urticaria or angioneurotic œdema. And a hive (or urticaria or angioneurotic œdema) is not an inflammation. It is a vascular spasm, a spasm of the minute vessels that drain small areas of skin, causing a local stoppage of the circulation in that small area, a turgescence or exudate, the hive. Just as suddenly as it began, the spasm of the vessels may relax, the swollen area is drained rapidly, and the hive disappears, leaving a faint redness. This is exactly the case with hay fever. It is an urticaria, a vascular spasm. The sudden onset in response to a specific irritant and the sudden disappearance—this is no catarrhal inflammation and no rhinitis or inflammation of any kind.

Those cases of hives that appear quickly after chilling the skin are perfect analogues of hay fever, appearing in response to the local irritation of odors and dust. There are cases of hay fever that resemble ordinary hives in being aggravated by certain foods, especially strawberries, acid foods, and malt liquors. This has a practical bearing on treatment; for, in such cases, simply excluding these foods from the diet and the administration of an alkali gives relief. Again, many hay fever subjects suffer from urticaria, as in the case reported to me by Dr. Rice of Hawaii, in which the attacks of hay fever alternated with urticaria.

Sir Morell Mackenzie was wrong when he said that hay fever "had no pathology because it leaves no permanent structural lesion behind it." Hay fever "has a pathology" if urticaria has a pathology, for urticaria, too, subsides and leaves no traces. However, in this statement, we recognize the effort to state the difference between the evanescent lesions of hay fever and the more persistent lesions of catarrhal inflammation; which is just the difference between an urticaria that comes and goes in half an hour and an eczema (catarrhal dermatitis) that takes several days to develop and is attended by a real inflammatory exudate that requires many days for its absorption.

In our text-books, our ablest specialists perpetuate this error by devising such names as hyperæsthetic catarrh, hyperæsthetic rhinitis, vaso-motor rhinitis—and then describing a neurosis. The two ideas will not mix. The very authors who introduce these names feel that there is something wrong with them, for usually they take several pages to explain what the name means. It is better to throw overboard both the name and the idea of catarrhal inflammation or rhinitis and start afresh.

Recent workers with pollens come near the truth in describing hay fever as an anaphylaxis. Right here my conception of the lesion of hay fever as an urticaria fits into the picture and brings us one step nearer to an understanding of the disease; for where is there a prettier example of anaphylaxis than those very hives with which long ago I compared the lesion of hay fever?

Since Bostock first described hay fever in 1816, hundreds of physicians have looked at thousands of patients, but, as far as I can discover, there was just one observer besides the modest author of this book who recognized the urticarial nature of the lesion of hay fever. This was Dr. Gueneau de Mussy, to whom we will devote the next chapter.

The Cause Behind the Lesion. All clinicians agree that there are two elements in the hay fever problem,—first, the irritant; and secondly, the abnormal sensitiveness of the patient. All are fairly well agreed as to the irritants, pollen and dust; but what makes the patient sensitive? This is still the dark side of the subject. Among the many theories, two seem to deserve further study and will be considered in the chapters on Hay Fever as Gout and Hay Fever as Anaphylaxis.

CHAPTER VII

DR. GUENEAU DE MUSSY HAY FEVER AS URTICARIA AGAIN

In searching through the early literature of rosin-weed, as related in Chapter XIV I noted that the article in the Eclectic Medical Review recommending rosin-weed for asthma seemed to have been copied only in the southern and western medical journals. I was curious to know if the aristocratic medical editors of the east, the intimates of Bigelow and Holmes and Warren, had deigned to notice a drug of such lowly parentage, discovered by the Indians and indorsed by the medical heretics. I began with the stately row of bound volumes of the Boston Medical and Surgical Journal, running back to 1860, that repose on a dusty back shelf of the Library of the New York Academy of Medicine. Looking through the volumes around 1868, when the use of rosin-weed in asthma was being quoted in the south and west, I found many quaint notes and comments, but no mention of rosin-weed. To any physician who has a taste for the history of his art, I would recommend reading a journal of fifty years ago. So many things have been settled that those old physicians puzzled and fought over that it gives one the sense of amusement or lofty detachment of the gods, looking down on struggling, wriggling humanity, yet knowing all the time how it would come out.

In those old books I noticed abundant quips and sneers at homœopathy, now happily taboo in the more courteous journalism of to-day. Besides, they are not so funny now. The doctrine of like-cures-like and the small dose has achieved respectability. When armies all over the world are depending on a minute dose of typhoid poison to prevent and cure typhoid fever, when articles appear in the most respectable medical journals advocating doses of tuberculin so small that they have never been calculated and one-tenth grain doses of calomel instead of the twenty-grain doses of our grandfathers, most of the merry jests have lost their flavor to-day. Rather as I expected, in the Boston Journal, I found no notice of the eclectic rosin-weed, but I found something better, a clinical lecture on hay fever by a man after my own heart, who, away back in 1868, had recognized the urticarial nature of the lesion in hay fever. This was a Clinical Lecture on Spasmodic Coryza or Periodical Asthma, delivered at the Hôtel Dieu, by Professor Gueneau de Mussy, translated from the Gazette des Hôpitaux by W. F. Munroe, M.D. The lecture runs through several numbers of the Journal, beginning in March, 1869, page 125. It should be read by every rhinologist and by every physician who is treating hay fever.

When the chemist Woehler, one afternoon in 1828, tried to make up some ammonium cyanate by mixing ammonium sulphate and potassium sulphate and found that he had synthesized urea, one of his colleagues said that he was like Saul, who went out to find his father's asses and found a kingdom. I felt the same way; only, in my case, I went out among the asses and found a king.

When Solomon made his despondent remark that there was nothing new under the sun and that of the making of books there is no end, he must have been in his library sorting out his collection of old Assyrian bricks and found that his favorite thoughts had been said already and said better by some old Hittite scribe a thousand years before. So I, who had fondly thought myself the discoverer of the urticarial nature of hay fever because I had searched the books of the specialists and found nothing about it, was surprised to find my observation anticipated by the Frenchman.

Salut! Hail to you across the years, Gueneau de Mussy, kindred spirit. It is not recorded that the gray-headed Dean of a great university ever stood you on a platform and hurled Latin adjectives at you; but in 1868 you had the sharpest eyes and clearest mind of any of them,