812 
NATURE 
[JUNE 16, 1923 
Hay Fever. 
| lead fever is a catarrhal affection mainly of the 
upper respiratory passages, which occurs only 
in certain individuals and is due to the poisonous 
action of the pollen of certain plants which they 
have inhaled. Our knowledge of the disease may be 
divided into three periods, viz. clinical, experimental, 
and therapeutic. The clinical period was inaugurated 
by John Bostock, the physiologist, in 1819. He gave 
an admirable account of the symptoms as they occurred 
in himself every summer over a period of thirty-eight 
years. Other accounts, complete and incomplete, 
gradually accumulated, and these were analysed with 
great discrimination and acumen by Phoebus of 
Giessen, who published his work “‘ Der typische Frith- 
sommer-Katarrh ” in 1862. Nothing has been added 
to the pure clinical history of the disease since this 
time. The second period is typified by the masterly 
scientific research of Dr. Charles H. Blackley, of Man- 
chester, who was also a sufferer from the disease. In 
his work “ Experimental Researches on the Causes 
and Nature of Catarrhus aetivus,”’ 1873, he established, 
by ingenious methods, the fact that hay fever is caused 
by the inhalation of pollen. To this period belong 
also the works of W. P. Dunbar, of Hamburg. He 
also was a hay-fever sufferer. Going beyond Blackley, 
he proved that it is only the protein of the pollen that 
is the toxic agent. The third period, in which fall 
attempts to prevent or cure the disease by specific 
means, is associated particularly with the names of 
Noon and Freeman in England and Dunbar in 
Germany. 
It was in 1819 that the disease was made known 
by Bostock, who described the symptoms from which 
he suffered every June and July almost all his life. 
These symptoms were, a sensation of heat in the eyes 
with itching and smarting. After about a week, 
violent sneezing occurred, with a feeling of tightness 
in the chest, difficulty of breathing, languor, and loss 
of appetite. Towards the end of July, all this dis- 
comfort spontaneously disappeared. It is remarkable 
that medical history contains only one or two trivial 
and doubtful references to such a condition before 
the appearance of Bostock’s paper in 1819. In 1828 he 
made a second communication and included statements 
of twenty-eight cases like his own. All developed the 
disease at the same time of the year—the summer, and 
nothing special could be ascertained as to its cause 
from the age, sex, constitution, or mode of life of the 
sufferers, who were mostly males. 
In this second paper Bostock referred, however. to the 
idea, apparently prevalent even at that time, that the 
morbid state was engendered by effluvia from new- 
mown hay, but he was not of this opinion from 
observations on himself, both at Ramsgate, where 
there was no hay, and at Kew, where there was much. 
He considered that the main factors which led to an 
outbreak were dazzling sunlight and excessive summer 
heat. Even in 1828, however, MacCulloch refers to 
the “term hay-fever lately become fashionable” ; and 
William Gordon, writing in 1829 on the “nature, 
cause, and treatment of hay asthma,” said that there 
could be no doubt that it was due to the aroma emitted 
from the flowers of grass, particularly from those of 
Anthoxanthum odoratum or sweet-scented vernal grass. 
NO. 2798, VOL. III] 

He based this view on the grounds that (x) the plant 
is one of the most strong scented of the grasses; (2) 
because as soon as it begins to flower, and not until 
then, the asthma begins ; 
arrive at perfection the disease increases ; and lastly, 
because after the flowers have died away previous 
sufferers can pass through the most luxurious meadows 
with impunity. 
After the accounts of Bostock and Gordon, cases 
began to be published, and all the authors were of 
opinion that the disease occurred in certain persons 
who were presumed to have a predisposition to it, and 
it was early recognised, especially by Elliotson (1833), 
that inheritance plays a part in the idiosyncrasy, a 
belief that all later observation has confirmed. Of 
59 histories analysed by Phoebus, 23 occurred alone 
in their respective families, whereas 36 were associated 
with one or more other families. The whole of the latter 
occurred in 13 families, being distributed as follows : 
in 8 families 2 affected (brothers and (or) sisters) ; 
in 5 cases father and child. In 2 families 3 members 
were affected ; in 1 family 4 members, and 2 families 
5 members. In one of the latter, a man, his daughter, 
and three sons suffered, while a fourth son was made 
asthmatic by the smell of guinea-pigs. The disease 
was known to be commonest among the better classes, 
and many of those who have written on the subject 
were themselves attacked. Among these may be 
mentioned Bostock, Blackley, Gream, Kirkman, Fleury, 
Helmholtz (the physicist), Dunbar (the bacteriologist), 
and Verworn (the physiologist). Among 150 cases 
collected by Phoebus too were male and 50 female. 
Although it was early suggested that the origin 
of the symptoms was referable to vernal grass in 
flower, there were authors whose experience did not 
permit of such an exact diagnosis. Some thought 
that grasses were all equally detrimental, others 
that only aromatic grasses were the agents, and 
particularly Anthoxanthum odoratum. Others again 
blamed rye-grass, hay as such, roses, trees in bloom, 
dust, sunlight, heat, and even bacteria. The last was 
the view of Helmholtz. Even where grasses were 
incriminated it was believed that the actual cause 
was some aromatic effluyium wafted from the plant. 
Some believed that the chief agent was coumarin. 
Kirkman (1852) seems to have been the first who 
tested upon himself the effect of pollen. At Christmas 
he noticed in his hot-house a single plant of Antho- 
xanthum odoratum in blossom and laden with pollen. 
He plucked it, rubbed the pollen with his hand 
and sniffed it up. Almost immediately sneezing 
and all the symptoms of an attack of hay fever 
followed. 
It was, however, Charles Blackley who, in a series 
| of experiments well conceived and admirably carried 
out over a long series of years, definitely established 
the pollen etiolog gy of the disease. Having obtained 
negative results ‘with benzoic acid, coumarin, odori- 
ferous substances, ozone, dust, light, and heat , heapplied 
himself to the subject of pollen, not of grasses only 
but from plants belonging to no less than thirty-five 
other naturalorders. The experiments were made at all 
times of the year, the pollen being applied to himself 
or other patients by way of the nostrils, tongue or 
(3) because as the flowers. 
