Wednesday, November 23, 2016

1862: Phoebus studies 'summer catarrh'

Christian Freidrich Schonbein (1799-1868)
While not the first to mention ozone,
he was the first to produce it in a lab.
He wrote about how to make it in 1832.
He also noted that air containing ozone
caused certain catarrhal conditions,
including asthma and hay fever.
Phoebus noted the link in 1862,
and usually gets credit for it
(5, page 80) (6, page 311)
Since Dr. John Bostock defined hay-fever for the medical community in 1819 and 1828, there was little mention of the ailment until Dr. Philip Phoebus published a book titled "On the Typical Catarrh of Early Summer, or the so called Hay-fever or Hay-asthma" in 1862.  (1)

Dr. Phoebus was professor of medicine at the University Giessen in Germany, and he was apparently one of the first physicians to study hay fever who did not have the condition.  He is said to have gained interest in it by the single case that he treated.  (4, page 17)

In 1869 he issued circulars and advertisements inviting medical men all over Europe and the United States to respond to seven questions phrased to gain particular information regarding their patients diagnosed with hay fever. The questions were well worded to gain particular information, and were related to the following: (2, page 14-15) (3, page 2) (4, page 17)
  1. Where they lived (city, country, lowlands, mountains, etc.?)
  2. What they did in their every day lives (lawyer, doctor, industrial worker, farmer, etc.?
  3. Their sex (male or female?)
  4. Social position (rich, middle class, poor?)
  5. Inheritance (was their disease hereditary? Do they have parents, grandparents, or siblings with the condition?)
  6. Constitutional peculiarities (does it affect their health and well being?)
  7. When do attacks of hay fever occur? (autumn, winter, spring, summer?) (2, page 14)
He received many replies, and used the information he received to put together a complete theory about this disease.  He then published the results of his research three years later, in 1862, in a thorough treaties. (2, page 14-15)

He learned that hay fever was most common in England than any other nation of Europe.  He learned people were predisposed to it, although he didn't understand why.  (2, page 15)

He believed the exciting cause was the first heat of summer, and that the longer days of summer exposed those predisposed to it to more light, and probably more ozone too.  In this way he was among the first to suspect a link between air pollution (ozone) and hay fever or hay asthma. (2, page 15)

He also believed that odors, dust, the blossom of rye, and hay were also exciting causes. (2, page 15)

In reviewing the ideas regarding of Dr. Phoebus on hay fever, Dr. William Abott Smith said Phoebus described six groups of symptoms, of which may vary from one case to another. (1, page 16)

1.  Nostrils.  Severe catarrh (common cold) leads to sneezing, and this may irritate the bronchi, causing spasm.  (1, page 17)

2.  Eyes.  Catarrh and increased secretions. The eye feels full, itchy and irritating.  The eye looks red and swollen.  Eyesight is weakened, and there is an intolerance to light. Both eyes are usually affected simultaneously. (1, pages 18-19)

3.  Throat. Pharynx is red, and swollen; there is intense itching of the back of the mouth behind the tongue.  This causes an unpleasant sensation that is aggravated by the patients efforts to relieve the itching. Sometimes there is difficulty swallowing. (1, pages 19-20)

4.  Head.  A headache might occur, that might be caused or worsened by sneezing.  The patient might also complain of a feeling of itching over the forehead, nose, chin and ears. (1, pages 20-21)

5.  Airway.  The mucus  membrane of larynx all the way to the bronchi may become irritated, causing asthma or dyspnea.  This may result in a cough, increased sputum production, irritation of the throat, a heavy feeling over the chest, and a muffled and coarse voice.  If the bronchi become affected, this may result in wheezing that results from bronchial catarrh or asthma or, more specifically, hay asthma or periodic asthma.  Dyspnea generally occurs in the evening and continues through the night. Hay fever that affects the lungs in this way tends to be more severe, with the patient waking up gasping and struggling to breathe. (1, pages 21-22)

6.  Nervous disturbance.  This is coupled with catarrhal fever that results in shivering and cold perspirations with sneezing and coughing. When this happens the patient becomes restless, weary, and unable to perform normal activities. The patient becomes irritable, with something as simple as a cool breeze being disturbing to the patient.  These patients generally develop a nervous and anxious disposition during the paroxysm. (1, page 22)

All in all, Dr. Phoebus went into more detail on hay fever, what causes it, and the symptoms that resulted, than any of his predecessors. Yet, and he knowingly admitted, he left many questions still unanswered for future investigators to answer. (2, page 15)
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Dr. Blackley took the observations of Phoebus and Schonbein regarding their suspected link between hay fever and ozone, and set out to perform experiments with the substance.  He spent six hours in his office inhaling the substance and observed no effect. (11, page 35) (8, page 8, pages 79-91)

However, while he proved ozone had no effect on hay fever, he became the first to suggest that dust might cause hay-fever symptoms.
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References:
  1. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw, pages 17-24. 
  2. Beard, George Miller, "Hay Fever; Or, Summer Catarrh: Its Nature and Treatment," 1876, New York, Harper & Brothers, Publishers
  3. Wyman, Morril, "Autumnal Catarrh (Hay Fever)," 1872, New York, Published by Hurd and Houghton, The Riverside Press
  4. Mackenzie, Morell, "Hay fever and paroxysmal sneezing," 5th ed., 1889, London, J&A Churchill
  5. Blackely, Charles Harrison, "Hay-fever: its causes, treatment, and effective prevention," 1873, 1880 2nd edition, London, Bailliere
  6. Dickenson, Samuel Henry, "Elements of Medicine: a compendious view of pathology and therapeutics, or the history and treatment of diseases," 1855, Philadelphia,  Blanchard and Lea
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