Dr. Elliotson opposed the heat theory of Dr. Bostock, and rejected also the hay theory, and declared that grass, and probably the pollen, was the cause. • Up to this time the disease was probably not very frequent, for MacCulloch, already referred to, in his treatise published in 1829, while provisionally classing the disease among the intermittents on account of its periodicity, yet states that it is a disorder too trifling to attract much attention.

In 1847 Dr. Ramadge, in a work on asthmaf in general, described the symptoms of this disease, and detailed cases. He took decided ground that the effluvia from the flowers of grass, and the " odor of the bean flower," might occasionally cause this variety of asthma.

In 1850 Dr. Gream advanced a step in the study of this affection by the publication of a paper " On the Use of Nux Vomica as a Remedy in Hay-Fever," $ in which he declared that the flowers of grass had no more to do with the disease than any other flowers, and brought out for the first time the very important fact that in-door dust and out-door dust were exciting causes. It will be shown in the present treatise that in the United States, at least, dust is the most important of all the various exciting causes.

Gream also observed that the symptoms were relieved after a fall of rain, and he argues that the laying of the dust was the explanation; and, further, he maintained that the

* London Medical Gazette, 183 1, p. 411.

t London, 1847. x. t t 1 • ^

' I Lancet, vol. i, p. 692.

HAY-FEVER.

malady was peculiar to the summer, because at this season there was more dust of various kinds in the air.

In 1859 Walshe, in his " Practical Treatise on the Diseases of the Lungs, Heart, and Aorta," refers to hay-fever as " a singular variety of naso-pulmonary catarrh." He states that the disease occurs during the season of hay-making, "or where the odor of grass is powerful," and that the best relief is found at the sea-side, although even there a land breeze brings trouble. Walshe further states that he had " a very precise narrative of a case in which the patient retained his symptoms during a passage across the Atlantic." In my own researches I have been able to find no duplicate of that case; the symptoms of hay -fever, as it appears in the United States, always disappear in crossing the Atlantic between Europe and America.

Watson, in his " Lectures on the Principles and Practice of Physics," published in 1857, discusses the subject, recites some cases, and ascribes the malady to the vegetable matter of the atmosphere.

In 1859 Dr. Hyde Salter, in his standard treatise on asthma, states that periodical asthma is usually winter asthma, but that the disease called hay-asthma begins and ends with the hay season— about a month or six weeks. Among the exciting agents he names " bright, hot, dusty sunshine," laughter, a full meal, and hay. Dr. Salter cites two interesting cases.

In 1859 also. Professor Phoebus, of the University of Giessen, prepared a circular containing seven questions, referring to the geography and ethnography of the disease, its relation to sex, social position, inheritance, constitutional peculiarities, and the time of its occurrence. To this circular Dr. Phoebus received many replies, not from his own country alone, but from various parts of the Continent, from England, and from America; and on the basis of these replies he pub-

HISTORY OF HAY-FEVER.

lished the most thorough treatise that up to that time had appeared on this interesting subject. Dr. Phoebus noticed the fact of some kind of predisposition to the disease; but the nature of this predisposition he failed to determine. According to the statistics of Dr. Phoebus, hay-fever is an Anglo- Saxon disease, being more common in England than in any other European country; next comes Germany, and then France, Belgium, Switzerland, Scotland, Italy, Russia, and Ireland. Out of 152 patients whose parentage was known, 81 were natives of England, 36 of Germany, and 35 of other countries.

It is probable that at the present time this disease is more frequent in the United States than in England: so far as European countries are concerned, the statistics of Dr. Phoebus may, it is possible, fairly represent the relative frequency of the disease.*

In regard to the exciting causes, Dr. Phoebus took the ground that the first heat of summer may act indirectly, and that the longer days of summer, by giving more light, and possibly more ozone, might act as causes. Among the odors and different kinds of dust, he thought that hay and the blossom of rye were the most potent. He suggested, on the one hand, the theory that all of these various causes might have their influence ; and, on the other hand, that possibly but one c. the accused causes was the real one. Furthermore, he suggested that some patients might be susceptible to a portion only of these various exciting causes.

Dr. Phoebus, it was clear, had gone into the whole subject far more thoroughly than any of his predecessors ; he had pursued it by the true and only method by which the truth

* The number of subjects of hay-fever in the United States is variously estimated at 25,000 or 50,000. The bases of calculations of this sort are not very satisfactory. The United States Hay-Fever Association contemplates, I believe, a census of hay-fever.

i6

HAY-FEVER.

in matters of this kind can be reached, and he followed it out with true German thoroughness and persistence.

He failed to solve the problem of hay-fever; but his failure was due to the inherent difficulties and complications of the subject, and not to any radical defect in his method, or to want of ability or energy on his part. Dr. Phoebus, it should be said, appreciated the fact that he had not removed the mystery connected with this disease; he stated his own provisional conclusions guardedly, freely admitted doubts and possibilities of error, and expressed the hope " that future and more accurate observations, especially comparisons of the phenomena of the disease with meteorology and vegetable phenomena, will bring certainty instead of probability and possibility."*

In 1852 appeared an essay by Dr. Laforgue, of Toulouse, entitled "Observation de Catarrhe d'e'teV't in which the theory that heat was the exciting cause was advocated. In the following year an anonymous contributor to L'Abeille Medicale, in a paper entitled " Un dernier mot sur la Fifevre de Foin," gave his own case, and, judging by that mainly, concluded that hay, and not heat, was the exciting agent.

In July, i860, Dr. Cornaz, of Neufchatel, Switzerland, published a paper on hay-fever, entitled " De I'Existence du Catarrhe des Foins en Suisse,"! giving details of six cases, in each of which the flowers of grass seemed to be the exciting cause.

August 20, i860. Dr. Labosse, of Nitry, in a paper entitled "Nouvelle Observation de Catarrhe de Foin,"§ spoke of three persons who had suffered from this malady, and stated that their symptoms came on at the time that flowers were

* The work of Dr. Phoebus was entitled " Typischer Fruhsommer- Katarrh oder das sogenannte Heufieber, Heuasthnia." Giessen, 1862. t U7iion Medicale, No. 149. i8S9- t L'Echo Medicale, No. 7, i860.

§ VAbeille Medicale, p. 2.70, 1 860.

HISTORY OF HAY-FEVER.

in blossom. One of his patients, a farmer (a class, by the way, among whom hay-fever is rarely found), noticed that when the period of flowering of a certain herb with which he fed his sheep had passed he could handle it without harm.

In 1866 Dr. William Abbotts Smith published a work with the title, "On Hay-Fever, Hay-Asthma, or Summer Catarrh."* He suggested that strong light and great heat might bring on or make worse the symptoms ; and believed also that grass and flowering plants were exciting agents. The ozone theory presented by Phoebus he rejected, but raised the query whether the benzoic acid which, as Vogel had shown, was liberated by the heat of summer from the Anthoxanthmn odoraium and the Holcus odoratiis, the grasses that had been shown to have special relation to hay-fever, might be a cause. Dr. Smith relates the following interesting ex- . perience of one of his patients : " This year the disease first came on while I was on the sea yachting with a friend. It was a hot day in May, with the wind from the southwest, the nearest land to windward being nine miles distant. I felt myself, after some exertion in assisting to hoist the sails, suddenly seized with sneezing, and I have had it ever since" (up to June 13, the date of the letter).

In 1867 Dr. William Pirrie published a work on "Hay- Asthma and the Atfection termed Hay-Fever,"t in which two forms of the disease are recognized : one spasmodic, affecting the mucous membranes of the apparatus of respiration, and caused by emanations from flowering plants acting on the. nerves of these membranes; the other, in which the exciting causes, as heat and light, act upon the central nervous system, cerebro-spinal and sympathetic. Dr. Pirrie gives very few new facts on the subject, but clearly inclines to the belief that the nervous system is a more important factor in the disease than had been supposed. * London, 4th edition, 1866. t London, 1867.

i8

HAY-FEVER.

Dr. Pirrie admitted that the emanations from grass and hay and flowering plants acted as local irritants, and so excited one form of the disease; but the other form, he contended, did not need any of these external irritants. He insisted that light and heat were factors of great importance in exciting and aggravating the malady; and he also called special attention to the now well-understood fact that there may be premonitory symptoms — languor, malaise, insomnia, and irritability, which symptoms in England appear about the middle of May, while the local symptoms appear during the latter part of that month. Dr. Pirrie further insisted, as do most other writers on the subject, on the hereditary character of the disease, and observed, what my statistics have now fully established, that nervous and bilious temperaments are most liable to it.

For treatment Dr. Pirrie recommended quinine, arsenic, iron, and strychnine, and other tonics ; and for palliatives the familiar sedatives and antispasmodics — belladonna, cannabis indica, camphor, stramonium, and the inhalation of chloroform. Hygienically, Dr. Pirrie suggested a resort to the seaside, carefulness in diet, the avoidance of exhausting influences, and the keeping clear of hay, grass, flowering plants, and vegetation generally. He admitted that the tonic treatment had often failed; but explained the failures in part by the fact that the patients had delayed until the beginning of an attack, and he distinctly advised preventive treatment in the intervals of the attacks.

This little treatise of Dr. Pirrie is remarkable that in many respects it theoretically anticipates what by these statistics and facts has been demonstrated in regard to the nature of hay-fever, and the true principles of treatment as now confirmed by a large induction in Europe and America. The number of his facts was so limited, and the cases he gave were so imperfectly detailed, that none of the points he

HISTORY OF HAV-FEVER.

*9 suggested could be considered as proved; consequently, they have not been generally received, and have excited comparatively little attention ; they were suggestions, and nothing more, and they left the subject as mysterious as they found it. . In 1869 C. Binz, of Bonn, Germany, published in Virchow's Archives (Part I, February) an essay on quinine, under the title " Pharmakologische Studien iiber Chinin." In this essay was incorporated a letter addressed to Professor Binz by Helmholtz, recommending the local application of sulphate of quinine in hay-fever. Helmholtz stated that he had suffered since 1847 from what the English called "hay-fever;'' that the disease came on about the 20th of May, and lasted till the end of June, and that the symptoms were aggravated by exposure to heat and sunshine. Helmholtz further stated that he had found in the nasal secretion at that time "certain vibrio-like bodies" (infusoria), very delicate and small, and which could only be seen with a very good Hartneck's microscope; and on becoming acquainted with the experiments of Binz, in which the poisonous action of quinine on infusoria was demonstrated, he resolved to test the treatment of his hay-fever by this method. Accordingly, in 1867",- he injected a solution of quinine into his nostrils, lying on his back and moving his head to and fro, so that all parts might be affected, "^here was immediate relief; and this treatment repeated three times daily served to keep the disease at bay, and the vibrios disappeared from the secretion. After a few days of this treatment the symptoms entirely ceased, but if the applications were omitted the disease returned.