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."

I think that, from the evidence examined, we may say that British and American authors know nothing of de Mussy and his theory.

Next, I looked up the gout authorities, Ewart, Ebstein, Garrod, Falkenstein, Lancereaux, Lecorche, each of whom wrote a bulky treatise on Gout, but there is never a word on Hay Fever.

De Mussy in Germany. For many years, whenever I have wanted to know anything from the bottom up, historically, linguistically, philosophically, I have turned to a German book and have always found what I was looking for, if it is known to man. Where an American or British author will skim over or touch a subject carelessly, not seeming to care where the idea comes from or its relation to other ideas in different times or countries, a German will plow steadily through the matter from Hammurabi to Wilhelm III and lay bare all the collateral tributaries and branches, always with an index at the end.

First I tried Heymann's Handbuch der Laryngologie und Rhinologie (Wien, 1900) and found hay fever described in the article on Die Nasalen Reflexneurosen, by Professor Jurasz in Heidelberg; but there was no mention of gout. By this, I was truly convinced that nothing was known on the subject. If a Heidelberg Herr Professor does not know it, it does not exist. And "Professor Jurasz in Heidelberg" had failed me.

However, looking further in Heymann, my faith in German thoroughness and all-inclusiveness revived. Hay fever appears also in the article on Acute Rhinitis, by P. H. Gerber, of Königsberg, and here, on page 371, we find a complete "Literatur" spread out in true Teutonic style from Bostock to date. However, Gerber does not discuss the matter of gout in the text, but says merely, "Recently Bishop asserts that the nervous disturbances of hay fever are due to an excess of uric acid in the blood."

The gouty theory of hay fever receives scanty recognition from most German writers. Strümpell does not mention it. In his Handbuch der Specielle Pathologie und Therapie, Berlin and Wien, 1904, Eichorst says skeptically, page 326, "It has been stated often that gouty families are especially apt to develop hay fever," and on page 330 "Grote saw hay fever patients of gouty families cured (?) by a course of waters at Neuenahr."

In Eulenberg's Real-Encyclopædie der gesammten Heilkunde, 1887, page 509, article Hay Fever, we read:

"Of general diseases, malaria and gout have been advanced as the basis of hay fever, but without convincing proof."

We may conclude, then, that while British and American physicians know nothing about the gout theory, German physicians know about it but do not believe it.

Finally, in my wanderings through German encyclopædias, I came to the many-volumed Nothnagel and here, at last, found a modern writer who knew de Mussy and recognized the importance of his observations. At the end of Volume 4 there is a monograph on Hay Fever by Dr. George Sticker, of the University of Giessen, the most thorough and satisfactory book on the subject that I have found. It may be read in English in the American edition of Nothnagel, Philadelphia, 1902. Sticker resists the impulse to begin with Galen, though he notes rather wistfully that John Mackenzie of Baltimore succumbs to it. He gives the most complete statement in any modern book of the gout theory of hay fever, but, alas, Sticker misses the pearl in the oyster. He says nothing of de Mussy's recognition of the urticarial nature of the lesion in hay fever.

As this volume of Nothnagel may not be easily available to the gentle reader, I copy a paragraph from Sticker for his or her benefit.

Nothnagel's Specielle Pathologie und Therapie, Band 4, 1896. Article Bostock's Catarrh, by Dr. George Sticker, page 118. "In the last few years convincing proofs are accumulating that there is a certain constitutional disorder on which the individual tendency to hay fever depends. Though further careful proof is desirable, it can scarcely be doubted that the pathogenesis of hay fever is based on that constitution that the English and French describe as arthritic, which expresses itself in a hereditary or family tendency to rheumatism, gout, diabetes, obesity, migraine, furunculosis, bronchitis, asthma, etc. Bostock himself mentioned his gouty tendency. Phœbus found it in many patients. But it was Gueneau de Mussy who first recognized the prevalence and necessary basis of the disease in the arthritism of the hay fever patient; and his teaching has been accepted and enriched with new material by Herbert, Leflaive, Lermoyez, Ruault, de Dreyfus-Brissac, Rendu, Molinie.... And so it is probably no coincidence that, like gout, the morbus principum of Sydenham, so also the aristocratic hay fever is a prerogative of the Anglo-Saxon race."

Reading this praise of Englishmen and Frenchmen by a German makes one sad to-day. Hasten the day when the old hearty comradeship in science will return, the day when German and Frenchman and Englishman will again praise one another's achievements ungrudgingly and each learn eagerly as of old what the other had to teach.

De Mussy in France. As might be expected, among French rhinologists and writers on general medicine, de Mussy's teaching is well known and has many advocates. Note that the writers mentioned by Stickerare all Frenchmen. The usual view is well expressed by André Castex in his Maladies du Larynx, du Nez et des Oreilles. Paris, 1907, page 425.

"Hay fever attacks especially those who belong to an arthritic stock, whose parents have had or who themselves have migraine, gravel, eczema. This explains its frequency in England and America; for the Anglo-Saxon race is especially subject to arthritic disorders. In France it exists but is infrequent. In this way also we must explain why hay fever is rare among the laboring classes who frequent the hospitals and is observed almost exclusively among wealthy patients, people of sedentary habits and sluggish digestion (nutrition ralentie)."

In Brouardel and Gilbert's Traité de Médicine et de Thérapeutique, Volume 27, page 66, another André, André Cartaz, expresses mild skepticism as to the proof offered.

"The presence of an arthritic diathesis is accepted by many authors. Leflaive thinks it the sole predisposing cause, especially gout. During the attack he has demonstrated, as I would say, and that is proof for him, an appreciable decrease in the quantity of urine and percentage of urea, an increase in uric acid and, in one case, the presence of indican."

Lermoyez also advises caution in accepting the gouty theory to the neglect of known remedies for the disease. I abstract his sensible remarks from his Thérapeutique des Maladies des Fosses Nasales, Paris, 1896. Article Rhinites spasmodiques, rhume des foins, page 300.

"It would be a mistake to hold with the German school that the nasal lesions were the only cause of hay fever; for these lesions are completely absent in many true cases of the disease and, on the other hand, many people affected with hypertrophic rhinitis breathe air full of pollen without showing symptoms of hay fever. There is certainly a