Monday, December 19, 2016

1867: Abbots says hayfever often confused as something else

In his 1867 book, Dr. William Abbots Smith said that many people suffer from hay fever for years not knowing that they have the disease. He said:
Many individuals suffer from this affection for years, and, in fact, may continue to do so during their whole lifetime without being aware of the nature of the ailment from which they suffer. Persons find that, after going into fields where grass is ripening, or where hay is being made, they suffer from severe attacks of sneezing, watery discharges from the eyes, and other annoying symptoms; but they do not, in any direct manner, connect these symptoms with the actual cause. (1, page 29)
He gave two cases to prove his point.  In the first, a patient has the disease for many years without recognizing it.
A patient of mine having taken a house at a distance from London, was in the habit of making a near cut through some meadows on his way to and from the railway station, every morning and evening. This he continued to do with impunity during the earlier months of the year; but, as the summer came on, he found himself often* troubled with sneezing fits, occasional head-ache, and lassitude, which he attributed to the heat, and to the weariness produced by close application to business. He consulted me about the middle of June, on account of the debility from which he supposed that hewas simply suffering. Noticing the lachrymation and frequent sneezing, I inquired about the hay crops in the neighbourhood of his country-house, and in the course of conversation I soon ascertained what his ailment was attributable to. He was rather sceptical when I told him that his "weakness" would disappear speedily if he would adopt a different and more circuitous route to the , railway station, going along the turnpike-road instead of through the meadows, and if he would follow a course of alterative and aperient medicine which I prescribed for him. He adopted my advice, however, and the regimen and treatment which I prescribed, and in about a fortnight had completely recovered his accustomed good state of health. A relapse happened later in the year, but yielded in a few days to the same treatment as that previously successful. (1, pages 29-30)
In the second case he describes a case that was suspected to be measles, when it was actually hay fever.
Another instance of a similar kind occurs to my recollection. Some years since, in the month of June, I visited a patient at a school in Surrey. After I had prescribed for the case, my opinion was asked as to the probability of measles occurring in one of the other pupils, who had been suffering for two days from running at the eyes and nose, and other symptoms analogous to those observable before the eruption of measles presents itself. The weather was hot and close, and through the open window of the parlour, where the lad was laying on the couch, came an unmistakable aroma of newly-madehay. Struck by the coincidence of the boy's illness and of the hay-making in the immediate vicinity, I made inquiry and learned that the grass in the field next the play-ground haoV been cut three days previously, and that the boys had been allowed to assist in the hay-making. This lad became so ill after a few hours that he was taken into the house, and the head master of the school, fearing an outbreak of measles among the boys, had intended to send the patient to his home, but waited for my advice in the matter. I was able to assure him that he need be under no apprehension of an epidemic. The lad was, according to my directions, removed into a room on the other side of the house, as far as possible, from the exciting cause of the affection. I treated' the case afterwards by -correspondence, and the patient recovered in ten days. (1, pages 30-31)
These are some early examples of why it's important to get the word out about hay fever.  Dr. Abbotts said that when it was recognized early it was easier to treat, and was essentially preventable if the exciting cause was avoided.

Physicians, he said, need to recognize that when sneezing and headache occur during the early months of summer "when the hot weather sets in suddenly," the cause of the symptoms might be the flowering of grass or the conversion of grass to hay.  The episodes occur at intervals, and usually about the same time of the year, such as always during the month of May, or the months of August and September.   (1, pages 32-33)

References:
  1. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw
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