Monday, February 27, 2017

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
  • QuinineIt'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

No comments:

Post a Comment