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."

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. Phoebus 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_,