Monday, May 9, 2016

1802: Heberden first physician to recognize hay fever

For most of history people were clueless about colds and allergies.  The symptoms associated with them -- itchy and watery eyes, stuffy and runny nose, scratchy throat, coughing, sniffling and sneezing -- were probably brushed off as minor ailments.  Most people did not seek help, as doing so would be a sign of weakness. Instead, they went about their business the best they could.

While there were occasional vague and allusory descriptions of these common ailments, there were more serious diseases called plagues that earned the attention of most medical writers.

The term "plague" became a generic term used through most of history to describe diseases that were both lethal and destructive.  (1, page 17)

It was not until sometime during the 17th century that the term "fever" began to replace the term plague in describing diseases.  A good example of this came in the year 1666 when Thomas Sydenham published his book "The Method of Treating Fevers." He described diseases such as scarlet fever, perpetual fever, malaria fever, hospital fever, and typhoid fever. (1, page 17)

Still, it wasn't until the mid 18th century, and mainly during the 19th century, when the causative agents of specific symptoms were identified, that the term "fever" was used with increased frequency.  Examples would include rose fever and hay fever, with hay fever gaining the most recognition.  These terms crept into medical nomenclature as physicians linked sniffles and sneezes with rose and hay season. (1, page 17)

A generic terms that was more generally accepted by medical authorities was "catarrh."  This term comes from the Greek term katarrho, which means to flow. It generally referred to the flow of humors, or secretions, due to congestion of the vessels (swelling and inflammation) of certain parts of the body, such as the eyes, nose and throat.

Generally speaking, the symptoms that resulted were generally brushed off as the common cold.  For instance, William Heberden, in his 1802 book "Commentaries on the History and Cure of Disease," described catarrh this way:
If such a catarrh lasts only a few days, it is called a cold in the head; but in many it becomes a chronical disorder, and has lasted with no long intervals for several months, for four years, or every night for ten years; or has returned periodically twice a month for several years, or once in three weeks. (2, page 113)
The problem with the term catarrh, and the probably reason it was eventually phased out of the materia medica for the most part, was because nearly every disease causes some form of catarrh.  It was such a generic term that it lost its relevance. By Heberden's time the phase out had already begun, although the complete extrication of the term would take another 100 plus years.

Another term often used was Coryza, although it was not mentioned by Heberden.  It was a more specific term used to describe catarrh of the nose and throat, and was frequently used to describe the common cold. It was yet another generic term to describe a cold, although it was later used to describe a symptom of hay fever.  The word comes from the Greek term koruza which means "running of the nose."

As part of his chapter on catarrh, of which he also referred to as "defluxion," he described what may people think is the first description of hay fever by a medical writer.
I have known it (catarrh's) return in four or five persons annually in the months of April, May, June, or July, and last a month with great violence. In one a catarrh constantly visited him every summer; and in another this was the only part of the year in which it ceased to be troublesome. (2, page 113) (3, page 14) (4, page 14)
While he did not use the term hay fever, or hay asthma, or rose cold, or any of the other terms to describe the condition that had gained the fancy of the public, it's quite obvious this is was he was describing here.

  1. Ergonul, Onder, Chris A. Whitehouse, editors, "Crimeon-Congo Hemorrhagic Fever: A Global Perspective," 2007, Netherlands, Springer
  2. Heberden, William, "Commentaries on the History and Cure of Disease," 4th edition, 1816, London, Printed for Payne and Foss - Pall Mall
  3. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw
  4. Mackenzie, Morell, "Hay fever and paroxysmal sneezing," 5th ed., 1889, London, J&A Churchill
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