CHAPTER X
HAY FEVER AS ANAPHYLAXIS THE GOUTY DIATHESIS REAPPEARS
Fifty years ago de Mussy pointed to the resemblance between hay fever and gout and claimed hay fever as a manifestation of the gouty diathesis. As related in Chapter VII, he based his theory on the resemblance between the history and symptoms of hay fever patients with those of gouty patients. In his day he found both hay fever and gout confined to the Anglo-Saxon race, both hereditary and familial, both exhibiting urticaria, eczema, and asthma, and he recognized that the lesion in the eyes and nose of the hay fever patient was not a true catarrh but an urticaria.
On the other hand, Wolff-Eisner declared that hay fever is an anaphylaxis and this idea has been developed and confirmed by Koessler and others so fully that we must accept it as proven. Let us examine this matter of anaphylaxis to determine whether after all there is any essential difference between the two views of hay fever.
Anaphylaxis. The conception anaphylaxis or lack of protection begins with the discovery that a harmless protein injected into a dog will so sensitize him that, after ten days or so, another injection of the same protein will kill him. The point is that the change has occurred in the animal, not in the protein injected. The protein is the same as before and can be injected once into any number of dogs without harm. In this way we explain the cases in which drugs and foods that are harmless to most people may be virulent poisons to those who happen to have been sensitized by a former overdose. The widespread use of antitoxin in diphtheria gave abundant opportunity to study the phenomena of sensitizing a human being with one dose and killing him with another dose of the same thing.
The symptoms of anaphylaxis first observed were urticaria, arthritis, and dyspnœa. Then Bruck showed that what we used to call idiosyncrasy to drugs and foods that are harmless to most people is really an anaphylaxis, attributable to a former overdose of the same thing. Next, it was learned that anaphylaxis may persist through life and be transmitted to the offspring of rabbits and guinea-pigs, illustrating the cases in human families where sensitiveness to a certain food or drug runs down through several generations. Then the dermatologist brought in a list of skin eruptions, urticaria in the lead, as examples of anaphylaxis to certain foods or to poisons generated within the body, especially in the intestines. Then asthma was included among the anaphylactic reactions and, finally, Wolff-Eisner pointed out that the lesion of hay fever is an anaphylaxis. I may add here that this view of hay fever confirms my observation that the lesion is not a catarrhal inflammation but an urticaria.
So we have a picture of anaphylaxis as a sensitiveness to bacterial poisons or to foods or drugs that are harmless to most people expressing itself as an urticaria, an arthritis, an asthma or hay fever. But this is the very group of symptoms on which de Mussy based his theory of gout. When we add that this sensitiveness or anaphylaxis is hereditary and that it is aggravated by foods, drugs, or pollens that are harmless to most people, I submit that we have a pretty picture of the gouty diathesis; for the gouty diathesis, too, is a susceptibility to arthritis, to urticaria, and to asthma from causes that do not trouble other people, and in gout, too, this weakness is hereditary. One thinks of the gouty patient who cannot take iron or digitalis because it aggravates the gouty pain and of the attack of gout that is brought on by a glass of champagne or a piece of beef or a few strawberries that the majority of mankind can take freely without harm. Now, if urticaria, eczema, arthritis, asthma and hay fever form a picture of anaphylaxis, and if these symptoms also form the picture of the gouty diathesis, is it not probable that one of these pictures can be explained in the terms of the other? If the anaphylaxis to the diphtheria antitoxin, horse serum, can develop arthritis, is it not probable that the most striking feature of gout, the inflammation of the joint, is also an anaphylaxis to poisons yet unknown to us but the same poisons that make the gouty urticaria and asthma?
What if gout should prove to be a sensitization or anaphylaxis to uric acid that does not exist in the non-gouty? This would explain the puzzle of one patient full of gouty pains with very little uric acid in his blood while another patient, like the leukæmic, has a blood full of uric acid that does not trouble him.
The Mechanism of Anaphylaxis in Hay Fever. The anaphylaxis theory of hay fever is based on the observation that the epithelial cells of the mucous membranes of the eyes, nose, and throat have not lost their primitive power of digesting foreign protein.
Ages ago, when we were amœbæ or little drops of protoplasm, we had no eyes or nose or separate stomach for digesting food. The one little cell body did everything. One of the most important powers of that cell body was its power of digesting and assimilating food, and its most important food was the nitrogenous food or protein from which it built up its own body substance. Now, foreign or food protein cannot be simply absorbed as such. Foreign protein is a poison and never tolerated in the blood. The foreign protein used as food must first be changed into the special kind of protein that the body can use. The foreign protein is changed by splitting its molecule into its simplest parts and then recombining them in the desired form. The complex protein molecule, containing those sixty atoms of carbon that gave the Schrecklichkeit to the German professor of chemistry as related on page 71, is split up again and again into simpler forms. The end products are harmless, but the early splittings produce both poisonous and non-poisonous products. The end-results of these successive splittings, the splinters, as it were, are then combined by the amœba to form its own kind of protein or body substance.