Friday, February 24, 2017

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.

  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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