Wednesday, July 27, 2016

1819: Bostock defines hay fever for medical community

Figure 1 -- John Bostock (1773-1846) (12)
Even thought hay fever had caught the fancy of the public by the turn of the 19th century, the malady was barely recognized by medical authorities. This left the task of defining it, and giving it an official name, to Dr. John Bostock Jr. of London, England.

He was born in 1773 to Dr. John Bostock Sr.  As a student at New College at Hackney he attended the lectures of Joseph Priestly (the man credited with the discovery of oxygen) on chemistry and natural philosophy. He received his medical degree from the University of Edinburgh and opened up a practice at Liverpool.

He moved to London in 1817, and two years later, on March 16, 1819, when he was 46-years-old, he presented a study to the Medical and Chirurgical Society called  "Case of a Periodical Affection of the Eyes and Chest."

It was in this report that he described a subject by the name of JB who suffered from hay fever since the age of eight, and who realized over time that there was an association with his seasonal catarrh, runny eyes, nose and scratchy throat with the appearance of the season of summer. (1, page 12)(8, page 3)(12)

In his 1878 book on hay fever, Dr. George Beard said that in the report Dr. Bostock...
...cited a number of facts from his own experience which went to show that, in his case at least, heat and 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." (5, page 12)
A little less than a decade later, in 1828, he provided another report that this time he called "Summer Catarrh" or "Catarrhus Aestivus."  He referred to the condition as such because he did not believe, as the public fancy had suspected, that the condition was caused by emanations from dry hay during the hay season.  Instead he suspected it was caused by moist heat, sunshine, dust and fatigue. (1, page 12)(5, page 11)(8, page 3)(10, page 19)

However, despite this recognition for hay fever, it should come as no surprise that the condition continued to go unrecognized by a dogmatic and proud medical profession.   It continued to go unrecognized even as King George IV of the United Kingdom was diagnosed with it.  (10, page 19)

Still, once Dr. Bostock described the disease other physicians were quick to write about it, some creating unique terms to describe it, and others their own theories as to the cause and nature of the disease.  Regardless of any confusion as to the name, cause or nature , there was a general consensus it was seasonal.

Later in 1828, Dr. MacCulloch wrote an essay titled "An Essay on the Remittent and Intermittent Diseases."  He said hay fever was caused by hot houses and green houses, and that it was caused by hay fields. (5, page 11)(also see 8, page 4) (11, page 14)(13, page 603)

Despite the diagnosis, MacCulloch advocated nothing new about the disease. (10, page 19)

A year later, in 1829, Dr. W. Gordon, of Welton, in Yorkshire, published a paper in the London Medical Gazette (volume IV) titled "Observations on the Nature, Causes, and Treatment of Hay Fever."  He said it was caused by the aroma of the flowers of grass, particularly anthoranthum odoratum, and suggested it be called grass asthma. (6) (13, page 603) (14, page 962)

He said he observed the disease usually appeared when this plant flowered and disappeared when the plant disappeared.  He said that after the death of this plant grass asthma sufferers could go through meadows without suffering. (6)

Gordon recommended a tincture of lobelia inflata as the remedy, and also recommended the cold shower as the best preventative for the malady. (14, page 962)

In 1831, Dr. Elliotson of England described hay-fever, and two years later agreed with Dr. Bostock that the disease was not caused by hay, but opposed Dr. Bostock's claim the disease was caused by heat.  Instead, he insisted it was caused by grass, similar to Gordon.  (10, page 19) (13, page 603)

In 1837, any patient seeing Dr. J.J. Cazenave of Bordeaux, and who complained of hay-fever-like symptoms, were encouraged to wear goggles to protect their eyes from irritating matter.  It's possible this was the first time a physician recommended protection to prevent allergies. (11, page 15)

Dr. Morell Mackenzie, in writing a history of hay fever, would write that Cazenave also...
...attempted to prepare the nasal mucous membrane for the enemy's attack by hardening it with nitrate of silver.  Cazenave attributed the complaint to the effect of light, and does not seem to have known that it had been described before. (11, page 15, 16)
In 1841 Dr. Francis Hopkins Ramadge referred to it as hay asthma and viewed it as just another form of asthma.  Although in this form he suspected it to be caused by an effluvia from flowers, and that avoidance of such would prevent the condition from occurring.  (10, page 19)(8,page 20)

In 1850, Dr. Gream published a paper in the London Lancet (volume I, page 692) in which he described his observation that asthma was relieved after a fall of rain.  He said this was true because the causative agent was not grass or even the flowers of grass, but dust that fell on the grass.  He said house dust was just as much an exciting cause as outdoor dust.  (7) (13, page 603)

In 1852, Dr. Swell of New York may have been the first to observe a difference between summer fever and hay fever.  (11, page 15)

In 1859, asthma expert Dr. Henry Hyde Salter referred to "hay asthma" as "periodic asthma," meaning that it comes and goes with the hay season and lasts about 4-6 weeks. He said the cause was heat, dust, and "bright, hot, dusty sunshine." He also suspected laughter, eating too much, and hay. (5, page 14) (13, page 603)

Also in 1859, Laforque of Toulouse described two patients he diagnosed with hay fever, and he believed the cause in both cases was nervous in origin and that it was excited by heat.  Various other physicians would likewise conclude hay fever, like asthma, was a nervous condition.  (11, page 15)

In 1860 Dechambere was convinced that "'an occult atmospheric influence' was the cause." (11, page 15)

So mainly thanks to the efforts of John Bostock, hay fever had gained the interest of the medical community, inspiring various physicians to further study the condition for the benefit of hay fever sufferers worldwide.

References:
  1. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press
  2. Taylor, C.F., editor, "The Medical World," volume 16, 1898, Philadelphia, 
  3. Fry, John, "The Natural History of Hay Fever," J. Coll. Gen. Practi1, 1963, 6, page 260
  4. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
  5. Beard, George, "Hay-Fever; or Summer Catarrh: It's Nature And Treatment," 1876, New York, Harper & Brothers
  6. Beard, ibid, pages 12 and 13, referenced by Beard from Dr. Mr. W. Gordon's paper "Observations on the Nature, Cause, and Treatment of Hay-Asthma," London Medical Gazette, 1829, vol. iv, page p. 266
  7. Beard, ibid, pages 13 and 14, referenced from "On the use of Nux Vomica as a Remedy in Hay Fever, Lancet1850, vol. 1, page 692
  8. Blackely, Charles Harrison, "Hay-fever: its causes, treatment, and effective prevention," 1873, 1880 2nd edition, London, Bailliere
  9. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw
  10. Hollopeter, William Clarence, "Hay-fever and it's successful treatment," 1898, Philadelphia, Blakiston's Sons & Co.
  11. Mackenzie, Morell, "Hay fever and paroxysmal sneezing," 5th ed., 1889, London, J&A Churchill
  12. Parkinson, Justin, "John Bostock: The Man Who 'Discovered' Hay Fever," bbc.com/news/magazine,  http://www.bbc.com/news/magazine-28038630, accessed 7/24/14
  13. Rumbold, Thomas F., "A Practical Treaties on the Medical, Surgical, and Hygienic Treatment of Catarrhal Diseases of the Nose, Throat, and Ears; Including Anatomy, Physiology, Pathology, Etiology, and Symptomatology...," 1888, St. Louis, Medical Journal Publishing Company, Chapter XV: "Pleuritic Rhinitis Catarrhalis -- Pleuritic Rhinitis  (Hay Fever, June Fever, Summer Catarrh, Autumnal Catarrh, etc, etc, etc.," pages 596-654
  14. Watson, Dr., "Lectures On the Principles and Practice of Physic: Hay Asthma, Chronic Bronchitis. It's varieties. Morbid anatomy of these affections," London Medical Gazeette, volume 28, Friday, September 17, 1841, London, 
  15. Ergonul, Onder, Chris A. Whitehouse, editors, "Crimeon-Congo Hemorrhagic Fever: A Global Perspective," 2007, Netherlands, Springer
  16. Heberden, William, "Commentaries on the History and Cure of Disease," 4th edition, 1816, London, Printed for Payne and Foss - Pall Mall
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