THE TREATMENT
OF HAY FEVER
BY ROSIN-WEED, ICHTHYOL AND FARADIC
ELECTRICITY, WITH A DISCUSSION OF THE OLD
THEORY OF GOUT AND THE NEW
THEORY OF ANAPHYLAXIS
BY
GEORGE FREDERICK LAIDLAW, M.D.
Consulting Physician to Yonkers Homoeopathic Hospital; to St. Mary's
Hospital, Passaic; and to the Ann Mary Memorial Hospital, Spring
Lake, New Jersey; Consulting Physician to Cumberland Street
Hospital, Brooklyn, Department of Public Charities
Formerly Professor of Practice of Medicine in the New York
Homoeopathic Medical College; formerly Visiting Physician to Flower
Hospital; to Hahnemann Hospital and to the Metropolitan Hospital,
Blackwells Island, Department of Public Charities, New York
BOERICKE & RUNYON
NEW YORK
1917
COPYRIGHT, 1917, BY
BOERICKE & RUNYON
PREFACE
The essentials of this book, rosin-weed, ichthyol, and faradism, were
announced at the Baltimore meeting of the American Institute of
Homoeopathy, in June, 1916, and published simultaneously in the _New
England Medical Gazette_ and in the _Journal of the American Institute
of Homoeopathy_ in December, 1916. They were presented also at the New
York City branch of the United States Hay Fever Association in July,
1916; at the annual meeting of the same Association at Bethlehem, New
Hampshire, in August, 1916; and rather widely printed in the public
press of New York and Boston in the summer of 1916.
As a suggestion to those who may wish to follow the subject of hay
fever in its recent interesting developments, chapters have been added
on the old conception of gout, the new theory of anaphylaxis and
treatment by diet, by pollen extracts and by bacterial vaccines.
CONTENTS
PAGE
I. The Diagnosis 9
II. Rosin-weed 14
III. Ichthyol and the Point in the Naso-pharynx
that Controls the Symptoms 17
IV. Menthol and Eucalyptol 20
V. The Faradic Current and Other Forms
of Electricity 27
VI. Hay Fever as Urticaria 38
VII. Dr. Gueneau de Mussy. Hay Fever as
Urticaria Again 44
VIII. Hay Fever as Gout 51
IX. The Uric Acid Theory 66
X. Hay Fever as Anaphylaxis 76
XI. Immunizing with Pollen Extracts 91
XII. The Bacterial Vaccines 108
XIII. Diet 113
XIV. Rosin-weed Again. Historical and
Pharmacological 123
THE TREATMENT OF HAY FEVER
CHAPTER I
_THE DIAGNOSIS_
Under the name "hay fever" I include rose-cold and the so-called
hyperæsthetic catarrh or vaso-motor rhinitis, all characterized by
intense itching of the eyes, nose, and throat, free discharge, sometimes
asthma, the attacks being precipitated by strong odors, dust, or pollen.
There are many forms of the disease, some occurring in May or June, some
as early as March, before the budding of vegetation, some even in the
winter; but the large majority of cases occur in August, coincident with
the flowering of late summer vegetation, notably the rag-weed and
golden-rod. It is not so well known that the California privet, so
widely used in hedges and parks, aggravates many patients, especially in
June and July, when the scent of the flowers is strong. Others are
irritated instantly by the odor of crude oil that is spread so freely
on the roads in summer, by metal-dust, and by the cinders of a railway
trip. Some patients are sensitive to one irritant, some to many
irritants. I knew one man whose itching of the eyes began in March, nose
and throat following in April and May, cough in July and August, who was
sensitive to each and all of these irritants from March to October every
year for thirty years.
If we follow the modern tendency and classify the cases according to the
specific irritant, we shall have an endless number of varieties
according to the endless number of possible irritants; and where will
you classify the man who is subject to them all? In the present state of
our knowledge, it seems better to regard the sensitiveness to irritants
as the characteristic of these cases and to think of them as different
forms of the same disease. In most text-books this idea is expressed by
the terms _hyperæsthetic catarrh_ and _vaso-motor rhinitis_; but there
are serious pathological objections to the terms _catarrh_ and
_rhinitis_. These objections and the reasons for regarding the lesion as
an angioneurotic oedema are discussed in Chapter VI, on Hay Fever as
Urticaria, to which the reader is referred.
An additional reason for regarding all these varieties as superficially
differing forms of the same disease is the fact that all of them are
curable by the same methods. I am aware of the danger of error in this
argument, the persuasive but misleading _Analogieschluss_, and would not
advance it too strongly. However, for all practical purposes except the
vaccine treatment, described in Chapter XII, all these hyperæsthetic
cases may be regarded as varieties of the same disease.
With a patient suffering from hay fever, as with a patient suffering
from any other disease, the first thing to do is to take the history and
make an examination. Usually, the nature of the case will be clear from
the history, but it is a mistake to rest here without looking into the
nose and throat. In the nose, you may find anything from a polyp to a
shoe-button, any of which may require mechanical removal before you will
make any progress with your medicines, no matter how well selected.
Usually, you will find nothing but a swelling of the mucous membrane of
the turbinates with free discharge. If you are an adept at examining the
nose, you will probably search for the sensitive areas, touching of
which causes a spasm of sneezing. These may be found anywhere in the
nose, but most commonly at the anterior and posterior ends of the middle
and inferior turbinated bones. I apply ichthyol to the naso-pharynx to
test the sensitive area described in Chapter III.
What constitutes a gross lesion requiring surgical removal? Competent
men differ widely and the practice of the same man has differed widely
at different stages of his career. For a time there was enthusiastic
cutting of septal spurs and burning of redundant mucosa and cauterizing
of sensitive areas. I think that the relation of the nose specialist to
hay fever is similar to the relation of the abdominal surgeon to
neurasthenics. The more experienced he becomes, the more he advises
letting them alone or using gentle measures. Distinct polyps should be
removed.
Having finished the examination and found no gross lesion requiring
surgical removal, the treatment must be decided. The easiest plan for
both patient and physician is to give rosin-weed, as described in
Chapter II.
The most painful for the patient but often effective in severe cases is
the application of ichthyol, as described in Chapter III.
If the patient is systematic and will attend to it, the ichthyol may be
replaced by the _frequent_ spraying with menthol and eucalyptol, as
described in Chapter IV.
The best treatment of all, but that which takes the most time of both
patient and physician, is the use of electricity, as described in
Chapter V.
Consider the possible importance of diet in the case, as described in
Chapter XIII.
Finally, ponder on the nature of hay fever, as discussed in Chapters VI
to X, and the advisability of using vaccines or pollen extracts, and you
will have done your whole duty by your patient and by your art.
CHAPTER II
_ROSIN-WEED_
For many years the fluid extract of rosin-weed has been known in my
family as a remedy for rose-cold and hay fever. This use of it was
discovered by my father, Dr. Alexander H. Laidlaw, in the epizoötic days
of 1872, when horses were dying by the thousands all over the United
States and Canada. Though he knew it first as a horse medicine, its use
seems to be forgotten in veterinary practice, for I find no mention of
it in available veterinary books, old or new.
In my father's practice this remedy acquired considerable fame, and I
still receive a letter or two every summer from distant cities from some
one who has heard of the miraculous medicine. For many years it was his
intention to give this remedy to the world in proper form, supported by
competent testimony; but, in a busy life, with many projects
unfulfilled, this was never done. During my own professional life I have
been interested in many things that seemed more important than hay
fever and have not heretofore taken up the matter of publishing our
experiences with the drug. Realizing that there were many hay fever
victims both in this country and in Europe who might just as well be
getting the relief that this drug would give them if they only knew
about it, and having no desire to profit by my possession of the secret
of this remedy, I made the announcement last summer, first to the
American Institute of Homoeopathy and next to the United States Hay
Fever Association. I announced it first to my old society, the
Institute, believing that my friends there, who have known me many
years, would credit my statements as made in good faith and give the
drug a fair trial.
=The Dose.= Beginning ten days before the expected attack, give ten drops
of the fluid extract of rosin-weed in a little water four times daily,
after meals and on retiring. To children, give five drops. If the
symptoms of hay fever appear, increase the dose to twenty and even
thirty drops and continue this dose through the entire hay fever
season.
It is better to begin ten days before the expected attack, for, in hay
fever, as in all periodic diseases, prevention is better than cure,
requires smaller doses, and is more certain. However, few patients are
wise enough to anticipate trouble. Most patients apply for treatment
when, literally, the disease is in full blast, and most of my
observations have been made on the latter class. In case the disease has
already begun, start with the same dose, ten drops. If not relieved in
three days, increase the dose by five drops every third day up to thirty
drops. If the symptoms should be relieved by the smaller dose, it is
unnecessary to increase it.
=Cure Or Palliation?= In regard to the permanence of the cure, most
patients require it for several seasons. Some need it every season for
many years. A few are permanently cured in one season.
For further information about the plant, rosin weed, its preparation and
use in medicine, the reader is referred to Chapter XIV.
CHAPTER III
_ICHTHYOL AND THE POINT IN THE NASO-PHARYNX THAT CONTROLS THE SYMPTOMS_
While the use of rosin-weed was discovered by my father, the value of
ichthyol in the treatment of hay fever and the point in the naso-pharynx
that controls the symptoms are discoveries of my own or, at least, I
fondly think so. In current medical literature, I find no reference to
it. In Merck's _History and Preparation of Ichthyol_, a summary of its
use to 1913, ichthyol is advised in hypertrophic and atrophic rhinitis,
but hay fever is not mentioned. Reference to recent books, as Coakley,
Ballenger, Ivins, Bosworth, Kyle, Grayson, show no knowledge of the use
of ichthyol in hay fever nor of the spot in the naso-pharynx that
controls the symptoms.
The point of the matter is this. In hay fever, the itching and redness
of the eyes, nose, and throat are controlled from a sensitive point in
the naso-pharynx. Local applications to this point will relieve almost
instantly not only the itching of the throat but also the itching of the
eyes and nose and all symptoms of the disease. In some cases such relief
carried out for several seasons makes permanent cures.
My knowledge of it came about in this wise. At about the age of sixteen
I developed a rose-cold that began in June and extended into September.
A few years later it began in April and lasted until October. By one of
those ironical tricks that fate plays on the great ones of the earth,
rosin-weed, the family remedy that cured everybody else, gave me only
partial relief. It is unnecessary to follow in detail the various
experiments made. This was long before the days of Dunbar's pollantin,
Holbrook Curtis' ambrosia, adrenalin, and the modern vaccines. I did not
think cocaine a safe drug and never used it, preferring the hay fever to
the cocaine habit. About this time ichthyol was introduced by Merck for
the treatment of catarrh of all mucous membranes and I found that
ichthyol, used in a certain manner, relieved the symptoms completely. On
swabbing the naso-pharynx with pure ichthyol, there was a severe
burning sensation for a minute or so, but, when the burning subsided,
there was great relief, not only of the itching throat but also of the
itching of the eyes and nose. That is, in the customary swabbing of the
naso-pharynx, we touch a point that controls the whole group of symptoms
of the eyes, nose, and throat.
In those days the laryngeal and pharyngeal tonsils were very much to the
fore in medical discussions, and at first I thought that this point was
probably the pharyngeal tonsil of Luschka. However, judging from the
location of the most severe burning, the controlling point is rather on
the upper surface of the soft palate. The exact location of this point
is not of practical importance. If you swab each side of the
naso-pharynx with plenty of ichthyol, the reflex contraction of the
pharynx while the swab is in it will spread the ichthyol over the right
territory.
CHAPTER IV
_MENTHOL AND EUCALYPTOL_
The ichthyol treatment described in the last Chapter is very effective,
but it burns severely for a few minutes and, for this reason, some
patients will not endure it. With children, it is impossible. Another
disadvantage to the patient and, sometimes, to the doctor, too, is that
it requires the patient to come to the doctor every day for the
application, though Dr. Hollister tells me that he had one patient who
learned to apply the ichthyol to her own naso-pharynx and, what is more
wonderful still, kept up the treatment long enough to get well. In
recent years I have hit on a treatment that is more comfortable than
ichthyol and in many cases equally effective, though a little slower in
giving relief. It can be carried out by the patient with little trouble
and requires no skill in handling nasal swabs, an important matter with
nervous patients and children.
I have found that the ordinary solution of menthol and eucalyptol and
thymol in liquid albolene will relieve hay fever if applied to a certain
spot a certain number of times a day. At this point I can see the
reader's face assuming an expression of pained surprise. What is there
wonderful about that? Is there not a bottle of this solution on the
table of every doctor in the country and does not every modern textbook
on the Nose and Throat advise inhaling vapor of such a solution to
relieve hay fever? True. Note that I did not say that simply spraying
this solution in the nose and throat will cure hay fever. I said that it
must be applied to a certain spot a certain number of times a day. It is
a case of the technique being more important than the remedy; for I have
no doubt that there are other medicines than ichthyol and menthol that
will relieve if put on the right spot. The reason that every doctor has
not discovered for himself the full value of this commonly used solution
is that he did not put it on the right spot and he did not use it often
enough.
=The Right Spot=, as related in the chapter on Ichthyol, is either the
vault of the pharynx or the upper surface of the soft palate.
=Frequency.= Once or twice a day is insignificant. It must be used every
hour or oftener when the symptoms are acute. Here I borrow an idea from
the dermatologist who learned long ago from Unna that when an ointment
rubbed on twice a day fails to cure an eczema, it may be cured by
keeping the same ointment constantly applied to the part, day and night.
The naso-pharynx of the hay fever patient requires the same continual
application of the cure and we come as near as possible to a continual
application by applying the solution every hour or two.
Such frequent applications are impracticable as office treatments, but
must be carried on at home or at business by the patient or a member of
the family. If an expert hand is available to spray the naso-pharynx,
the tip of the atomizer should be pointed forward so that the spray is
directed into the posterior nares and the posterior surface of the soft
palate as well as the vault of the pharynx. An adroit patient may learn
to do this, but even an adroit patient, unfamiliar with the anatomy of
the throat, may spray only the front of the palate and fail to get the
solution correctly applied. To avoid these mistakes and insure the oil
getting on the right spot, the patient should be taught the following
simple technique.
=Method of Application.= Taking an ordinary atomizer full of the oil, the
patient lies on the back with the head low or on one flat pillow. He
must be able to breathe freely through the nostril to be treated.
Usually, one side of the nose is free and he begins with that side,
inhaling the oily spray freely. He then remains lying on the back with
the head low while the oil runs backward into the naso-pharynx,
especially on the upper surface of the soft palate, where it burns a
little but not nearly as much as ichthyol. After two minutes or so, the
other side must be treated, but it must first be opened up so that the
patient can breathe freely through it. This is done by turning on one
side so that the stuffy side is upper-most. In a few minutes this side
will open up and the spray can be inhaled through it freely back into
the throat. To be thorough, the patient treats each side several times.
For the first few days the treatment should be carried out every hour or
so. After a few days or a week mild cases get perfect relief and even
severe cases may drop to four treatments daily. Such a method is far
safer than cocaine, which should never be put in the hands of the
patient for any purpose whatever.
For obstinate cases ichthyol remains the most effective of the local
applications. With those adults who can learn to spray the naso-pharynx
and who are heroic enough to bear the sharp burning for a few minutes
for the sake of ultimate relief, I mix one-tenth ichthyol with the
albolene spray solution. Ichthyol leaves the throat raw and
uncomfortable for a few minutes. For this reason it should not be used
as frequently as the albolene solution.
Ichthyol does not mix well with the albolene, but precipitates quickly.
As it does not mix readily by shaking, the mixture must be stirred
before using. The manufacturers, McKesson and Robbins, were good enough
to experiment in their laboratory with mixtures of ichthyol and
albolene. They report that they were unable to make a satisfactory
combination and that "the only way to get a permanent mixture of the two
would be by a process of emulsion, which would be too thick for spraying
purposes."
It may be objected that my newly discovered point in the naso-pharynx is
merely the posterior end of the inferior turbinated bone, as described
by Mackenzie and Sajous and others long ago, and that the spraying of
the nasal passages simply benumbs the sensitive areas, anterior, middle,
and posterior, that are well known to rhinologists. This may be so. At
any rate, the method just described makes possible a treatment of these
areas in every case, though far from skilled assistance. The treatment
by cautery must always remain a treatment by the skilled specialist in
selected cases. Even if my sensitive spot in the pharynx is nothing new,
this method will at least place in the hands of thousands of hay fever
sufferers a simple method of relief, which thought there is more
satisfaction than in being reputed the discoverer of the resurrection
bone itself.[1]
FOOTNOTES:
[1] Throughout the middle ages, there was a firm belief in the existence
in the human body of an indestructible bone which was thought to be the
necessary nucleus of the resurrection body. With the revival of
dissection and the study of anatomy in the sixteenth century, many
anatomists searched for it eagerly but it was never found.
CHAPTER V
_THE FARADIC CURRENT AND OTHER FORMS OF ELECTRICITY_
The distinguished dermatologist, Dr. Duncan Bulkley, used to argue that
lupus erythematosus was a neurosis because he could cure it with
phosphorus and thought so highly of this _tour d'esprit_ that he made it
the subject of a Presidential Address.
In the same way I might argue for my favorite theory that hay fever is a
neurosis, an angioneurotic oedema, because it is curable by
electricity; or that electricity cures hay fever because it is a
neurosis. These are examples of reasoning by analogy, found so
frequently in medical writings, so plausible and so perilous, leading
more often to error than to truth. So I will not argue the matter at
all, but simply state the result of my observation that faradic
electricity cures hay-fever. This electric treatment takes time and
trouble, but if both physician and patient are willing to take that
time and trouble, more permanent cures may be secured than by any other
treatment known to me.
The use of electricity to cure hay fever is one of those bits of
therapeutic gold that lie long hidden in medical literature, are found
for a moment, and quickly lost again. Back in 1875 Beard and Rockwell
speak of two cases, one cured and the other relieved by descending
galvanism. In 1871, Neftel relieved a case of hay asthma by galvanizing
the vagus; but recent books know nothing of it. Monell, Bigelow, Massey,
and Bartholow know electricity about the nose only as a cautery.
Tousey's big book suggests the local application of the high frequency
current in hay fever, of which more anon at the end of this Chapter.
It was from none of these that I stumbled on the fact that faradic
electricity would cure hay fever. In 1894 there appeared in New York a
patriarchal old gentleman with a queer idea that he could cure
pneumonia, tuberculosis of the lungs, and asthma by manipulation. He was
Dr. Orrick Metcalfe, of Natchez, Mississippi, a brother of Dr. John T.
Metcalfe, long one of the leading physicians of New York and Professor
of Medicine in the College of Physicians and Surgeons. Dr. Metcalfe
visited various hospitals, trying to interest physicians in his method,
demonstrating it freely to whomever would attend. He had a hard time
with the Philistines, who, for his brother's sake, would receive him
politely in their clinics, give him any number of charity patients to
work on, but seldom take the trouble to go personally and see what he
could do. He remained in New York for several years, during which time I
watched his work and was convinced that the principle was sound and the
results good. He made one striking cure of a patient of mine, an old
lady who for many years had a most obstinate cough that she had taken
all over the world, to Egypt and Switzerland and Colorado, without
relief. Dr. Metcalfe treated her by his manipulation in the winter of
1896, cured the cough so thoroughly that it has never returned, now
twenty years, as I know personally, because the old lady still consults
me for minor ills. Let me add this tribute to his memory, that there
never lived a more unselfish, practically benevolent physician than
Orrick Metcalfe, true to the noblest traditions of medicine, working
away at his hobby, not because it was profitable, which it was not, but
because he believed it to be true, constantly seeking with open mind to
improve his methods and to learn better ways.
In regard to asthma and pneumonia and phthisis, his starting point was a
supposed stiffness or rigidity or lameness of the muscles of respiration
as the first step in the chain of events, and his effort was to limber
up at as early a time as possible this stiffness of the muscles. By
manipulating the muscles of the chest, neck, back, and abdomen, he would
find certain points that hurt or where the muscles were plainly tight or
stiff. Continuing the manipulation, he would have the patient take deep
breaths and try to cough. Often, when a certain spot was manipulated,
the patient would begin to cough without prompting. Such a spot was his
delight to find. He would continue to manipulate it, encouraging the
patient to cough and expectorate, holding that free expectoration
brought relief to the lesion. In pneumonia the expectoration was often
bloody, which pleased him mightily. I have seen him thus manipulate a
consumptive only a few hours after a hemorrhage and encourage him to
expectorate, in such direct contradiction to our usual policy of
absolute rest that I trembled inwardly for the patient.
The possible relation between a muscle-bound chest and dyspnoea is
easily understood, but those of us who watched him could not see a clear
connection between the muscle-bound chest and pneumonia or phthisis.
However, in some later paper I will return to this part of Dr.
Metcalfe's work. To return to asthma, Dr. Metcalfe used to say that he
thought there was some way of relieving the tight muscles better than by
manipulation and regretted his unfamiliarity with electricity, which he
thought might be that better way. I gave him a spare battery that we had
around the office, but the old dog cannot easily learn new tricks and
the old doctor stuck to what he knew and had relied on for so many
years, his own fingers. He treated hay fever by manipulating the eyes,
nose, and both the inside and the outside of the throat, wherever the
itching appeared.
About this time a patient applied for relief of attacks of asthma that
were brought on by inhaling dust. Every time he stirred the papers on
his desk--and being an artist, his desk was always dusty--he had a
disagreeable attack of asthma. Here was an opportunity to test the
Metcalfe theory of tight muscles. As I was much more familiar with the
faradic battery than with manipulation and it was more agreeable to use,
I placed one sponge on the back of the neck and with the other twitched
the muscles over the chest. To include all the respiratory muscles, I
exercised those of the neck and throat, the abdomen and back, as well as
the pectorals and the muscles about the scapulæ. Until one stops to
think of it, he does not realize the extent of the respiratory muscles.
Almost every muscle from the base of the skull to the brim of the pelvis
is directly concerned in respiration.
With the faradic current just as with the manipulating fingers, there
are sore spots that the patient describes as bruised. They may be
extremely tender, though the patient is not aware of them until you
find them with the battery sponge or the finger. These sore spots may be
found anywhere over the chest or abdomen, but are particularly common at
the attachment of tendon to bones, the joints between the ribs and the
costal cartilages and the joints of the sternum, especially the joint
between the ensiform and the gladiolus. My idea was that if there were
any stiff or tight muscles restraining the action of the ribs, the
faradic exercise would limber them up.
I treated this patient twice a week for three months and had the
satisfaction of seeing this asthmatic sensitiveness entirely cured; for
he has remained free from it ever since, now twenty years. This case
lead me to try the current on hay fever patients, passing the current
over the eyes and nose and sometimes inside of the throat, wherever
there was itching, just as Dr. Metcalfe had done with his manipulating
finger. If cough or asthma were present, I treated them as in the case
of the artist just described.
=Treatment.= With one sponge on the nape of the neck or between the
scapulæ, pass the other sponge over the eyes, nose, and throat for ten
minutes. Use a gentle current, just enough for the patient to feel it
but not strong enough to cause pain. If cough or asthma are present,
twitch the respiratory muscles for ten minutes more, not forgetting that
the respiratory muscles include the abdominal muscles, those of the
whole length of the spine, and the cervical muscles all around, as well
as the pectorals and the scapular muscles.
In regard to polarity, I do not think it makes any real difference
which pole is used in each place. I am old-fashioned enough to remember
when the polarity of a faradic battery was determined by holding two
sponges of equal size, one in each hand, turning the current on quite
strong and calling the stronger one the negative. In those days I
learned to use this "negative" pole for active treatments and this is
still my habit, putting the positive on the back and twitching the
muscles with the negative. If this exposition seems crude to the modern
electro-therapeutist, I can only say that I am not writing a treatise
on electro-physics, but relating the experiences in actual practice
over a period of nearly thirty years. The customs in which I was
brought up are good enough for me until I see real reason for changing
them. The electro-therapeutist is at liberty to turn the sponges around
and use them the other way if it appeals to him as more fitting.
One of the most brilliant cures of hay fever with faradic electricity
was made by Dr. Thomas P. Birdsall, of Pawling, New York, about fifteen
years ago. The patient was a farmer's daughter of twenty years who had
lived all her life on a farm in Putnam County and had suffered many
years from hay fever. Dr. Birdsall used the faradic current from a small
portable battery three times a week, _while the patient remained on the
farm in the irritating environment_, and in one season made a cure that
has lasted to this day.
=Other Forms of Electricity.= It is probable that all forms of electricity
will relieve or cure hay fever. I have used the faradic current because
it was the most convenient. It is still the most convenient current for
most physicians. The old reports are of the galvanic. Ballenger
recommends the leucodescent light. I have seen several reports of the
use of the high frequency current and Tousey devotes a short paragraph
to it, as follows:
"The author suggests the use of a glass vacuum electrode insulated by a
double wall except at its extremity, which can be applied to all parts
of the nasal mucosa but especially to the inferior and middle turbinated
bones.... A similar application may be made to the outer surface of the
nose at the sides, halfway from the root to the tip." (Second Edition,
page 598.)
From my experience with patients I doubt whether many of them would
submit to the intra-nasal spark. A theoretical objection to using any
form of high frequency or diathermia on the outside of the nose is that,
in some skins, frequent application of these currents causes a permanent
dilatation of the capillaries of the skin, resulting in permanent
redness. I tremble to think of the wrath of the fair lady whom you
should cure of the hay fever by endowing her with a permanently red
nose. I know that these currents are used on the face freely by
dermatologists and have often made a few applications to break up a
catarrhal cold; but I have seen cases enough of capillary dilatation and
its intractability to make me pause and choose for the nose and face the
surely safe faradic current rather than the more spectacular but risky
high-frequency.
CHAPTER VI
_HAY FEVER AS URTICARIA_
The fundamental error in all the literature on hay fever is the teaching
that the lesion is a peculiar kind of catarrhal inflammation; whereas it
is not an inflammation at all, catarrhal or any other kind. The symptoms
of hay fever _resemble_ those of catarrhal inflammation, but the
resemblance is only superficial. The resemblance is striking and must be
so to have deceived so many skilled observers, but it is only
superficial, nevertheless.
When you see a patient with eyes red and swollen, overflowing with tears
and mucus, burning and sensitive to light, you say at once, catarrhal
conjunctivitis. In the nose the sneezing, the discharge, the obstructive
swelling suggest at once catarrhal rhinitis. But stop a moment. Did you
ever cure a catarrhal conjunctivitis or rhinitis in three minutes by
moving the patient from one room to another? You can do that with hay
fever. If you can remove the patient from the irritating atmosphere,
the swelling and redness will subside rapidly, the discharge cease, and
in five or ten minutes you would scarcely know by examining the patient
that there was anything the matter with his eyes and nose. By returning
him to the irritating atmosphere the symptoms will return instantly. By
removing him again, they will rapidly subside. I have watched this many
times in my own eyes. It was in watching the changes in my own eyes and
nose that I realized that this was no catarrhal inflammation but a much
more superficial lesion.
Did you ever see a catarrhal conjunctivitis that acted in this way or a
cold in the head in which the patient could be cured and catch a fresh
cold twenty times a day? I think you never did. A true inflammation
requires time, a few hours, for its development, and when an
inflammatory exudate oozes into the meshes of the tissue, it requires
some days or at least some hours to be absorbed. This one point of rapid
appearance and rapid disappearance would forbid our calling the lesion
of hay fever a catarrhal inflammation.
Next, associate this rapid appearance and disappearance with the chief
symptom of hay fever, the itching, the intolerable itching, of the eyes,
nose, and throat, itching that ceases at once on removal from the
irritating atmosphere and returns instantly when the irritating
atmosphere is reapplied. Turn to the skin, the external mucous membrane.
What is that disorder of the skin that appears abruptly, presents
redness, swelling, and intense itching, and ceases abruptly after a few
minutes or a few hours according to your ability to get rid of the
irritating cause,--that can be reproduced any number of times by
exposure to the same cause? Why, hives, of course, urticaria or
angioneurotic oedema. And a hive (or urticaria or angioneurotic
oedema) is not an inflammation. It is a vascular spasm, a spasm of the
minute vessels that drain small areas of skin, causing a local stoppage
of the circulation in that small area, a turgescence or exudate, the
hive. Just as suddenly as it began, the spasm of the vessels may relax,
the swollen area is drained rapidly, and the hive disappears, leaving a
faint redness. This is exactly the case with hay fever. It is an
urticaria, a vascular spasm. The sudden onset in response to a specific
irritant and the sudden disappearance--this is no catarrhal inflammation
and no rhinitis or inflammation of any kind.
Those cases of hives that appear quickly after chilling the skin are
perfect analogues of hay fever, appearing in response to the local
irritation of odors and dust. There are cases of hay fever that resemble
ordinary hives in being aggravated by certain foods, especially
strawberries, acid foods, and malt liquors. This has a practical bearing
on treatment; for, in such cases, simply excluding these foods from the
diet and the administration of an alkali gives relief. Again, many hay
fever subjects suffer from urticaria, as in the case reported to me by
Dr. Rice of Hawaii, in which the attacks of hay fever alternated with
urticaria.
Sir Morell Mackenzie was wrong when he said that hay fever "had no
pathology because it leaves no permanent structural lesion behind it."
Hay fever "has a pathology" if urticaria has a pathology, for urticaria,
too, subsides and leaves no traces. However, in this statement, we
recognize the effort to state the difference between the evanescent
lesions of hay fever and the more persistent lesions of catarrhal
inflammation; which is just the difference between an urticaria that
comes and goes in half an hour and an eczema (catarrhal dermatitis) that
takes several days to develop and is attended by a real inflammatory
exudate that requires many days for its absorption.
In our text-books, our ablest specialists perpetuate this error by
devising such names as _hyperæsthetic catarrh_, _hyperæsthetic
rhinitis_, _vaso-motor rhinitis_--and then describing a neurosis. The
two ideas will not mix. The very authors who introduce these names feel
that there is something wrong with them, for usually they take several
pages to explain what the name means. It is better to throw overboard
both the name and the idea of catarrhal inflammation or rhinitis and
start afresh.
Recent workers with pollens come near the truth in describing hay fever
as an anaphylaxis. Right here my conception of the lesion of hay fever
as an urticaria fits into the picture and brings us one step nearer to
an understanding of the disease; for where is there a prettier example
of anaphylaxis than those very hives with which long ago I compared the
lesion of hay fever?
Since Bostock first described hay fever in 1816, hundreds of physicians
have looked at thousands of patients, but, as far as I can discover,
there was just one observer besides the modest author of this book who
recognized the urticarial nature of the lesion of hay fever. This was
Dr. Gueneau de Mussy, to whom we will devote the next chapter.
=The Cause Behind the Lesion.= All clinicians agree that there are two
elements in the hay fever problem,--first, the irritant; and secondly,
the abnormal sensitiveness of the patient. All are fairly well agreed as
to the irritants, pollen and dust; but what makes the patient sensitive?
This is still the dark side of the subject. Among the many theories, two
seem to deserve further study and will be considered in the chapters on
Hay Fever as Gout and Hay Fever as Anaphylaxis.
CHAPTER VII
_DR. GUENEAU DE MUSSY HAY FEVER AS URTICARIA AGAIN_
In searching through the early literature of rosin-weed, as related in
Chapter XIV I noted that the article in the _Eclectic Medical Review_
recommending rosin-weed for asthma seemed to have been copied only in
the southern and western medical journals. I was curious to know if the
aristocratic medical editors of the east, the intimates of Bigelow and
Holmes and Warren, had deigned to notice a drug of such lowly parentage,
discovered by the Indians and indorsed by the medical heretics. I began
with the stately row of bound volumes of the Boston _Medical and
Surgical Journal_, running back to 1860, that repose on a dusty back
shelf of the Library of the New York Academy of Medicine. Looking
through the volumes around 1868, when the use of rosin-weed in asthma
was being quoted in the south and west, I found many quaint notes and
comments, but no mention of rosin-weed. To any physician who has a
taste for the history of his art, I would recommend reading a journal of
fifty years ago. So many things have been settled that those old
physicians puzzled and fought over that it gives one the sense of
amusement or lofty detachment of the gods, looking down on struggling,
wriggling humanity, yet knowing all the time how it would come out.
In those old books I noticed abundant quips and sneers at homoeopathy,
now happily taboo in the more courteous journalism of to-day. Besides,
they are not so funny now. The doctrine of like-cures-like and the small
dose has achieved respectability. When armies all over the world are
depending on a minute dose of typhoid poison to prevent and cure typhoid
fever, when articles appear in the most respectable medical journals
advocating doses of tuberculin so small that they have never been
calculated and one-tenth grain doses of calomel instead of the
twenty-grain doses of our grandfathers, most of the merry jests have
lost their flavor to-day. Rather as I expected, in the _Boston Journal_,
I found no notice of the eclectic rosin-weed, but I found something
better, a clinical lecture on hay fever by a man after my own heart,
who, away back in 1868, had recognized the urticarial nature of the
lesion in hay fever. This was a _Clinical Lecture on Spasmodic Coryza or
Periodical Asthma_, delivered at the Hôtel Dieu, by Professor Gueneau de
Mussy, translated from the _Gazette des Hôpitaux_ by W. F. Munroe, M.D.
The lecture runs through several numbers of the _Journal_, beginning in
March, 1869, page 125. It should be read by every rhinologist and by
every physician who is treating hay fever.
When the chemist Woehler, one afternoon in 1828, tried to make up some
ammonium cyanate by mixing ammonium sulphate and potassium sulphate and
found that he had synthesized urea, one of his colleagues said that he
was like Saul, who went out to find his father's asses and found a
kingdom. I felt the same way; only, in my case, I went out among the
asses and found a king.
When Solomon made his despondent remark that there was nothing new under
the sun and that of the making of books there is no end, he must have
been in his library sorting out his collection of old Assyrian bricks
and found that his favorite thoughts had been said already and said
better by some old Hittite scribe a thousand years before. So I, who had
fondly thought myself the discoverer of the urticarial nature of hay
fever because I had searched the books of the specialists and found
nothing about it, was surprised to find my observation anticipated by
the Frenchman.
_Salut!_ Hail to you across the years, Gueneau de Mussy, kindred spirit.
It is not recorded that the gray-headed Dean of a great university ever
stood you on a platform and hurled Latin adjectives at you; but in 1868
you had the sharpest eyes and clearest mind of any of them, M.D.'s or
LL.D.'s, though bespattered with all the letters of the alphabet.
Of all the foolish things that scientific men quarrel about, one of the
most foolish is the question of priority of discovery. A scientist who
will welcome the opinion of another scientist agreeing with him the day
after he announces his discovery will fight like a cat against evidence
that the same man agreed with him the day before. It seems to me that
if another human being confirms your work, it does not make any
difference whether he does it the century before or after your transient
existence. In fact, you should be more pleased to have it "confirmed"
the century before, because then you will have a chance to know about
it.
Besides recognizing the urticarial nature of the lesion, de Mussy sought
the underlying cause of hay fever and thought to find it in the gouty
diathesis. He notes the occurrence of hay fever in gouty families, its
periodicity, its association with urticaria, eczema, granular
pharyngitis and asthma, all characteristics of gout or arthritism.
As de Mussy's lecture is not readily available, I quote from the _Boston
Journal_ some of his conclusions.
"I have dwelt at length on the constitutional condition in order to show
in what diathetic conditions spasmodic catarrh has developed. The direct
and collateral hereditary tendency appears to indicate a diathetic
origin. The two sisters belong to a gouty stock. Chronic urticaria and
granular pharyngitis are not rare in gouty families.
"Periodicity is characteristic of many arthritic affections. The
spring-time periodicity is especially common to them. The periodicity of
this coryza places it in the same category as the arthritic affections
which generally manifest themselves by regular or irregular paroxysms.
"If hay fever has been more often noticed in England than France, can
this be due to the greater frequency of gout in the former country?
"Continuing the study of these analogies which, if not enough to prove a
common origin, are enough to justify further study of the question, I
find in one of my patients a morbid condition due to an arthritic
source, _i.e._, an urticaria alternating with asthmatic coryza (hay
fever), the latter appearing with symptoms such as _injection and
itching and tumefaction of the eyes which recall the cutaneous affection
to which it had succeeded_." (Italics mine. Here is my urticaria theory
expressed in 1868. G. F. L.)
"_Behind a vast number of nervous troubles, behind a vast number of
bizarre functional anomalies stamped with a nervous imprint, we find
arthritism._" (Italics mine. Here is my pet theory of the gouty origin
of neurasthenia and perhaps Beard's _neurotic constitution_, beloved of
rhinologists. G. F. L.)
"As to analogies between summer catarrh and urticaria, I wish to draw no
conclusions from them. If it be admitted that both are due to
arthritism, their succession and the analogy in their local development
can be understood." (My urticarial nature of the lesion again. G. F. L.)
I might add that de Mussy reports success in preventing the appearance
of the symptoms by the use of quinine for seven or eight days before the
expected attack. During the attack he used sulphur and arsenic for the
catarrh.
In the next chapter we will consider the fate of de Mussy's theory of
gout as the underlying cause of hay fever.
CHAPTER VIII
_HAY FEVER AS GOUT_
In the last chapter we read that the theory of a gouty diathesis as the
constitutional basis for hay fever originated with Dr. Gueneau de Mussy,
in 1868, on account of the many resemblances that he found between the
symptoms of gout and the symptoms of hay fever. We have now to consider
the fate of the de Mussy doctrine in those countries where hay fever is
best known and has been most closely studied, Great Britain and America,
Germany and France.
=De Mussy in Great Britain and America.= If any specialist on the nose and
throat in England or America ever heard of de Mussy and his theory that
hay fever is rooted in a gouty diathesis, he is keeping the secret well,
for it does not appear in any of the books that he writes; but in every
book I find the disease attributed to the _neurotic constitution_ first
suggested by Beard. In this statement I do not include several
references to "uric acid poisoning" which is not the same thing as gout,
as will be explained in Chapter IX, on the Uric Acid Theory.
After reading de Mussy's argument for the dependence of hay fever on a
gouty diathesis, I turned first to the English books. For centuries,
England has been famous as the home of gout and, since the Englishman,
Bostock's, account of his own case, hay fever, too, like parliamentary
government and gout, has been recognized as an inheritance of the
Anglo-Saxon race. As British physicians see more gout than any other
physicians in the world and as, for many years, they have had the best
opportunities for the study of hay fever, I turned first to the English
books, thinking that if there was any truth in the gouty theory, the
British physicians would have found it out long ago. To my surprise I
searched book after book by both British and American authors, but in
not one instance did I find hay fever associated with gout. These books
included Allbutt's _System of Medicine_, F. T. Robert's _Practice_,
Lennox Browne, Morell Mackenzie in England and, in this country,
Ballenger, Bosworth, Coakley, Kyle, Solis-Cohen, Ivins and Vehslage and
Hallett.
No one is more saturated with the traditions of British medicine than
Sir William Osler, but, in his _Practice of Medicine_, in discussing the
constitutional causes of hay fever, he seems to know nothing of the
gouty theory.
Besides the article on hay fever in his _Diseases of the Nose and
Throat_, Sir Morell Mackenzie wrote a comprehensive work on _Hay Fever
and Paroxysmal Sneezing_ that ran through five editions and bears on the
flyleaf the admiring comment of the _London Lancet_ that it "must be
regarded as one of the most complete expositions of our knowledge of
this curious complaint in our language." It is a wicked joy to catch
such a scholarly writer as Mackenzie napping. In a footnote he even
refers to the de Mussy lecture in the _Gazette hebdomadaire_, Jan. 5,
1872, as calling the disease spasmodic rhinobronchitis, with which name
the disease is still known in France. One suspects that the learned
Doctor was very busy that day and that the footnotes were looked up by
somebody else; for, though he gives "the most complete exposition in our
language," as the _Lancet_ puts it, of the constitutional causes
underlying hay fever, there is never a word of de Mussy's theory of
gout.
In Osler and McCrae's _Modern Medicine_ the article on Hay Fever is
written by Professor Dunbar, of Hamburg, deviser of pollantin. Here at
last we get away from British insularity, for, in spite of his Scotch
name, Dunbar is a German. On page 863 he writes:
"For a long time it has been believed that the predisposition to hay
fever rests on a gouty diathesis. This view is not on the face of it
inconsistent with the pollen theory. Inquiries, however, have shown that
gouty persons form only a small portion of hay fever patients."
Finally, in the great Edinburgh _Encyclopædia Medica_, 1900, Volume 4,
Greville MacDonald, of London, in the article on Hay Fever, seems to
know nothing of the gouty theory and says innocently at the end of the
article, "No special dietary is indicated, seeing that these patients
present no tendency to lithæmia, etc." He makes the extraordinary
suggestion that, in relieving the attack of hay fever, "rather than give
the patient cocaine, it might be wise to allow the opium pipe." In the
early prescriptions for hay fever, opium sprays and nasal douches were
common enough, but this is the only time I ever heard a reputable
physician and a teacher, at that, advising a patient to "hit the pipe."
I think that, from the evidence examined, we may say that British and
American authors know nothing of de Mussy and his theory.
Next, I looked up the gout authorities, Ewart, Ebstein, Garrod,
Falkenstein, Lancereaux, Lecorche, each of whom wrote a bulky treatise
on Gout, but there is never a word on Hay Fever.
=De Mussy in Germany.= For many years, whenever I have wanted to know
anything from the bottom up, historically, linguistically,
philosophically, I have turned to a German book and have always found
what I was looking for, if it is known to man. Where an American or
British author will skim over or touch a subject carelessly, not seeming
to care where the idea comes from or its relation to other ideas in
different times or countries, a German will plow steadily through the
matter from Hammurabi to Wilhelm III and lay bare all the collateral
tributaries and branches, always with an index at the end.
First I tried Heymann's _Handbuch der Laryngologie und Rhinologie_
(Wien, 1900) and found hay fever described in the article on _Die
Nasalen Reflexneurosen_, by Professor Jurasz in Heidelberg; but there
was no mention of gout. By this, I was truly convinced that nothing was
known on the subject. If a Heidelberg Herr Professor does not know it,
it does not exist. And "Professor Jurasz in Heidelberg" had failed me.
However, looking further in Heymann, my faith in German thoroughness and
all-inclusiveness revived. Hay fever appears also in the article on
Acute Rhinitis, by P. H. Gerber, of Königsberg, and here, on page 371,
we find a complete "Literatur" spread out in true Teutonic style from
Bostock to date. However, Gerber does not discuss the matter of gout in
the text, but says merely, "Recently Bishop asserts that the nervous
disturbances of hay fever are due to an excess of uric acid in the
blood."
The gouty theory of hay fever receives scanty recognition from most
German writers. Strümpell does not mention it. In his _Handbuch der
Specielle Pathologie und Therapie_, Berlin and Wien, 1904, Eichorst says
skeptically, page 326, "It has been stated often that gouty families are
especially apt to develop hay fever," and on page 330 "Grote saw hay
fever patients of gouty families cured (?) by a course of waters at
Neuenahr."
In Eulenberg's _Real-Encyclopædie der gesammten Heilkunde_, 1887, page
509, article Hay Fever, we read:
"Of general diseases, malaria and gout have been advanced as the basis
of hay fever, but without convincing proof."
We may conclude, then, that while British and American physicians know
nothing about the gout theory, German physicians know about it but do
not believe it.
Finally, in my wanderings through German encyclopædias, I came to the
many-volumed Nothnagel and here, at last, found a modern writer who knew
de Mussy and recognized the importance of his observations. At the end
of Volume 4 there is a monograph on Hay Fever by Dr. George Sticker, of
the University of Giessen, the most thorough and satisfactory book on
the subject that I have found. It may be read in English in the American
edition of Nothnagel, Philadelphia, 1902. Sticker resists the impulse to
begin with Galen, though he notes rather wistfully that John Mackenzie
of Baltimore succumbs to it. He gives the most complete statement in any
modern book of the gout theory of hay fever, but, alas, Sticker misses
the pearl in the oyster. He says nothing of de Mussy's recognition of
the urticarial nature of the lesion in hay fever.
As this volume of Nothnagel may not be easily available to the gentle
reader, I copy a paragraph from Sticker for his or her benefit.
Nothnagel's _Specielle Pathologie und Therapie_, Band 4, 1896. Article
_Bostock's Catarrh_, by Dr. George Sticker, page 118. "In the last few
years convincing proofs are accumulating that there is a certain
constitutional disorder on which the individual tendency to hay fever
depends. Though further careful proof is desirable, it can scarcely be
doubted that the pathogenesis of hay fever is based on that constitution
that the English and French describe as arthritic, which expresses
itself in a hereditary or family tendency to rheumatism, gout, diabetes,
obesity, migraine, furunculosis, bronchitis, asthma, etc. Bostock
himself mentioned his gouty tendency. Phoebus found it in many
patients. But it was Gueneau de Mussy who first recognized the
prevalence and necessary basis of the disease in the arthritism of the
hay fever patient; and his teaching has been accepted and enriched with
new material by Herbert, Leflaive, Lermoyez, Ruault, de Dreyfus-Brissac,
Rendu, Molinie.... And so it is probably no coincidence that, like gout,
the _morbus principum_ of Sydenham, so also the aristocratic hay fever
is a prerogative of the Anglo-Saxon race."
Reading this praise of Englishmen and Frenchmen by a German makes one
sad to-day. Hasten the day when the old hearty comradeship in science
will return, the day when German and Frenchman and Englishman will
again praise one another's achievements ungrudgingly and each learn
eagerly as of old what the other had to teach.
=De Mussy in France.= As might be expected, among French rhinologists and
writers on general medicine, de Mussy's teaching is well known and has
many advocates. Note that the writers mentioned by Stickerare all
Frenchmen. The usual view is well expressed by André Castex in his
_Maladies du Larynx, du Nez et des Oreilles_. Paris, 1907, page 425.
"Hay fever attacks especially those who belong to an arthritic stock,
whose parents have had or who themselves have migraine, gravel, eczema.
This explains its frequency in England and America; for the Anglo-Saxon
race is especially subject to arthritic disorders. In France it exists
but is infrequent. In this way also we must explain why hay fever is
rare among the laboring classes who frequent the hospitals and is
observed almost exclusively among wealthy patients, people of sedentary
habits and sluggish digestion (nutrition ralentie)."
In Brouardel and Gilbert's _Traité de Médicine et de Thérapeutique_,
Volume 27, page 66, another André, André Cartaz, expresses mild
skepticism as to the proof offered.
"The presence of an arthritic diathesis is accepted by many authors.
Leflaive thinks it the sole predisposing cause, especially gout. During
the attack he has demonstrated, as I would say, and that is proof for
him, an appreciable decrease in the quantity of urine and percentage of
urea, an increase in uric acid and, in one case, the presence of
indican."
Lermoyez also advises caution in accepting the gouty theory to the
neglect of known remedies for the disease. I abstract his sensible
remarks from his _Thérapeutique des Maladies des Fosses Nasales_, Paris,
1896. Article _Rhinites spasmodiques, rhume des foins_, page 300.
"It would be a mistake to hold with the German school that the nasal
lesions were the only cause of hay fever; for these lesions are
completely absent in many true cases of the disease and, on the other
hand, many people affected with hypertrophic rhinitis breathe air full
of pollen without showing symptoms of hay fever. There is certainly a
general predisposition. In hay fever certain patients present a
peculiar idiosyncrasy, often inherited, almost always neuroarthritic.
But to say with the French school that the arthritic diathesis (trivial
diathesis, commonplace diathesis, _diathèse banale_) is the only cause
of hay fever is to make a mistake that leads to inefficient treatment."
=Conclusion.= How this discussion of the gouty nature of hay fever escaped
English and American authors is a strange thing. British physicians
frequent French hospitals and are familiar with French medical writings.
In 1868 American physicians studied in Paris as they went later to
Vienna and Berlin. It is strange that they never brought back with them
this French theory of the gouty nature of hay fever and that no British
or American author seems to have quoted from their books.
I must make one partial exception to this statement. In his _Diseases of
the Nose, Throat, and Ear_, Philadelphia, 1906, Professor Grayson says
that, in hay fever, there is "some diathetic state that is rooted in
defective nutrition. Whether we term this lithæmia or gout or uric acid
diathesis is immaterial, the central fact being that through intestinal
toxæmia or some disturbance of normal metabolism we have resulting a
persistent poisoning of the blood-current."
Now this is simply substituting one theory for another without proof of
either; for the origin of hay fever in auto-intoxication is as little
proved as its origin in gout or uric acid. Auto-intoxication has simply
replaced uric acid in the Doctor's mental picture gallery; for, like
uric acid, auto-intoxication often exists in the imagination of the
physician and not in the patient. For further discussion of this point,
the reader is referred to the next chapter, on the Uric Acid Theory.
A novel and interesting article in Grayson is the description of
angioneurotic oedema as affecting the nose and throat, page 182. He
writes:
"I have no doubt that in this disease, as in hay fever, the
gastro-intestinal tract is the birthplace of the toxic material.
Although the disease may occur in gouty or rheumatic individuals, there
is scarcely sufficient reason for ascribing any pathological connection
between it and these other affections."
The comment on this is that, until we know what gout is, which we do
not at present, we cannot argue satisfactorily either way. Some day I
shall tell a listening world what I know about gout. I shall elaborate
my favorite theory that the American neurasthenia, now rapidly
increasing in other countries, is a form of gout, a gout of the nervous
system. And here, too, I find that Frenchman, de Mussy, anticipating me
in his remark that "_Behind a vast number of nervous troubles, behind a
vast number of functional anomalies stamped with a nervous imprint, we
find arthritism._" The name _neurasthenia_ was not known in de Mussy's
day, but he hit off the condition neatly as "functional anomalies
stamped with a nervous imprint."
The defect in all these discussions of the gouty or non-gouty nature of
hay fever or of neurasthenia is our lack of a sure diagnostic sign of
the disease gout. Gout occurs in two forms, typical and atypical,
irregular gout. In typical gout, with the deposits of urates in the
joints and cartilages, the diagnosis may be easy. In atypical or
irregular gout we may have a group of inflammations or functional
disturbances in any tissue of the body. From their frequent occurrence
in gouty people, we suspect them to be gouty, but can prove nothing.
When they appear in people who have never had typical gout we can only
say that a gouty origin is probable. There is no sign in the blood or in
the urine or anywhere else by which we can say that gout is or is not
present. It is in this class of atypical gout that hay fever and
neurasthenia belong, if they be gouty at all. Until somebody discovers a
diagnostic sign of gout that is available in these irregular cases, the
evidence of the gouty nature of hay fever and neurasthenia must remain
exactly what it was to de Mussy fifty years ago, analogies of symptom
groups, and not an exact laboratory diagnosis based on physiological or
chemical tests such as we have come to depend upon with such confidence
in recent years.
One matter that should be made clear in the reader's mind is that the
so-called _uric acid poisoning_ or _uricacidæmia_ is not the same thing
as gout by any means, though Grayson confuses it with gout, as do nearly
all American authors. For fuller discussion of this point, we will pass
to the next chapter.