The Treatment of Hay Fever by rosin-weed, ichthyol and faradic electricity / With a discussion of the old theory of gout and the new theory of anaphylaxis

by George Frederick Laidlaw

CHAPTER VIII
HAY FEVER AS GOUT

In the last chapter we read that the theory of a gouty diathesis as the constitutional basis for hay fever originated with Dr. Gueneau de Mussy, in 1868, on account of the many resemblances that he found between the symptoms of gout and the symptoms of hay fever. We have now to consider the fate of the de Mussy doctrine in those countries where hay fever is best known and has been most closely studied, Great Britain and America, Germany and France.

De Mussy in Great Britain and America. If any specialist on the nose and throat in England or America ever heard of de Mussy and his theory that hay fever is rooted in a gouty diathesis, he is keeping the secret well, for it does not appear in any of the books that he writes; but in every book I find the disease attributed to the neurotic constitution first suggested by Beard. In this statement I do not include several references to "uric acid poisoning" which is not the same thing as gout, as will be explained in Chapter IX, on the Uric Acid Theory.

After reading de Mussy's argument for the dependence of hay fever on a gouty diathesis, I turned first to the English books. For centuries, England has been famous as the home of gout and, since the Englishman, Bostock's, account of his own case, hay fever, too, like parliamentary government and gout, has been recognized as an inheritance of the Anglo-Saxon race. As British physicians see more gout than any other physicians in the world and as, for many years, they have had the best opportunities for the study of hay fever, I turned first to the English books, thinking that if there was any truth in the gouty theory, the British physicians would have found it out long ago. To my surprise I searched book after book by both British and American authors, but in not one instance did I find hay fever associated with gout. These books included Allbutt's System of Medicine, F. T. Robert's Practice, Lennox Browne, Morell Mackenzie in England and, in this country, Ballenger, Bosworth, Coakley, Kyle, Solis-Cohen, Ivins and Vehslage and Hallett.

No one is more saturated with the traditions of British medicine than Sir William Osler, but, in his Practice of Medicine, in discussing the constitutional causes of hay fever, he seems to know nothing of the gouty theory.

Besides the article on hay fever in his Diseases of the Nose and Throat, Sir Morell Mackenzie wrote a comprehensive work on Hay Fever and Paroxysmal Sneezing that ran through five editions and bears on the flyleaf the admiring comment of the London Lancet that it "must be regarded as one of the most complete expositions of our knowledge of this curious complaint in our language." It is a wicked joy to catch such a scholarly writer as Mackenzie napping. In a footnote he even refers to the de Mussy lecture in the Gazette hebdomadaire, Jan. 5, 1872, as calling the disease spasmodic rhinobronchitis, with which name the disease is still known in France. One suspects that the learned Doctor was very busy that day and that the footnotes were looked up by somebody else; for, though he gives "the most complete exposition in our language," as the Lancet puts it, of the constitutional causes underlying hay fever, there is never a word of de Mussy's theory of gout.

In Osler and McCrae's Modern Medicine the article on Hay Fever is written by Professor Dunbar, of Hamburg, deviser of pollantin. Here at last we get away from British insularity, for, in spite of his Scotch name, Dunbar is a German. On page 863 he writes:

"For a long time it has been believed that the predisposition to hay fever rests on a gouty diathesis. This view is not on the face of it inconsistent with the pollen theory. Inquiries, however, have shown that gouty persons form only a small portion of hay fever patients."

Finally, in the great Edinburgh Encyclopædia Medica, 1900, Volume 4, Greville MacDonald, of London, in the article on Hay Fever, seems to know nothing of the gouty theory and says innocently at the end of the article, "No special dietary is indicated, seeing that these patients present no tendency to lithæmia, etc." He makes the extraordinary suggestion that, in relieving the attack of hay fever, "rather than give the patient cocaine, it might be wise to allow the opium pipe." In the early prescriptions for hay fever, opium sprays and nasal douches were common enough, but this is the only time I ever heard a reputable physician and a teacher, at that, advising a patient to "hit the pipe."