Monday, January 23, 2017

1872: Wyman recommends mountainous hay fever vacations

Morrill Wyman (1812-1903)
(6, title page)
Victims of hay fever realized early on that severity of the disease was directly proportional to certain geographic regions. And for this reason one of the original remedies recommended by hay fever physicians was to vacation during the offending season. One physician to do extensive studies on the geographic effects of hay fever was Dr. Morrill Wyman.

Wyman was born in Chelmsford, Massachusetts, in 1812, the second son of Dr. Rufus Wyman, who was chosen in 1817 to be physician and superintendant at the Mclean Asylum for the Insane at Charleston (A branch of the newly founded Massachusetts General Hospital), where he worked for 17 years.  Morril's older brother was Jeffries,who likewise became a reputable physician. He also had a younger a brother Edward. (3) (6, page 6, 84)

Morrill and his brother Jeffery entered Harvard College together, both graduating in the year 1833. (3) (6, page 52)

After receiving his Harvard degree he worked as an assistant engineer on the Boston and Worcester Railroad.  He said the "open-air life" was beneficial to his health, and after a year he had the urge to return to medicine. (6, page 52)

He studied medicine with his father, and, in 1834, he became the medical student of Dr. William Johnson Walker, a physician and surgeon at Charleston and a friend of his father. He studied the books recommended to him, and tended to patients who came to Dr. Walker's office.  Occasionally he traveled with the doctor to his see his other patients. (6, pages 52-53)

In the meantime, he also attended classes at the Medical School at Harvard University.

Beginning in 1836, Morrill served for one year as house physician of Massachusetts General Hospital.  While they he worked under Dr. James Jackson and Dr. Jacob Bigelow.  At the time anaesthetics were being experimented with, so Dr. Wyman had an opportunity to participate in these experiments. He and the other house physicians experimented on themselves by inhaling the various anaesthetics to personally observe their effects. (6, page 54)

After this assignment, he returned to the university to complete his medical degree, receiving it at the same time as his elder brother in 1837.  (3) (6, page 53)

He then started a practice at Cambridge and became a surgeon.

Among his first interests was the ventilation of sick rooms and public buildings, and he would end up publishing an essay on the subject called "A Treaties on Ventilation." In 1846, the same year the essay was expanded and published into a 400 page book, he earned the Boylston medical prize for the essay. (3) (5) (6, page 57)

He observed that methods of opening the chest to remove excess fluid from it were unchanged since the days of Hippocrates.  The operation was difficult to perform, dangerous, and offered uncertain results.  In 1850 he introduced a procedure for removing excess fluid from cavities of the body, particularly the chest cavity, that was both safer and easier to perform.  (3)

His son, Morrill Wyman Jr., described the device as consisting "essentially of an exploring trocar and canula of a very small diameter fitted to an exhausting syringe." (6, page 58)

His first demonstration of this device was on a 39-year-old lady who presented with a respiratory distress and pain.  By auscultation and percussion he diagnosed her with pleurisy with effusion (fluid or pus from infection or cancer) in the pleural sac (the cavity the surrounds the lungs). (6, page 58)

After waiting several days and allowing for traditional treatments to be trialed, the patient's condition deteriorated to the point that it appeared she was going to die and a priest was called.  It was at this point it was decided for Dr. Wyman to tap the ladies chest to draw out the fluid with his new instrument (a procedure called thoracentesis).

Dr. Wyman described the procedure:
The patient was, with Dr. Homans' aid, seated in a chair inclined to the right and the body bent a little forward. An exploring trocar and canula one-sixteenth of an inch in diameter was then passed by me through the intercostal space between the sixth and seventh ribs (counting from above) midway between the spine and the line of the axilla; it was pushed steadily on until its point moved freely in the pleural sac; withdrawing the trocar, twenty ounces of straw-colored serum were allowed to flow. The canula was taken out; the pain was slight, the patient expressed herself as much relieved, and she was laid in her bed. Two days after the operation she had occasional paroxysms of dyspnoea, and at her earnest solicitation the same trocar and canula was passed near the same place as before. This time, the canula had fitted to it a pump, so arranged that fluid was continuously drawn through it without the possibility of the entrance of air, or any septic fluid. With this, ten ounces of clear serum were drawn with immediate relief to the patient. The recovery was steady; in about three weeks after the operation she was about the house; a fortnight later she drove ten miles in a carriage, and was soon no longer under medical observation. (6, page 60)
The treatment was a success, and the lady survived.

Dr. Henry Ingersoll Bowditch (1808-1892)
He was an ardent abolitionist
who prayed for the end of slavery
and for the forgiveness of slave hunters.
During a second second case Dr. Wyman performed his procedure on a patient of Dr. Henry Ingersoll. Bowditch, which was also successful.  In 1851 Dr. Wyman and Dr. Bowditch read papers to the Massachusettes Medical Society on the successful results of 39 successful operations they both performed using Wyman's new method of thoracentesis.  (6, pages 64-65)

These two physicians proved the simplicity and safety of the new method, and soon thereafter gained the confidence of the rest of the medical community.

Wyman became particularly interested in hay fever, which he referred to as "autumnal catarrh" in 1833 when he first had a severe attack of hay fever, the same ailment his father, brothers, and later his son (Morril Wyman Jr.) suffered.  So he had ample reason to partake in a study of the aliment and, ultimately, publish a book on the subject.  (1, page 174)(2, page 18) (6, page 82)

Yet such research would be delayed due to his busy career and the Civil war. Prior to the ware he was a strong supporter of President Abraham Lincoln, and did whatever he could to support the Union.  (6, page 75)

He offered his services as a surgeon, but governor Andrew said his was needed at home.  A short while later, however, he was requested to serve on the U.S. Sanitary Commission, and his role was to inspect army medical facilities to make sure they were sanitary. (6, page 77)

It was only after the war that his interests in hay fever peeked.  Yet he didn't have to start from scratch, as his father had gathered some data on the subject.  (1, page 174)(2, page 18)

He was determined that "autumnal catarrh" was caused by the pollen from ragweed, and so he collected data from various correspondence to determine where the disease was most common. He published the results of his findings and his opinions on autumnal catarrh in his most famous book in 1972 book aptly titled "Autumnal Catarrh."

He wrote that the results of his studies proved that hay fever was both seasonal and geographical.  
Dr. Wyman interviewed patients who noted they had no symptoms
of hay fever while vacationing at resorts in the White Mounntains.
Partly due to Wyman writing about it in his 1872 book "Autumnal
Catarrh," the White Mountains became an elite hay fever resort area.

For instance, he noted that people who suffered from hay fever in May in the United States may have no symptoms while vacationing during May in Great Britain, and vice versal.
This, he said, was ample evidence that different geographic regions have unique causes of hay fever.

This is a map of the White Mountain region from Dr. Wyman's book.
 The uncolored areas represent regions safe from Catarrh.
So, for this reason, he suspected a vacation to the opposite country may actually provide a remedy for the hay fever. (1, page 58-61, see also pages 1-6)

Wyman said: 
It may be assumed, therefore, with a good degree of certainty, that the Autumnal Catarrh of the northern portion of the United States does not exist in Great Britain, nor in those countries on the Continent above mentioned. To this we may add, that although Dr. Phoebus makes mention of asthmatic and catarrhal attacks occuring in these countries annually, at other seasons than early summer, he makes no mention of a regularly recurring catarrh in September. He gives the average duration of the June Cold as about eight weeks. (1, page 61)
Wyman also observed that hay fever...
...does not exist over the whole United States. It is a matter of difficulty to give the exact limits the number of cases not being sufficient for that purpose. We can, however, arrive at proximate results which further observations may render more definite. We have no other evidence of its non-existence in the indicated places than this, that certain persons who have suffered elsewhere have ceased to suffer on removing to them. (2, page 61)
Using data he collected, he was able to create various pollen maps of the United States showing hay fever sufferers the best places to plan their hay fever vacations.  (You can view the maps here, click and scroll up one or two pages).

He believed places with low pollen counts would end an attack within 24 hours, or prevent one from occurring altogether.  Such locations were:  (1, page 73)
  1. Along the shores of Lake Michigan
  2. Canada
  3. Latitude 35°
  4. Extreme east of the continent
  5. Pacific coast.
  6. In the sea
The best methods of escaping the pollen, and the hay fever, were: 
  1. Sea voyage: symptoms do not seem to occur out at sea (1, page 73-4)
  2. Sea side:  Sea air seems to provide relief from hay fever symptoms.  If symptoms occur they are generally milder, and the cooler air is soothing and provides better ability to deal with symptoms. (1, page 74-9)
  3. Islands: They are protected by sea air, which seems to provide relief (1, page 74-9)
  4. City residence: It provides relief, but it is never complete, especially if there are fields nearby, or if there is a wind.  Although, for the most part, there is less vegetation in the city.(1, page 80) 
  5. Mountains:   Generally, the disease does not exist in places that are 800 feet above sea level. (1, page 81-95)
The only time the above may result in hay fever symptoms was when, as noted, the wind was blowing.  When this occurred, pollen from fields would waft to these regions, thus increasing the risk of hay fever symptoms.  

To further explain this, Dr. Wyman quoted Dr. Phoebus:
"Moist air brings to many, probably to most, great relief. Many praise the sea air. It brings a quick and lasting amelioration during the whole attack, even without sea bathing, which is also useful. Dr. Bostock proved this in his own case. Many reside at the sea-shore, or cruise about in yachts during the critical period. The asthma is immediately relieved at the sea-coast; but if the wind blows from the land, even for a single hour, the disease immediately returns." (1, page 79)
Dr. Wyman was not the first physician to propose the benefits of mountainous air for treating diseases, as tuberculosis had long been treated this way.  Likewise, for many years hay fever sufferers had noted to their physicians that they felt better when they traveled into mountainous regions. Dr. Wyman was, however, probably the first to make light of this observation, thus inspiring him to further question his patients.

The Glenn house was one of the earliest resorts in the White
Mountain region.  The original hotel was built in 1851, an expansion
 of an old farm house.  The name Glenn House was established in 1852
after the hotel was sold to J.M. Thompson (see this link for more).
Wyman notes in his own biography that he too found that staying
at the Glenn house offered him the most relief.  (1, page 173)
One of the hay fever sufferers he talked to was a lady from Lynn, Massachusetts. Wyman said:
She had suffered severely, especially in the asthmatic stage. She accidentally noticed, in 1853, while traveling in the White Mountain region, that her catarrh, which for twelve years had commenced in August 20th, had failed to make its appearance. The following year she visited the same region before the usual time of attack, with the hope of escaping it. She did escape it. During the remaining ten years of her life, until 1864, she was at the Franconia Notch, White Mountain Notch, or at the Glen House (a White Mountain resort established in 1851.  You can read about it here), — most of the time at the latter place. During this whole period she,obtained complete relief. (1, page 81)
Image of Wyman used in his obituaries in 1903. 
Another patient he talked to was Jacob Horton.  Wyman said:
In 1860, Jacob Horton, Esq. of Newburyport, Mass., who bad suffered so severely that he was obliged to keep his room during much of the attack, to answers to my inquiries replied: "The only relief for me is at the White Mountains."  (1, page 81-82)
So, it was by questioning his patients that he realized mountainous regions worked to the benefit of hay fever sufferers, and his further investigations verified his theory.

Places that he recommended were: (1, pages 85-89)
  1. White Mountains in New Hampshire
  2. Mount Mansfield in Vermont, one of the Green Mountains
  3. Slow Village near the foot of the Green Mountains
  4. Adirondack Mountains in northeastern New York State, including St. Lawrence and Chateaugay ranges
  5. The great Pennsylvania and Ohio plateaus (proves to be a good refuge)
  6. Catskill Mountain House 
  7. Alleghany Holds (only in certain plaes)
  8. Other, including regions not necessarily of high altitude (1, pages 85-89)
He said:
The large number of persons, who have visited these regions successfully, demonstrates their safety. But we have other evidence: persons who have left them before the end of the critical period, have been at once attacked, and the attack has ceased immediately on their return. (1, page 89)
The change in a sufferer fully under the influence of this malady, on arriving at the mountains is sudden and striking. His first night's sleep is refreshing, and in the morning his most annoying symptoms — the itching and watering of the eyes, the sneezing and nose-blowing, or the asthma — have much diminished. A second night gives still more relief and usually in the course of the following day most of the symptoms disappear. Besides this relief of the local symptoms, a still greater change takes place in the spirits. Activity of mind and body replaces discouragement and weakness, the usual flesh and strength are regained, and the sufferer feels assured that he has at last shaken off his enemy. 
(1, page 90)
The number of cases obtaining this relief in certain regions is too great to be explained by coincidence; the repetition, year after year, of the same relief at the time of arrival in such regions, is conclusive that the relief is connected closely with the arrival; that the causes of the disease, whatever they may be, have ceased to be efficient. We have no evidence that persons, residents of these regions, suffer.1 We have also the still further evidence that it is not dependent upon simple change of residence, for very many of those who are relieved in these regions have tried various other places without success; and yet these places, by their distance from their usual residence, and different physical conditions, should have afforded relief, provided ordinary changes alone were required. They have also tried various kinds of drugs, and different methods of medical treatment, with as little success. 
And he concluded by saying:
We are forced to the conclusion, then, that the causes of a paroxysm of disease which exist elsewhere, are less active, or entirely wanting in the places above mentioned; and that those who visit these places in due season, are for the much larger part greatly relieved, or entirely free. (1, page 92) 
Dr. Wyman was not the first to recommend mountainous regions as the cure for maladies, but he was the first to recommend them for hay fever sufferers.  He was the first to create maps showing ideal places of refuge for hay fever sufferers.

Still, his favorite place to recommend was the White Mountains. Partly due to the publication of his book  "Autumnal Catarrh" in 1872, the While Mountains became a prime location for hay fever vacations, thus becoming a prestigious mountain resort.

In fact, it was partially, if not significantly, because of his studies that the White Mountains became one of the most sought after vacation spots for hay fever sufferers, especially for those with money (such as hay fever doctors with the affection).

After serving as a physician in Cambridge for greater than 60 years, he announced in 1902 that he was no longer fit to see patients.  He passed away in Cambridge at the age of 91 in 1903. During the course of his life he saw Cambridge grow from a small town to a city, while himself becoming one of the most famous physicians in the United States. (3) (5)

Further reading:
  1. 1872: Wyman's two types of hay fever
  2. 1872: Good times for hay fever sufferers
  1. Wyman, Morrill, "Autumnal catarrh," 1876 (first edition 1872), New York, Hurd and Houghton
  2. Mitman, Gregg, "Breathing Space," 2007,
  3. Walcott, H.P., "Fruitful career: sketch of the late Dr. Wyman by Dr. H.P. Walcott-- his professional and public service," The Cambridge Tribute, Saturday, June 27, 1903, page 9, accessed from Cambridge Public Library,, accessed 9/12/14
  4. "Morrill Wyman, M.D.", 1863, Cambridge Historical Society,, accessed 9/12/14
  5. "Dr. Morrill Wyman Dead: One of the Most Famous Physicians in the United States Passed Away in Cambridge Aged 90," Boston Daily Globe, 1903, January 31,, accessed 9/12/14
  6. Wyman, Morrill Jr., "A brief history of the lives of Rufus Wyman (1778-1842) and his son Morrill Wyman (1812-1903)," Cambridge, Fourth March, 1913, privately printed
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