1876: Dr. Beard: Remedies for hay fever

Dr. George Miller Beard was was a hay-fever sufferer himself, and would often spend the hay fever season among the company of other well-to-do hay fever sufferers in the comfort of the resorts of the White Mountains.  He was so respected that he became the president of the Hay Fever Association.

In his 1881 book "American Nervousness" he proclaimed that diseases like asthma and hay fever were caused by "nervous exhaustion."  The cause of this was modern civilization, or American civilization.  Ideas similar to this are still hotly contested to this day.  (2, page 12)

He believed that modern civilization, along with the depressing influence of heat, diminished the nervous system of some people, thus causing diseases like hay fever and asthma to develop.  The result was a weakened nervous system that was susceptible to certain changes in the climate and substances such as food, medicine, and certain external irritants. (2, page 12)

Particularly during the dog days of summer, when the influence of heat was at its greatest, the nervous systems of some individuals are weakened to such a point that they become susceptible to the influence of summer irritants such as dust, sunlight and pollen.  (2, page 12)

Beard also wrote a well respected book about hay fever that was published in 1876 called "Hay fever or Summer Catarrh."  In this book he likewise postulated that hay fever was a nervous affection, caused by modern civilization.  (1, page iv)

In his introduction he said, while spending time in Bethlehem, White Mountains, he spent time with another famed hay fever expert, Dr. Jeffrey Wyman.  He said Wyman introduced him to the idea that hay fever was a nervous affection. (1, page i-ii)

He said:

The conclusions which will be most likely to excite surprise are those which show the relation of this disease to the nervous system. To those who have given the subject no more thought than is suggested by general observation of cases, and who have been witnesses of the unquestioned fact that the malady numbers among its subjects some who are otherwise unusually strong, it seems beyond belief that hay-fever is more markedly hereditary than any disease of which statistics have been gathered; and that the majority of its victims are of the nervous diathesis, and suffer otherwise from an indefinite number of nervous symptoms. (1, page ii)

He understood that the idea that a disease, hay fever in this case, was a nervous affection, or all in your head, would be readily rejected, or would readily offend, many sufferers of the disease.  However, he attempted to allay such concerns.  He said.

In regard to the nerve theory of hay-fever there prevail two popular misconceptions, which, it is to be hoped, this work may assist in correcting.

First, that nervous susceptibility implies debility and emaciation. Many suppose nervous diseases are imaginary diseases, and get their idea of the nervous temperament from those in whom it predominates, and especially from the hysterical (women) and hypochondriacal (men), who are always ailing, and who fancy themselves much worse than they really are. The nervous temperament is really consistent with great strength and power of endurance, especially when combined with the bilious (bad tempered) and sanguine (optimistic) temperaments; one may be fleshy and full-blooded, and yet be exceedingly sensitive.

Secondly, that the theory dispenses entirely with the influence of the exciting causes—as heat, dust, pollen, and other irritants. On the contrary, by the facts here collated the potency of these irritants is absolutely demonstrated, and their number is far greater than has been supposed. Individuals vary widely, however, in their susceptibility to different forms of irritation, and not one of these exciting causes nor all combined can avail to produce the disease, except when acting on a predisposed organization. 

The theory taught in this book, that this disease is a complex resultant of a nervous system especially sensitive in this direction, acted upon by the enervating influence of heat, and by any one or several of a large number of vegetable and other irritants, has the advantage over other theories that it accounts for all the phenomena exhibited by the disease in this or in any other country. (1, iii-iv)

He, like many other physicians of his era, and lacking any other effective remedy for the malady, benefited greatly from hay fever holidays, and recommended them for his patients.

  I therefore will use him as my 1870s reference for hay fever remedies.  Basically, if you were a physician in this era, it is what follows that would be your options.

As you are viewing this list you will see that finding the best remedy for a particular patient with hay fever is basically a crap shoot.  Plus you will more than likely have to come up with the ingredients yourself at a local general store or pharmacy,  and you will have to put together the ingredients (or instruct your patient to do so) and instruct proper use of the remedy.

So, you have a young man who is obviously suffering from hay fever.  You reference Dr. Beard's book, which is titled: "Hay-fever; or, Summer catarrh: it's nature and treatment."  You flip the book open to a spot you have marked with a sheet of paper marked "treatment" on the top.

You read on, and basically learn that Beard recommends basically two types of treatment:

1. Prevention of the attack:  
2. Treatment of the attack

A.  Prevention:  "To prevent is always better than the cure."  The best way to do this is by removal of the patient to a region where hay fever does not exist.  Since heat is the cause, the best remedy is removal to a place that is cool, "and where irritants do not abound."   Examples include:

1. Sea voyage:  It is "tonic and sedative." There are no irritants found in the air. You'll want to make sure the trip is mid ocean into cooler air, and there is no irritants (such as hay) on the ship.
2. Travel to Europe: First there is a long ride in the ocean, where "hay fever never appears." Second, "the victims of autumnal catarrh seem to be safe almost anywhere in Europe."  Flowers and grasses that cause hay fever in Europe should not affect Americans. Generally, 9 out of 10 Americans will escape hay fever symptoms while in Europe.
3. Regions that are cool and elevated (like mountainous areas): The air is generally cool and dry, and presents with fewer irritants in the air.  Increased electricity and ozone at high altitudes has a stimulating, sedative and tonic effect on the system, preventing nervous disturbances that result in hay fever symptoms. There is also rarified air (less oxygen) at higher altitudes, and this causes a person to take deeper breaths, something that may help prevent hay fever.
• White Mountains:
• Adirondacks:
• Summit of the Alleghanies:
• Rocky Mountains:
• Catskills:
4. The seashore:  Nearly all cases are prevented here, so long as the air is blowing from the sea.  The idea is that air from the sea is cool and free from irritants (like pollen).  Islands are great places to escape hay fever (examples include Mackinac Island and Fire Island)
5. Cool regions without regard to elevation:  Symptoms in colder regions "cannot long survive the cold."  A person can travel north, to areas such as Canada or Alaska, or Makinaw or Marquette
6. Large Cities:  Fewer farms in cities lends the air to less pollen and other such irritants.  Studies were done by Dr. Charles Blackley. However, it must be considered that large cities tend to lend themselves to causing or making hay fever worse.  He notes: "It is certain that the worse cases of hay fever I have ever seen have been residents of large cities like New York, Boston, Philadelphia and Brooklyn."

B. Medical Treatment:  What works for one person may not work for another, so a period of trial and error to find what works best for your patient (or you) may be necessary.  (Note: for all of the following remedies you will need the recipe.  You may also find products containing any of the following at your local pharmacy, or recipes advertised in various newspapers and magazines.)  

1. Constitutional:  Things inherent in the person's body (dictionary.com).  Things that make the body function better, such as that relieve pay and induce sleep, and therefore make the body less sensitive to the effects of a disease such as hay fever.  
• Tonics:  
• Sedatives:
• Narcotics:
• Stimulants:
2. Local Agents:  Things that "cleanse and soothe the irritated parts." (1, page 157
• Salves: topical to the skin, nose or eyes
• Inhalents:  topical to the respiratory passages

Systemic Medical Treatment: 

• Quinine: It's "helped more cases of hay fever than any other single remedy."  Can be used in large quantities with out any side effects (except loss of hearing, although temporary).  One, two or three grains should be taken two to three times a day for up to two weeks prior to the hay fever season and during the season. The dose can be doubled or tripled during a attack.
• Arsenic: Prepared in the form of Fowler's Solution*, and given from 3-10 drops after each meal.  May start taking before the hay fever season.  A side effect is they may injure stomach.
• Whisky:  Has both a stimulating and narcotic effect.  It "is only be used during the attack, and for the purpose of inducing sleep and relieving the symptoms."  Likewise, "those who resort to this remedy should bear in mind the danger of forming the habit of drinking; and for this reason the young especially should first try other methods of relief."
• Electricity: "A mild galvanic current, from six to a dozen or more cells, may be applied centrally and locally with much advantage. Electricity acts at once as a stimulant, a sedative, and a tonic of great power, and hence is indicated both for temporary and permanent effects—for the relief of pain, and for the fortifying of the system against the attacks." It requires a "special apparatus," and only a person with experience should apply it to the patient.
• Stychnine and Iron:  Good for patients with anemia and nervous exhaustion.  Good for patients who are "pale, bloodless, and run down."  No studies show it's usefulness in hay fever, but two teaspoons have shown to relieve cold symptoms in less than 24 hours. 
• Phosphorus and Cod-liver oil:  Cod-liver oil might help patients who have a cough, although it's only in the trial stages.  Thompson's preparation is to be commended. The prescription is as follows: Phosphorus 1 grain, Alcohol absolute 5 drachms, Glycerin 12", Alcohol 2", Spirit of peppermint 2 scruples. Take one quarter to half a teaspoon 3-4 times daily after meals. 
• Turkish and Russian Baths: They act as sedatives and tonics. They can be taken before or during the attack.
• Opiates: When given by hypodermic injection will break up an attack. Helps induce sleep. May be combined with Atropine to ease breathing. 
• Cold Powder: Camphor may be used externally or internally, and is generally tasteless. Can be combined with opium and carbonate of ammonia in a formula.
• Bromide of Potassium and Hydrate of Chloral: Useful to induce sleep when combined together. Dose should be monitored due to side effects, and it should only be given under the care of a physician. 
• Belladonna:  To ease breathing difficulties, 2 drachms of this may be added to one ounce of Fowler's Solution.  Give 5-10 drops after meals. May also be given by inhalation, and there are a variety of methods for this: cigarettes, cigars, incense, or simply igniting the powder placed on a plate and inhaling by using a rolled up magazine.  Proven very useful for asthma. 
• Iodide of Potassium, Iodine: Proven very effective for asthma and bronchitis. It's an active ingredient in many bottled asthma medications. Dose is five grains three times daily for asthma symptoms. If you are in dire straights and brave, you can try doubling the dose. 
• Aconite, Digitalis, Veratrum Veride, Gelsemin:  All good for febrile stages of hay fever, but should only be used with permission of a physician.
• Guarana:  Two-six teaspoons of the elixir may prove beneficial for treatment of headache. Can trial it for hay fever. 
• Caffeine:  Good for treatment of headache.  One cup of coffee or some chocolate provides this remedy, or you can try 1-3 grains in water. No evidence it has ever worked to treat hay fever, but if you have a headache it may be worth trialing. 
• Muriate of Ammonia: This salt is good for sick headache. The Germans use it for diseases of the respiratory tract.  It should be well diluted, and can be taken frequently.
• Prussic Acid: Can be used alone or with quinine, but is highly dangerous.  
• Nitrate of Amyl: Inhalations of it are proven effective for asthma.  Place a few drops on a handkerchief and inhale. Rapid in effect and harmless. Can be useful for asthma, and may be tried for hay fever. 
• Iodoform: Can be taken internally in the form of a sugar coated pill. Good for hysteria.  It can be useful as a tonic and sedative. It can be tried when nothing else works. 
• Ergot: If there is a log of discharge, this may be taken 2-3 teaspoons every three hours. It constringes  blood vessels, and therefore is beneficial for hemorrhage (bleeding) of the lungs and nose. 
• Epecac:  Some experts (like Dr. Henry Hyde Salter) claim it works to relieve asthma.
• Inhalations of ether or chloroform: Place a few drops on a handkerchief. It's dangerous and should only be tried in presence of another person, and with permission of doctor.  It's one of those desperate measures to try.  It acts to induce sleep and as a sedative. Works similar to morphine.
• Apocynum andromifolium: A 'saturated tincture of this drug relieves the cough and asthma.  May also chew the root. 
• Grindelia robusta: Two -three grains of the solid extract three times a day has proven effective for ordinary asthma. 

Topical Medical Treatment: Keep in mind here that local treatment refers to medicines that can be made in to a lotion and applied to the skin, or made into a substance that can be inhaled and immediately applied to the lungs.  

• Quinine:  You can try atomizing it, although the best application is by direct application to the irritated areas, as the "sensitive and irritated nerves are without doubt soothed and strengthened by the direct local action of the quinine upon them."  When given by mouth some of the medicine will be absorbed, thus also giving the patient a systemic effect.
• Salicylic Acid: "seems to act kindly on mucous membranes."
• Pinus Canadensis: Works for some on "diseased mucous membranes."  A recipe is listed that may be given with atomizer.
• Subnitrate of Bismuth:  A powder, made by combining it with morphine and gum arabic, has been shown to be good for the common cold, and may also benefit hay fever sufferers. "The powder can be snuffed up freely and often."
• Ice: "A piece of ice held on the nose, or bits of ice held in the mouth, have relieved the burning feeling by which some of the victims are annoyed. Chapman's ice bag** may be applied to the upper part of the spine for five or ten minutes at a time, with a view of making an impression on the nervous system."
• Wet handkerchief over mouth and nose: Works well when traveling to prevent the inhalation of dust and ciniders.
• Head Bath:   Hold the head over a bowl of hot water.  The steam can give relief to irritated nasal passages, and the "discharge is profuse. A shawl may be placed over the head and shoulders to confine the steam." (Authors note: My grandma used to do this for me when I was having symptoms at her house.  I remember her using it many times.)
• Smoking stramonium and inhaling Saltpetre Paper:  This is reserved for the asthmatic stage of hay fever. "Three parts of stramonium to one saltpetre is a good combination. A recipe is listed that includes blending stramonium with opium to relax the patient.
• Aqua ammoniae: Inhalation of hartshorn has been found to relieve symptoms in a few patients.  Due to risk of side effects, it should only be performed by a physician. The patine inhales some ammonia, and then the physician applies a solution containing it to the back of the throat (one part liquor ammonia to nine parts water).  The amount of water is diminished each day by one so the patient can adjust to the treatment, so that on the second day the mixture contains one part ammonia and eight parts water. This is done until one part ammonia and one part water, or another equal portion of the two, is used.  Another method is to place ammonia in a vessel and inhale through the mouth for up to a half hour (the nose should be blocked, perhaps with cotton, to prevent harming the sensitive nasal passages).
• Chlorate of Potash:  May be combined with anodyne and morphine and inhaled by atomizer for direct application to the air passages.  May be useful in treating common catarrh.
• Sulphur: Hold a piece of sulpher in the mouth when you suspect symptoms coming on. One doctor suggests "it relieves by fumes that rise into the nose.
• Dry Camphor: "Place on a thin cloth on the pillow at night" is one method suggested.

Hygienic Treatment:  

• Diet:  "A liberal and varied diet is suggested, consisting of those article that are nutritious and agreeable, and not specially difficult of digestion, is to be preferred always, both before and during the attack."
• Exercise: "Severe physicial exertion during the attack is neither agreeable nor advisable.  Exercise that induces a gentle perspiration is in some cases of temporary utility; but usually patients are indisposed to exertion." Out door exercise should be avoided because that is where that's probably where the exciting causes are (sunlight, heat, dust, etc.)
• Clothing: "The sufferers from hay fever should dress warmly at all seasons; and during the attack flannel should be warn next to the skin
• Sleep: "wakefulness and loss of sleep tend to aggravate symptoms."  It should be a goal to get as much sleep as possible, sometimes with the aid of medicine. 
• Abstaining from shaving: Some claim not shaving the beard may be of great value.  A theory states that close shaving of the beard may increase the sensitivity of the nerves of the nose and eyes.  Shaving the mustache may introduce the irritants into the nasal passages.  

Dr. Beard provides the following messages to the physician (or patient) referencing his book:

1.  Any remedy that is inhaled should be used with caution, as the desire to get relief during the panic the ensues during an attack of hay fever, and the willing to do anything to get relief, may cause a person to use high doses in hopes of obtaining relief.  It should be noted this is unwise, considering the tissue lining the respiratory tract is very sensitive, and overuse of some medications may cause more harm than benefit.

2.  Also of note, most of the preventative measures for hay fever involve traveling, which can be expensive.  So generally, this is something mainly for upper class citizens with a superfluous cash flow, such as physicians, lawyers, etc.  Most others may have no choice but to suffer through the symptoms, or try one of the medical treatments listed above.

3.  "No one need be deterred by the variety of treatment here suggested. All of these various remedies, and methods of using remedies, are referable to the same general principles of treatment—namely, to fortify the system against the attacks and to relieve the symptoms. All of these remedies act as tonics, sedatives, or anodynes. No one, nor all combined, act specifically for all cases; but some are almost specifics for individuals. The best course for patients is to submit themselves to their medical adviser, who can act according to the suggestions here given." (1, page 180)

4.  "Those who have never tried any medical treatment would do well to begin with those remedies which have thus far proved to be of service in the largest number of cases—as quinine, arsenic, camphor, electricity, hydrate- of chloral, bromide of potassium, and stramonium, and then, if these fail, to experiment with other substances." (1, page 180)

5.  The proper treatment for each case, after it is once ascertained, will usually be found to be very simple and easily carried out. None of the remedies indicated above, when properly used, need injure any one. In judicious hands the most powerful poisons can be tested without incurring the risk of permanent injury, local or general.

*Fowler's solution was an arsenic solution recommended by Dr. Thomas Fowler (1736-1801) in 1786 for the treatment of agues, fevers and headaches. (merriam-webster.com)
**Around 1868  Dr. John Chapman performed some studies on the use of ice to ease nervous diseases, of wich it was believed hay fever was.  He invented what he referred to as Chapman's ice bags tha could easily be applied to various parts of the body, preferably the spine.  The idea was this provided relief of nervous disorders by stimulating the nervous system.  One of his original uses for the bag was to treat sea-sickness.  You can check out his 1868 book "Sea-sickness and how to prevent it." Due to lack of any truly effective treatment for hay fever, physicians and patients often experimented, and this is, perhaps, how the ice bags came to be mentioned in Dr. Beard's book.

References:

1. Beard, George M, "Hay-fever; or, Summer Catarrh," 1876, New York, Harper and Brothers, Publishers, pages 139-182
2. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press

1981: Terror in a smoke filled room

In 1980 most people didn't think twice about smoking in front of others, let alone asthmatic kids like me. My family was no different.

I want it to be clear this is simply my version of events on this particular evening, and that this is not meant to be a knock on members of my family who smoked.

I had an Alupent inhaler, but it was at home. If you have asthma, you know the drill, "If you forget it, you will need it." So, this was probably my first experience with asthma anxiety caused by not having my inhaler.

Grandpa was sitting on the day bed of his sitting room, a cigarette dangling between two fingers. I watched as the smoke swirled above his hand, polluting the air. In a way I enjoyed the smell of cigarette smoke, but my lungs hated it. My throat burned. My head ached. My chest was tight.

Someone flatuated, and grandpa laughed. I watched as his body bobbed up and down as he did so, and then he put the cigarette to his lips, inhaled, and blew his smoke across the room where it lingered in the stale air. No one seemed to notice this but me.

I heard a smack, and I turned and saw that Uncle Tad, who was sitting on a bench by the window with baby Jody on his lap, was cringing away from his wife, who sat next to him. She was blushing. He was laughing. I assumed she smacked him.

Uncle Timmy was sitting in a faded leather chair facing away from me, and all I could see of him was his foot as it dangled over the thick arm of the chair. I could hear his laughing over the laughter of the others.

I was standing in the doorway trying to breathe air from the hallway that was barely fresher than that in the room. My shoulders were high. I was calm. I was breathing slowly, but with difficulty. I did not want anyone to know I was in distress. I was ten-years-old.

Aunt Mary, who had been curled on the floor near her brother Tad, stumbled across the room and darted past me into the hallway, laughing the whole way. I could hear her laughing all the way down the stairs, only to cease with the slamming of a distant door.

My Great Aunt Dolly, who was sitting on the tile in front of the crackling fire in the fireplace, was rolling side to side with laughter. Aunt Tossi was sitting on the floor between the leather chair her
brother Timmy was slouching in and the TV, was laughing so hard she fell over onto her side.

My dad and mom were sitting on the bed to the right and left of grandpa. Mom had a smile on her face, but she wasn't laughing. I was hoping she had had enough of the foolishness of dad's siblings and would want to go home. They were a fun family, but I wasn't in the mood for fun: I just wanted to get home to my Tedral. I had not been introduced to Alupent yet. That introduction would come later in the year.

Despite my hopes, mom made no effort to move. She looked comfortable wrapped in one of grandma's afghans, and more than likely was in no hurry to go back out into the blizzard that was raging outside.

I wanted her to look at me at least and notice I was miserable, but she didn't do that either. I was on my own.

You are probably wondering: why didn't you just ask for help? Well, for one thing, the last time we went to grandmas I told mom I couldn't breathe, and we all had to leave. My brothers seemed annoyed about this. So, this time, I didn't want to ruin everyone's fun. Worded another way, I was shy.

After the laughter boiled down, there was silence in the room for several long minutes. Dad spoke, breaking the silence. He said, "You should have seen dad in action today," he was smiling cheek to cheek, peering at his dad, who chuckled, and puffed on his cigarette.

I heard a bang from down the hall, and turned and saw my brother David rush from a room. "Come
on, John. We're gonna play hide and seek downstairs."

"I can't." I whispered, hoping no adult heard me. The last thing I wanted to do was explain why I didn't want to play. I turned back around, and saw that none of the adults I could see were paying attention to me anyway. They were all looking at dad. This was fine with me.

"So anyway," dad said, "We had a light green Gremlin with an orange hockey-stick stripe down the side. Dad and I were checking it out. He said, 'Isn't that the God Damned ugliest car you'd ever seen?'"

He cowered as mom reached around grandpa and made to slap him. Grandpa, it seemed anyway, pretended not to notice.

"Watch your mouth, Bob!" She meant business. There was no swearing when mom was around.

I watched as grandpa dumped the butt of his cigarette in his beer can, and I felt a moment of joy because, I assumed, the air would be fresh now for a while. Then I heard the flicker of a match, and smoke billowed into the air where Aunt Tossi was sitting. She blew out the match and a new cloud of smoke wafted up to mingle with the cigarette smoke. For a brief moment the sulfurous incense of the match seemed to mask that of the cigarette smoke.

She set the wasted match into an ashtray and tossed the match book to Aunt Dolly, who proceeded to pluck a Marlboro from a basket, and then she handed the same match book to my dad, who buried it in his grasp. I took a difficult breath of hallway air, but couldn't prevent myself from breathing in some of the smoke that was now lingering thick and fog-like in the room.

Dad said, "And dad said, 'Son, ain't that the the God damned ugliest car you'd ever seen?' and I laughed because that's exactly what I was just thinking. And here it we had just parked it in the middle of the showroom." He plucked a cigarette from a pack in his breast pocket, and stuffed it into his mouth.

I heard a another bang behind me, turned, and watched as my brothers rushed from a room, down the stairs. "Come on, John!" The shout of one of my brothers reverberated through the house.

"Anyway, it wasn't five minutes later," dad continued, talking with the unlit cigarette dangling from his lips, "and this costumer came in. Dad," he paused, seemed to snicker off a laugh, and lit a match. "Dad walked this guy over to that ugly Gremlin and said, 'Now, ain't that the most beautiful car you'd ever seen."

Slow breath in through the mouth and out the mouth. It was very thick air, so it seemed. My chest burned as I inhaled. The breath only went about half way into my lungs. I had to work hard to fight off the anxiety. I had to stay calm so I didn't ruin my family's fun.

Laughter filled the room.

Dad cooly chuckled as he lit his cigarette, took in a deep breath, and blew smoke across the room. He chuckled again, then added, "He sold that car less than an hour later." Even mom joined in the laughter this time. But not dad and grandpa; they were too cool to laugh. They both smiled as they puffed on their respective cigarettes.

Time passed. Listening to the stories of the adults made me forget my conundrum, if not for a short while. Then it all came back to me as I heard mom's voice.

"Do you want to sit up here," mom said to Aunt Dolly, who was sitting Indian-style on the floor. Yes, get up mom, and come over by me

"No," Aunt Dolly said, "I'm doing just fine here on the floor. Besides, it feels good by the fire." Oh, she just wants to sit by the fire. Come on mom! Look over here! I felt a sting through my arm as I hit the door frame with my fist.

I heard grandma's voice from the part of the room I couldn't see from where I stood, and then watched as she walked around the leather chair, past me and down the hall. I heard a door shut.

I felt a breeze as David rushed into the room. He had a fresh beer for grandpa. Kr-chick went the beer tap. Grandpa tossed a quarter into the air and it plopped onto the floor. Devin bent to pick it up. Grandpa took a swig of his beer. Moments later my older brother Bobby popped into the room with more beers, and handed them out to the men in exchange for quarters.

"No running!" I heard grandma say from behind me as Devin rushed past me again and down the stairs. Grandma came into the room with a box. She sat on the floor and set the box next to her and removed the lid. She started handing out pictures.

Oh, come one, I thought as mom took a pile of pictures and slowly flipped through them, I just want to go home. Come on! Can we just go! COME ON!

Once she was done handing out pictures, grandma came and stood by me. "Why aren't you playing with your brothers?" Then, as though she had come up with an answer to her own question, she said, "Come with me."

I followed her through the room, over legs and around chairs, to a connecting room where her bed was. My cousin Timmy and Tyler were playing with something on the other side of the bed, giggling all the while. On this side of the bed were cousins Julie and Jennifer lying on the floor coloring in a Bugs Bunny coloring book.

Grandma walked me around the bed, and moved a few things around the top of an antique dresser (the same one I now have in my basement, decorated as my shrine to grandma). She was looking for something, and now she found it. She picked up the object and proffered it to me. It was a wooden puzzle. “I picked this up at a yard sale the other day," she said, "I was thinking of you.”

She told me I could sit on her bed and play with it. However, she had already told all the other kids they were not allowed on the bed. That was her rule.

You're letting me on your bed because you feel sorry for me, I thought, and opted to not get on the bed. You know something is wrong with me. But you don't know what. She doesn't know that I can't breath. Or does she? 

"Go ahead, John, it's a fun puzzle." Grandma said.

Knowing I had no other options, I hopped onto the bed and pretended to play with the puzzle. It was hard to feign interest at this point. It was getting really hard not to let everyone know I couldn't breathe. I did it though, just like so many other times.

As soon as grandma was back in the other part of the room I heard a boom, a rush of laughter, and noticed Uncle Tom was rolling around the floor wresting with Torri. At first I thought they were really fighting, but then I realized they were both holding their guts. They were laughing.

I started playing with the puzzle, but stopped as my brothers rushed into the room in a loud furry and jumped onto the bed.

“You can’t be on here,” I said. They didn’t listen. A moment later all the boys were on the bed, and I was sitting on the floor. My chest was now itchy tight, and I could feel the wheezes. I really had to work at making them not audible. I sat leaning against the wall behind the leather chair.

I could smell the smoke over the smell of antiques, and I could feel my throat burning. I made to wipe snot away from my nose, wiping it on my sleeve, eyeing grandma as I did so, knowing she'd say something if she noticed. My nose burned.

I poked my head around the leather chair hoping no one would notice me, and listened to the lighthearted conversations and the laughter. I didn't care about that stuff. What I was interested in most was my mom. I knew she usually would get to the point she'd want to leave and would hint to dad it was time. Usually she would do this and nobody else would want to go.

This day, when I really wanted to leave, she didn't say anything. She just continued looking at grandmas pictures.

"You want to look at these?" I looked to my right and saw Tossi was holding the stack of pictures to me.

"No thanks," I half grunted. I wanted to, boy did I want to look at pictures, but I wanted to go home even more. I thought if I were home I'd be able to breathe fine.

I was wrong.
------------------------
On the way home I sat in the backseat, with Bobby and David on either side. I concentrated hard not to letting on that I couldn't breathe. I would be fine if I could just get to my Alupent inhaler. I will have it soon. I will use it soon.

Only one problem: it was close to being empty. I had never had this experience before. I had been short of breath many times, had mom or dad take me to the emergency room many times, but I never had an experience where I had my own rescue medicine. I also never had experienced before having such a rescue inhaler and it being empty. Okay. So, you can imagine my stress.

In retrospect, I should have just said something. In retrospect, the fact that i had gone through my inhaler so fast was a sign I should have sought help. In retrospect, mom should have kept charge of dosing my inhaler to me.

Think of it this way. Most kids should have died in the 1980s. We played on slides that were a mile high. We ran in front of huge torpedo swings made of metal. We never wore seat belts. We never even heard of bike helmets. And, to add to this, kids were in charge of their own asthma rescue medicine. Okay.

Some kids probably didn't survive this decade. Most kids, including me, did. Somehow.

I would scratch and claw my way through the night. I would open one of the two windows in my room and inhale some of the cool outdoor air. I would pile up my pillows and blankets so I could lean on them. Sometimes I'd fall asleep out of pure exhaustion, only to wake up to audible wheezing. My chest would feel heavy. My inhalations would only go half way in. The panic set in.

I would use my inhaler sparingly. I would try to spread it out. However, at some point, there was no mist. I would run it under hot water. I would finally give in and wake up mom.

1978: No antihistamines for this asthmatic

I remember my mom specifically telling me when I was a kid that I can't have antihistamines. She said they may cause bronchospasm, and that doctor said so. What my doctor prescribed for me instead was Tedral and salt water drops. That's it!

I remember many times when my nose was so plugged I couldn't sleep. I remember playing outside and my eyes would basically swell shut. Mom would have me lie on the couch, or on my bed, with a cold, wet rag over my eyes. Obviously, this affected my social life.

It also affected my asthma. 

My doctor, according to a 1978 notes my mom took while talking with my doctor on July 14, 1978, I was supposed to take Tedral three times a day, and rinse my nose with salt water drops four times every day. The medicine tasted terrible, and rinsing out my nose with salt water was torture. I hated both. 

It kind of reminds me of something Teddy Roosevelt wrote in his diary about growing up with asthma in the mid 19th century: "The medicine was often tortuous, and was often worse than the disease." I am paraphrasing it here, but that's pretty much what he was saying. I would have to say, that in the 1970s, asthma treatment wasn't much different. 

I can understand why my doctor would not prescribe for me a medicine that probably would have offered me some relief. It goes back to a myth in medicine during the 1950s and 60s that antihistamines, although they offered relief from allergies, dehydrated your lungs. This, it was believed, would cause bronchospasm and asthma.

I think it would have made more sense if they would have prescribed me an antihistamine, such as Marax (I am told it actually tasted good). I could have trialed it to see if it offered a benefit, If it didn't, or if my asthma got worse while taking it, I could have stopped. But this trial never happened. Instead, based on a myth, I suffered.

Now, by 1976, this myth was on the way out the door. The down side here is that most doctors were educated back in the 1950s, when the myth was taught in medical schools. Unless they kept up to date on their studies about asthma and allergies (and asthma was considered an allergic disease back then), doctors -- such as my doctor -- would have prevented themselves from prescribing antihistamines to asthmatic kids such as myself. 

An article in the January, 1968, edition of the Journal of the National Medical Association makes light of this myth. 

Antihistamines. The use of antihistamines in asthmatic children has been condemned in the past. In theory, they should be valuable in counteracting the effect of one of the principal allergic mediators-histamine. However, they do dry secretions and possibly, aggravate the patient with asthma. Practically speaking, some small children with pollen allergy do respond to antihistamine. But, generally, they are not effective in reversing bronchospasm. (1)

I did not start using antihistamines until I was over 18. They worked great, and have never induced asthma. I suppose I could hate my doctor and parents for not allowing me to have them, but I'm not. This is just one of those life lessons you learn as you grow older. You do the best you can with the wisdom you have today, and as you learn better you do better.

References:

1. LeNoir, Michael A., Lawrence D. Robinson, outpatient management of an asthmatic child, Journal of the National Medical Association, January, 1976, page 46-50, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2609533/pdf/jnma00473-0072.pdf, accessed 2/22/17

1978: Tedral and Brondecon

During the late 1970s, there was a medicine mom gave to me when I was having trouble breathing. I remember standing just inside the bathroom door watching mom opening the medicine cabinet above the sink, grabbing the bottle, pouring some of it on a teaspoon, and feeding it to me. I remember it tasted nasty.

I do not remember if it worked. I do not remember any side effects. However, it must have worked, because I do remember asking for it. I do remember my mom observing that I was sniffling, sneezing, and wheezing, and taking me to the bathroom to take my medicine. I do remember going on vacation and forgetting to take my medicine, and then having to deal with an asthma attack with nothing to take for it other than a cough drop.

I had been thinking of this medicine for a couple years. I asked my mom about it, and she has no memory of doing this, let alone what medicine it might have been. Ironically, a few days ago I was talking to one of my fellow-asthmatic co-workers about asthma medicines we took as a kid, and she said that she took a medicine called Tedral. She said it was nasty tasting, but it worked.

The next morning I woke up around 4 a.m. and an epiphany occurred to me that I should go into the basement and look at my asthma books mom put together for me. I just re-organized them about a year ago. The books mom put together were made of acid, and many of the papers and pictures she saved were no longer bound to the pages. So I bought an acid-free picture book and remedied the situation, saving what my mom worked so hard to put together for the future version of me (the me of today -- the nerdy amateur historian).

I opened up a green storage bin and was thrilled to find the picture book right on the top. I set it on the table, sat down, and began to flip through the pages. Only a few pages in I found what I was looking for: a note from my mom dated July 14, 1978.  As a bonus, a picture of me at that age was next to the date (you can see the note and a picture of me at age 8 below)

I had looked at it many times before, but never thought to actually read it until just now. My mom was a note taker. After my doctor's appointments, I would wait in the hallway while mom talked to my doctor in his office without me. Mom would take notes. Considering I was the sickly one in the family, this was probably necessary.

You can see the note below. Item #5: "I teaspoon Tedral or Brondecon 2 p.m., 6 p.m. and 10 p.m.to August 28th."

There are a four reasons why Dr. Gunderson ordered for me to stop taking it in August. First, Tedral was recommended for asthma and seasonal allergies. So, it must have been estimated that the pollen season (hay fever) was the cause of my asthma.

Second, asthma at this time was treated as bronchospasm, and the treatment was bronchodilators. The most common one to start with was theophylline. The products Dr. Gunderson was most comfortable prescribing to kids were Tedral and Brondecon. A medical journal from 1976 described asthma as follows:

"Asthma, as a pathologic process, involves change in the terminal bronchiole. Components of the disease include mucous plugging, mucosal edema, and bronchospasm... Bronchospasm is reflected by varying degrees of respiratory difficulty and wheezing. It is important to realize that significant bronchospasm must be present before respiratory difficulty or wheezing becomes clinically apparent." (1)

Third, asthma at this time was treated as an acute disease, meaning that it was only treated when symptoms were observed. Once symptoms went away, or when asthma went back into remission, treatment was stopped.

Fourth, asthma was considered an allergic disease. Note the following description from the same article referenced above:

IgE antibody develops in response to exposure to specific antigens in susceptible individuals... . Once the antibody forms, it circulates in the serum and ultimately finds its way to the surface of mast cells throughout the body. When the patient is subsequently exposed to the antigen, it combines with this IgE antibody. The reaction results in the release of allergic chemical mediators. These substances are released in various locations throughout the body causing vascular permeability, vasodilation and bronchospasm. When these reactions occur in the lungs in significant quantity, asthma results."

The authors of the article recommended starting with one bronchodilator, and usually with a theophylline product. There were various theophylline products on the market, with Tedral being one of the most popular. It was a combination drug that was available over the counter. It included theophylline, ephedrine, and phenobarbital.

Both theophylline and ephedrine were bronchodilators. While they worked to open airways, they also cause side effects, such excitement, hyperactivity, and insomnia. Phenobarbital was a sedative, added to the product in an effort to reverse some of the side effects of the other medicines.

As I searched the Internet, I found quite a few discussions about Tedral, including one at medchats.com.

As I noted earlier,  I was too young at this time to remember any adverse effects. However, I do remember being hyperactive, excitable and having trouble sleeping. I also remember having some horrible dreams. Whether these were a side effect to medicines I would have no idea, but one can't help but to assume that this is a strong possibility.

I thought it would be neat here to publish some of the comments noted by various people about taking Tedral. Here are some of the ones I found the most interesting.

1. When I was a kid I had asthma, and I had some yellow medicine that had a vaguely medicinal flavor, with a nasty alcohol kick, and the texture of snot, no kidding. I used to try to hide the wheezing to put off the moment when I'd have to take some Tedral. from 2001, 35 YO
2. It tasted like black licorice and was black and gross. It was a yellow elixir. Side effect is increased adrenaline. May cause excitability and trouble sleeping. Tremors are another side effect. Heart racing and nausea signs of side effects. I remember days when I would have horrible headaches and nausea, and I now wonder if I had overdosed on this medicine. possible. I gagged because of the horrible taste. "I felt like I had so much energy I couldn't sit still. Some people note hallucinations and confusion. Thick yellow asthma me
3. "I always wondered what happened to the spiders running around the ceiling when I was a child drinking thick yellow asthma m medicine. I thought it was only me and they were real. Used to use Teddy bears to protect me. Used from 4 years old until Primetine Mist came out
4. I had asthma as a child for several years...was allergic to a bunch of things...pollen, dust, citrus, horse hair etc...This would have been maybe from about 1959 to 1966. I had extreme agitation and felt so hyped up. I hated the feeling. Sometimes wasn't sure which was worse...the gasping and wheezing from the asthma or the "speed" like feeling from the Tedral...(Milky looking liquid...syrupy...tasted like licorice).
5. I took it in tablet form as a kid in the 50s and 60s. My mother, who also took 
it, described the taste of the tablet (if she didn't swallow it fast enough) as
a dirty streak across her tongue. I agreed then and can still remember it.
Yuck! And if it didn't work, there was always a doctor's visit (ah, those were
the days!) or a trip to ER.

These descriptions seem to fit my memories. Add in the note my mom put in my picture book, and my memory of taking a medicine that tasted horrible, and I bet Tedral was the medicine I remember. This might also explain why I abhor the taste of licorice.

Here are some descriptions from random people about taking Brondecon. 

1.  I remember "cherry flavoured Brondecon - a bronchitis medicine I used to have as a kid. My gawd..........it was one of those medicines that you used to still be able to taste hours afterward. I think it MAKES you get better by means of scaring you into 4 hourly rituals of tasting this horrid glomp."
2. When I was a lid my dad swore by Brondecon as a sure-fire remedy for a cough. We had a huge bottle of "Wild Cherry' flavoured hell on top of the fridge.

So, it was one of these medicines I took as a kid. As I noted earlier, I remember going on a vacation and forgetting my medicine. Considering how terrible it must have tasted, perhaps I forgot it on purpose.

As a side note here, I remember grimacing each time I was spoon fed this medicine. I remember one time mom was excited to tell me she got a different medicine. In retrospect, I bet it was Brondecon. It had a powerful taste. I remember grimacing and telling mom it was also terrible, like when we got a fluoride treatment at the dentist.

I also remember mom getting annoyed with me for saying this, and saying something like, "Well, these are the only options if you want to breathe."

"But it's nasty," I wined.

"Then I'll just get the other stuff, because it's cheaper!" she chimed.

This got me to thinking. I decided the new stuff, while nasty in and of itself, was better than the older stuff. So I decided to tolerate it. This strategy worked fine until, one day, she spoon-fed me the horrible stuff again. Needless to say, I was disappointed. I don't remember why she switched back, but at the time I figured it was because I complained. In reality, however, and knowing my mom's frugal (if not parsimonious) tendencies, I bet Tedral cost less.

Both Tedral and Brondecon were marketed by Warner-Chilcott. Both these medicines were available over the counter. Both were discontinued in 2010.

On the note you will also see # 6, which states, "Salt water nose drops 4 times daily to August 28." I hated doing that too. Can you imagine putting salt water up your nose? Yeah! Imagine being 8 YO and doing this, and not even feeling any different when you were done torturing yourself.

You can see advertising for both Tedral and Brondecon in this 1968 edition of "Diseases of the Chest." There is also an article called "Asthmatic Bronchitis" which lists various other theophylline products, including Marax, of which, I am told, tasted pretty good. 

When I showed this picture to my 8 YO daughter Laney, she said, "You look kind of nerdy in that picture." 

References:

1. LeNoir, Michael A., Lawrence D. Robinson, outpatient management of an asthmatic child, Journal of the National Medical Association, January, 1976, page 46-50, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2609533/pdf/jnma00473-0072.pdf, accessed 2/22/17
2. Official Publication of the College of Chest Physicians, Diseases of the Chest, vol. 53, No. 1., see advertisements for Brondecon and Tedral. 

1888: Rumbold describes hay fever as 'pleuritic rhinitis'

On Monday, June 24, 1867, a printer from St. Paul by the name of Luke R. Gibson rode into town on his horse to visit Dr. Thomas Rumbold. He said his chief complaint was chronic catarrh, and he suspected this was the cause of a recent bout of sneezing and asthma.

The doctor asked, "Have these symptoms ever appeared before?"

"Yes," said the patient.  "They occurred in July of 1865, and again in 1866. However, the second time they appeared one night right after I left the printing office.  It was hot, so I opened the window so I might be more comfortable as I slept.  As it turned out, this was a bad idea."

The patient might have suspected these episodes were the common cold, although Dr. Rumbold would have recognized the patter.  He would later write in his book that one of the tel-tale signs of hay fever, or what he liked to refer to as pleuritic rhinitis, was a cold that appeared off-season, or in the spring, summer or autumnal seasons. (1, page 630)

Dr. Rumbold also believed that asthmatic breathing rarely followed a cold, and did frequently follow an episode of pleuritic rhinitis.  Likewise, most adults diagnosed with the condition had it as a child, and it frequently went undiagnosed. (6, page 631)

The doctor asked, "Did you ever suffer as a child."

He patient said, "Yes, as a boy I suffered from large crusts of secretion in my  nose, and these went away as I grew older."


Dr. Rumbold inspected his patient's face, nose, eyes and ears, and discovered two polypi in his left ear, of which he removed. Suspecting this might be the cause, he sent his patient home.

Mr. Gibson's next visit to Dr. Rumbold was on January 4, 1868. He reported to the doctor that, upon returning home to St. Paul after the previous visit, he was affected with great headaches. However, while not entirely cured, his hay fever symptoms were improved.

Dr. Rumbold inspected Mr. Gibson's nose, eyes, face and ears, and observed the same catarrh he had observed a year earlier, and this time he suspected this as the cause of the symptoms.  Being there were no polypi nor other suspected culprit, he decided to treat the catarrh.

"So, we have a few options," the physician said.  He then explained that option number one was to apply a spray into his airway to soothe his throat.  He said this might feel sensitive at first, especially the spray to the nose, although over time this should become easier.

A second option, one that he said he would rather not do, although he would if the patient wanted, was to apply gentle currents of electricity to the patient.  This was a relatively new therapy that seemed to work for some patients.

"A third option," he said, "was to give you a gentle diuretic to make you pee, or a laxative to soften your stools if you're constipated.  But I don't think this holds true for you, does it, Mr. Gibson?"

The printer shook his head.

"So, what do you think," the doctor asked.  "I can do any of those therapies, although, the one I recommend, because it is safe and soothing, at least most of my patients say so, is the spray."

"Yeah, the spray!" said the patient.

The doctor had the patient sit in a chair -- "Say Ahh!" -- and he carefully inspected the patient's airway once more. Sitting behind the doctor, on a small table, was a small device attached to a rubber squeeze bulb. This was the spray producer. The doctor was not quite ready for it yet.

When Mr. Gibson appeared to want to sniff and sneeze, he had the patient rub vaseline over his face, neck and head.  He then had him take off his socks and boots. Once this was done, the doctor rubbed vaseline over his patient's feet.  (1, page 634)

He then had Mr. Gibson put a clean silk handkerchief over his face and a hat over that.

"This seems kind of silly," smirked the printer.  "But if you think it will help, I'm all for it."

The doctor then grabbed the spray producer. He had previously introduced into it a mixture of muriate of ammonia, a tincture of iodine, and a tincture of aconite root.  He had the patient move aside his handkerchief from his airway.

"Hold this," the doctor said, handing Mr. Gibson a tongue depressor.  "I want you to insert this over your tongue and depress it."

Mr. Gibson did as instructed. The doctor inserted a warm topical to the back of his throat. This made made the patient cough and spit into the face of the doctor. The doctor was not bothered by this, and continued rubbing the warm topical all over the back of the patient's tongue and throat.

As soon as the procedure was done, Mr. Gibson made a sound around the tongue depressor, which he still held in place,  that was unrecognizable to the doctor. He then repeated it, and this time the doctor understood what the patient was trying to say.

"No, I'm sorry," said Dr. Rumbold. "I wish you didn't have to go through this."

Dr. Rumbold introduced the spray producer into the the airway and squirted it.  The patient winced, yet did not cough. Dr. Rumbeld had the product inserted into his own airway several times before, and he knew it produced a warm, pleasant sensation in the back of the airway.

The physician squirted several times, being sure to completely cover the tonsils and uvula. (1, page 634-635)

As soon as the doctor was finished, the patient pulled the tongue depressor from his mouth, smiled, and said,
"That was quite interesting."

"Well, the solution was warmed, and when it comes out of the cool spray it produces that sensation.  That appears to work best for my other patients with pleuritic rhinitis.  I think this should work for you too." (1, page 635)

"I sure hope so."

The physician then set down the spray producer, opened another drawer, grabbed one that was similar.  He grabbed a second medicine jar from the table top, poured some pre-mixed medicine from the jar into the jar on the producer. "Hold still," he said.

He then inserted this spray producer into the patient's right nostril and sprayed. He did the same for the other nostril. The patient barely winced both times, and the doctor took this as an indication that the inflammation there was quite severe and chronic, thus having an anesthetic effect.

The physician set that spray produce down and grabbed a third.  This time he had the patient open his mouth, and, as he sprayed, the patient could taste vaseline.

"Yuck!"  He said as the doctor pulled the spray producer out of his airway.

"It's a vaseline formula," the doctor said.  "It does taste kind of awkward."

"It did sooth my throat, though," the patient said, swallowing.  "Yeah!  It feels pretty nice for the moment anyway."

The physician gave the patient instructions.  The two gentlemen shook hands, and, after using the handkerchief to wipe the vaseline off his face, the printer left the physician's office.

Their next visit came in May of 1869, and from this time on he was treated with the spray every two weeks through July 23rd, and until August 21st once a week.  In this way, he would be treated for the duration of the season suspected of causing his agony.

About 20 years later, in 1888, Dr. Rumbold would write about Mr. Gibson's affection and treatment , and publish it in a book called, "A Practical Treaties on the Medical, Surgical, and Hygienic Treatment of Catarrhal Diseases of the Nose, Throat, and Ears."

Instead of describing the condition as hay fever, he used "pleuritic (itching) rhinitis."  This made him the first published author to refer to hay fever as rhinitis.

As with previous authors regarding the condition, he recognized that it affected its victims during certain seasons of the year, and in certain parts of the country.  He also recognized the significance of hay fever vacations, as in certain parts of the country tended to exempt sufferers from an attack.  (1, page 596)

He said that of 1884 no effective remedy had been discovered, with the exception maybe of hay fever vacations.  He said most investigations into the disease prior to his time were performed by those who were affected by the malady, instead of endeavoring to find the actual cause.  He, therefore, said much of what has been written on the subject has resulted in confusion.  (1, page 596)

He said the main reason for the confusion is that there is no subjective complaint regarding the disease, such that it causes no pain.  Likewise, most subjects who complain of hay fever symptoms don't notice any symptoms prior to a particular season, and this has lead many physicians to use their own experiences regarding the disease when describing it. (1, page 597)

He further noted that all previously used names regarding the malady -- hay fever, grass fever, rose cold, summer catarrh, autumnal catarrh, etc. -- were "inappropriate and misleading."  (1, page 597)

He likewise said it's not good for the name of a medical condition to change on the whim of each physician, and that, based on the symptoms present, that it should be uniformly be referred to as 'pleuritic rhinitis' or pleuritic rhinitis catarrhalis.'

The reason he chose this name, he said was because "the prominent symptom is an itching of the nasal passages, face and eyes." (1, page 598)

He said such a uniform name was essential as to prevent "erroneous diagnosis" that resulted from poor retention of all the various names. This, he said, might lead to "improper course of treatment." (1, page 598)

For instance, pleuritic rhinitis, he said, would be suffice to describe the symptoms of hay fever regardless of the cause or season. (1, page 598)

A good example, he said, as was previously noted by Dr. George Beard, is the fact that Dr. Morrill Wyman uses both the autumnal and spring forms of the malady as two separate diseases, when in fact they are one and the same.  Hence, the term pleuritic rhinitis would have been appropriate for both, leading to similar remedies. (1, page 498)

Rumbold said that regardless of the cause, and regardless of when the attack of hay fever came on, vacationing to certain parts of the country, as in the mountainous regions of the country, uniformly worked for them all as the preventative and the remedy.

Along similar lines, he said that, regardless of the cause or the season, his experienced showed him that all forms of the condition benefit from "hygienic treatment, and the same kind of constitutional and local treatment." (1, page 599)

He said it is much easier for a physician to treat similar symptoms with similar treatment, than to try to find the individual cause and their respective treatments.  (1, page 599)

While the name should be uniform, he said it was still possible to hunt for causes, of which he supported the parasitic or vegetable theory, that the condition may be a response to spores or bacteria (germs) from vegetative plants, and disappear when these spores are no longer abounding in the atmosphere. (1, page 600)

Note that this was a time in our history when the medical profession thought that a bacteria, or some form of parasytic or vegetative substance, was the cause of hay fever.

He said a similar theory was postulated by Dr. Beard, who actually did a study on the matter of 200 affected individuals, 101 of which said they had hay fever symptoms between the seasons of summer and fall. Rumbold said that he and Dr. Beard believed this evidence might be proof enough to disprove the parasitic theory of hay fever. (1, page 600)

External causes include dusts of various kinds, such as dust of steam cars, dust from old carpets, or from old feather beds, or moss beds or moldy hay from the street.  (1, page 627)

Other external causes are right sunlight, exhaustion from heat, hay, flowers, sulphur matches, smoke, damp air, flowers, moldy room, tobacco smoke, foggy mornings, night air, or damp cloths.  (1, page 628)

There are also internal causes, or mental conditions, that might cause the condition, such as ill temper, anxiety, and melancholy.  Also predisposing one to the malady is indigestion. (1, page 628)

Regardless whether the exciting cause is internal or external, Rumbold said:

The sudden, in fact the instant response of the Schneiderian to the irritating effect of the most of these agencies, apparently leaves no period for the incubation of parasites. Notwithstanding this, I presume that some one will soon lay claim to the discovery of bacillarire peculiar to or may be a cause of this complaint. The effects of these irritating agencies are so instantaneous, that there is no opportunity for imagination to act on the victim, as the attack is a surprise to every one of them, nor do they know positively, for some time, the cause of their paroxysms.  (1, page 628)

He was also one of the first to postulate that, upon repeated exposure to an irritant that causes inflammation of the nasal passages, that this inflammation may become chronic, or "continue for a long time." He said he believed this is what caused pleuritic rhinitis (hay fever), although he did not know for certain the cause nor the causative mechanism. (1, page 606)

Dr. Rumbold believed that whether the cause be rose, grass, hay or pollen, the symptoms are the same, differing only in severity, and include: "itching sensation in the face and eyes, soon followed by the same sensation in the nostrils and by sneezing." (1, page 599-600)

He therefore believed the symptom, not the cause, should be diagnosed and treated, and the term he postulated was, once again, 'pleuricic rhinitis.'to describe the symptom of eye, nose and facial itching.

He, therefore, essentially believed, as the case of Mr. Gibson and others showed, that pleurtic rhinitis was "one of the sequences of chronic nasal catarrh." (1, page 612)

Dr. Rumbold explained in his book that Mr. Gibson returned occasionally to see him. Frequent visits were not needed, as the patient reported that he spent most of his time in the country.  He said the patient complained of occasional itching of the eyes and nostrils, although his pleuritic rhinitis did not return prior to his death in 1870.

References:

1. 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

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1830-1900: Early ventilators and intubation devices

Figure 1 -- Bouchut's Endotracheal Tube
(23, page 6)

If you are a physician, nurse, or respiratory therapist you can skip the next couple paragraphs. For the rest of my readers, I would like to take a moment to explain about breathing and artificial breathing. I want to explain about ventilators and intubation.

Obviously, in order to stay alive people must continue breathing. By 1830 physicians were well aware of this fact. This was important for victims of near drownings, and for patients who required anaesthetics during complicated surgeries. During these times, some method of artificial resuscitation was required, or some means of breathing for the these patients, at least until they regained their ability to spontaneously breathe.

How do people inhale? Natural inhalation occurs when the muscles of inspiration constrict, thus pulling the chest wall outward. This creates a negative pressure inside the chest resulting in air being drawn (sucked) into the lungs.

How do people exhale? Natural exhalation occurs when the muscles of inspiration relax, thus causing the chest wall to naturally recoil. This creates a positive pressure inside the chest resulting in air being forced out of the lungs.

Figure 5

Negative Pressure Ventilators mimic the natural means of inhaling. The patient is placed inside a tank that creates a negative pressure that draws the chest outward, thus causing inhalation. The problem with these machines is that they made it so that it was difficult to gain access to the patient. This problem was resolved with positive pressure ventilation.

Positive pressure ventilation essentially involves forcing inhalation by creating a positive pressure. The most primitive, and most basic, form of positive pressure ventilation is mouth to mouth breathing. Another mean is to provide positive pressure by using a mask. A modern name for this is noninvasive positive pressure ventilation, although this term would not be introduced to the medical profession for another 150 years.

By the 1830s, the medical profession was well aware of the importance of breathing. They had some methods of manual resuscitation, although most of these required more than one person to perform, were time consuming, and were exhausting. None could be performed for any length of time.

An added concern of these methods is that they involved moving the patient's arms and legs, risking injury to the body. They also did not guarantee that a patient was receiving an adequate tidal volume. So the need arose for some mechanical apparatus to provide artificial resuscitation.

That said, the need had arisen for a mechanical apparatus to provide, or at least assist, with artificial resuscitation. Ideally it would be something that would eliminate the risk of breaking arms and legs, would provide an adequate tidal volume with a low pressure, and would reduce or eliminate the need for manual power.

1832:  Dalzeil respirator:  In 1832, Scottish physician John Dalzeil described what many refer to as the precursor to negative pressure ventilators that would follow, including the Woillez Iron lung which is described below. (16)  It was essentially the first known example of noninvasive negative pressure ventilation.

It was a box, and he once used it to ventilate a man who was a near drowning victim.  The patient sat up while in the box with his head and arms outside the box.  The box was airtight, and bellows inside caused a negative pressure that caused inspiration.(16)

A window on the outside of the box allowed an observer to see if it was actually causing respirations.  This is often referred to as the first tank respirator, or the first iron lung.  The box had to have been hand powered, and there is no documentation it actually worked.  (16)

1845:  Oxygen breaths  Of course another thing that physicians learned early on was the importance of making sure a patient is getting enough oxygen while artificial breaths were being performed. A man named Erichson invented the first device that provided positive pressure breaths with oxygen through a cannula inserted through a pipe inserted into one of the nostrils.  He recommended ten breaths a minute.

Figure 4

1858:  Bouchut's Intubation Tube:  The noninvasive methods of providing positive pressure ventilation were not effective long term.  The negative pressure ventilators were fine, although they usually consisted of large, bulky tanks that made gaining access to the patient difficult. So another means was needed to provide artificial resuscitation long term. 

So this inspired early experiments with inserting hollow tubes into the airway.  This is considered to be invasive. So, from here on out, anytime a person needs to have a tube inserted into their airway to provide resuscitation, it is referred to as invasive ventilation. 

Earlier physicians tried using a catheter, but this wasn't very effective. In 1858, French physician Eugene Bouchut (1841-1898) became the first to describe insertion of a tube into the airway as opposed to a catheter in a case of dyspnea. The tube he used during seven cases between 1856-1858 (24, page 661-662) was a rounded silver tube narrower at the end to be inserted as you can see in Figure 1, and it was 1.5 to 2 cm long and 7 cm in diameter.

Interestingly, a silk thread was attached to the distal end of the tube that was "brought out to the mouth, and was intended to prevent the tube from going down the trachea or esophagus; and to allow it to be taken out when necessary." 

He later "insisted on the distinction between his method and catheterism." However, of the seven cases he cited to the French Academy of Medicine, only two lived and both required tracheotomy.  Yet he proved the procedure could be done. 

Various other physicians described success with this or similar procedures between 1858 and 1880 when Joseph O'Dwyer (see below) introduced a more effective tube. (see figure 1)(23, page 5)

1867:  Richardson's Double Acting Rubber Bellows:  Benjamin Ward Richardson created a bellow system similar to Hunter's Bellows (although he may not have known of Hunter's Bellows). The original system took up a lot of room, so he invented the double acting bellows, which "consists of two rubber bulbs terminating in common tube that was called the nostril-tube."  One bellow supplied inspiration, the other expiration.  (See figure 4)

1875:  Blake cures poison victim:  Using a device similar to Richardson's Bellows, Blake connected a reservoir of condensed oxygen to it and treated a case of acute poisoning with success.  Before this time artificial respiration (often referred to as insufflation) was used mainly to treat neonatal asphyxia, but now the focus was also on treating adults.  The nozzle of the device was inserted into the nostril.  

1876:  Woillez Iron Lung (Spirophone): While the iron lung wasn't mass produced until the late 1920s, there were some earlier models that acted as prototypes of later designs.  In fact, the design described by Woilliz was quite similar to the Drinker and Shaw and Emerson iron lungs.  The only drawback to Woillez's design was he didn't have access to electricity, so his machine was powered by hand.

At the French Academy of Medicine in Paris in 1876 Woillez described his respirator this way:

"(The apparatus is) a zinc or sheet iron cylinder large enough to receive the body of an adult up to the neck. It is equipped with wheels which permit moving it rapidly to the place where it is necessary. The cylinder set almost horizontal slightly inclined is hermetically closed at the boot end and open at the head end. Through this opening at the head end you slide the body of the patient by means of a sort of stretcher equipped with rollers, on which he is previously placed; then you close the head opening around his neck by means of a diaphragm that you attach to the edges of the opening. The head thus remaining free rests on an appropriate support. A flexible impermeable fabric attached to the cover diaphragm is secured around the neck to avoid as far as possible the passage of exterior air to the inside of the apparatus, at the moment when the vacuum is produced there.

The air thus confined in the apparatus around the body of the patient can be partially rapidly withdrawn by means of a powerful aspirator bellows of about 20 litres capacity actuated by means of a lever. The interior of this pump communicates with the interior of the apparatus through a large tube tightly screwed on." (17)

There were other similar designs, yet none became mass producible mainly due to lack of knowledge of electricity at the time.

O'Dwyer's Intubation Tube for a child 2-3 years old (23)

1880:  The first useful endotracheal tube:  Dr. Joseph O'Dwyer (1841-1898) of New York, and his fellow physicians at the New York Foundling Asylum, observed problems with trachetomy.  He decided another means of breathing for patients was necessary, and he at first trialed flexible catheters into the nasal passages.

Yet this didn't meet his satisfaction so he devised a tube to be placed into the larynx where it would remain.  By trial and error he tinkered with the device until it met his satisfaction.  The device was made with a bivalve tube with a narrow transverse diameter, and about an inch long."

A shoulder on the upper end prevented the tube from slipping down.  By trial and error the tube transformed so the tube was a "plain tube of elliptical form about an inch in length."  He then played with longer tubes until he found the desired length.  The final tube used was made of brass and lined with gold, and was accepted by the medical community.  (See figures 2 and 3.)

A complete set was included in a box, that included sizes for different aged children, an obturator, an introducer, an extractor, and a gag.  The length of the tubes in inches were 1.5, 1 3/4, 2, 2.25 and 2.5.   The obturator of the physicians choice is connected to the end of the introducer, and this is used to insert the tube.  If necessary a small thread could be inserted and tied to a hole on the outer edge of the tube to prevent it from going down the trachea, and to facilitate removal.

The kit also came with a scale (see figure  5) which helped the physician determine appropriate depth of the tube according to age.  The scale is used like this: "The smallest tube reaches line 1, and is intended for children about one year and under. The next reaches line 2, and is for children between one and two years. The third size, marked 34 on the scale, should be used between two and four years. The fourth, marked 5-7, is for the next three years, and the largest tube is for children from eight to twelve."

O'Dwyer also designed larger tubes and equipment for adult intubation. (23, page 9-18)

O'Dwyer's introducer connected to obturator (23, page 16)

1888:  Foot operated Bellows

Dr. George Fell invented a system of bellows whereby the operator would use his hands to provide positive pressure breaths.  He would either use a tracheotomy or face mask.  In 1891 this system was revised by Joseph O'Dwyer of New York so that breaths were provided by pressing down on a lever with your foot.  O'Dwyer preferred to connect his bellow system to an endotracheal tube.  O'Dwyer was concerned about over-distention of the lungs due not allowing enough time for expiration, and therefore recommended giving slow breaths, or 10-12 per minute. (21, page 283)

1891:  Concerns of Intubation:  By the late 19th century many of the same concerns physicians have today about intubation were considered.  One such concern being the ulceration of tissue due to pressure of the tube set upon it for a long period of time.  Tubes were generally taken out after six days with success, although in some cases were left in 12 days or longer. Dr. Rank, a German physician, ultimately recommended removal of the tube after 10 days, and if necessary, the physician should consider tracheotomy.

Some physicians recommended extubation after the 5th day, which would be in line with modern protocols. Feeding the patient was also a concern, and was either done with soft foods or liquids, or by nasalgastric tube.  It was recommended that if the tube was accidentally spit up that the nurse take advantage of the moment to try feeding the patient prior to re-introducing the tube (if the tube was still needed). (23, page 29-20)

1898 Matas's Apparatus for Artificial Respiration:  Around this time the need arose for a means to prevent asphyxia when chloroform was used. There was also the concern of preventing pneumothorax during artificial respiration.  Matas deviced the "experimental automatic respiratory apparatus" as you can see in figure 4.  

This was never put in use on a real patient, and was mainly used to study the effects of pressure during inspiration and expiration.  You can see some of the major components in the picture: MF = O'Dwyer intubating cannula and stopcock for introducing chloroform; M = Mercurial manometer to measure pressure or vacuum; H is the handle to work the pump and forces air into the lungs. The operator placed a finger over a hole in the O'Dwyer intubation cannula, and when he removed his finger expiration occured.  (R = Rubber tubing.)

It was quite a contraption for its time. Experiments were performed on dogs and human cadavers, although it was decided it was not fit for use on humans. (See figure 4) (21, page 284)

Figure 4 (21)

1900:  Cuffed Endotracheal Tubes and laryngoscopes

Right around the turn of the century was when the furst cuffed endotracheal tubes (ETT) started showing up.  This was necessary to prevent air from leaking around the tube so that bigger breaths could be given, and it also worked nice to prevent aspiration around the tube. 

Another problem was how to insert the tube into the ETT into the airway. Blind insertion meant there was a risk of intubating the esophagus, which, if not recognized, resulted in asphyxia and death. 

A laryngoscope is a device that allowed the doctor to open the airway in order to see the vocal cords and glottis. This increased the likelihood of tracheal intubation. 

A larygoscope was first described in 1855 using sunlight to see the vocal cords, and by 1913 a battery powered laryngoscope with an external light was invented.  This was refined so it had a handle with a battery and a light bulb at the end of the scope for easy visualization of the vocal cords.   (18)

Related posts:

• 4000 B.C. - 1800:  Evolution of Artificial Respiration
• 1800-1900:  The Beginning of Pressure Therapy
• 1800-1900:  The Beginning of Pressure Therapy (part II)

References:

1. Szmuk, Peter, eet al, "A brief history of tracheostomy and tracheal intubation, from the Bronze Age to the Space Age," Intensive Care Medicine, 2008, 34, pages 222-228
2. Price, J.L., "The Evolution of Breathing Machines," (this must have been written in the 1950s or early 1960s because the last reference was to IPPB being used as a respirator) (reference to The Bible, Kings, 4: 34)
3. Tan, S.Y, et al, "Medicine in Stamps:  Paracelsus (1493-1541): The man who dared," Singapore Medical Journal,  2003, vol. 44 (1), pages 5-7
4. "Resuscitation and Artificial Respiration," freewebs.com, Scientific Anti-Vivisectionism,  http://www.freewebs.com/scientific_anti_vivisectionism4/resuscitation.htm, accessed March 1, 2012
5. Price, op cit
6. Lee, W.L., A.S. Stutsky, "Ventilator-induced lung injury and recommendations for mechanical ventilation of patients with ARDS," Semin. Respit. Critical Care Medicine, 2001, June, 22, 3, pages 269-280
7. Price, J.L., "The Evolution of Breathing Machines,"  (see also reference #1 and #3 above)
8. Szmuk, op cit, page 225
9. Price, op cit
10. "Resuscitation and Artificial Respiration," freewebs.com, Scientific Anti-Vivisectionism,  http://www.freewebs.com/scientific_anti_vivisectionism4/resuscitation.htm, accessed March 1, 2012 (see also reference 1 above)
11. Lee, op cit
12. Price, op cit
13. Price, op cit
14. Szmuk, op cit, page 225
15. Price, op cit
16. Woollam, C.H.M., "The development of apparatus for intermittent positive pressure respiration," Anaesthesia, 1976, volume 31, pages 537-147
17. Previtera, Joseph, "Negative Pressure Ventilation: Operating Procedure (Iron Lung)," Tufts Medical Center, Respirator Care Programs, http://160.109.101.132/respcare/npv.htm, and http://160.109.101.132/respcare/ironlung.htm, accessed February 27, 2012
18. Szmuk, op cit, page 226-7
19. Fourgeaud, V.J, "Medicine Among the Arabs," (Historical Sketches), Pacific medical and surgical journal, Vol. VII, ed. V.J. Fourgeaud and J.F. Morse, 1864, San Fransisco, Thompson & Company,  pages 193-203  (referenced to page 198-9)
20. "Biographical Dictionary of the society for the diffusion of useful knowledge," Longman, Brown, Green and Longmans, volume III, 1843, A. Spottingwood, London, page 124-5
21. Tissler, Paul Louis Alexandre, "Pneumotherapy: Including Aerotherapy and inhalation...," 1903, Philadelphia, Blakiston's sons and Company, page 284,5
22. Hasan, Ashfaq, "Understanding Mechanical Ventilation: A practical Handbook," 2010, New York, Springer
23. Ball, James B, "Intubation of the Larynx," 1891, London, H.K. Lewis
24. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, 3rd edition, Philadelphia and London, W.B. Saunders Company
25. Banser, Robert C., Sairam Parthasarathy, editors, Nocturnal Noninvasive Ventilation, Theory, Evidence, and Clinical Practice," 2015, Springer, New York, chapter 2, "Negative Pressure Noninvasive Ventilation (NPNIV): History, Rational, and Application," by Norma M.T. Braun