Evils Of Philosophizing In Medicine
( Originally Published 1943 )
Dr. Elliotson was not alone in his lack of imagination. For the next thirty years the interested doctors satisfied themselves with philosophy and theories, never venturing the slightest attempt at experimentation. A Dr. Laforgue was the first to introduce the idea of neuroticism in hay fever. Dr. Abbots Smith wrote a book that went through four editions from 1860 to 1866. Heat and grass emanations were his pet theories about the cause of hay fever. Helmholtz, the great physicist was himself afflicted with hay fever. He found infusoria in the membranes of his nose. He treated himself with quinine and told a fellow experimenter about it. The germ theory flourished and retarded progress for a few years until it was disproven. The quinine therapy was also shown to be useless.
Dr. Philip Phoebus of Germany made the first academic investigation of hay fever. He sent out circulars containing pertinent questions about geographical distribution, influence of sex, effect of social position, family tendencies, and time of occurrence, as they were related to hay fever. After all this he concludes that hay fever is due to the first heat of summer. Phoebus tells of a Dr. Kirkman who sniffed the pollen of sweet scented vernal grass growing in his hot house during December. As a result he showed all of the symptoms of hay fever for a full hour. Unfortunately that's all we hear about the inquisitive Dr. Kirkman. Philosophy was the order of the day rather than experimentation. The result was an array of theories emphasizing the first summer heat, sunlight, neuroticism, smells, ozone, germs, and dust.
DR. MORRILL WYMAN IN AMERICA
In 1872 we approach hay fever in America with no greater certainty about the cause than existed in Europe when it was first described. At this time there appeared what must be considered by comparison with the European hodge-podge an excellent treatise. Dr. Morrill Wyman a professor of Medicine at Harvard University published his book on autumnal catarrh. His interest centered on the late summer or ragweed type of hay fever. This was only natural; his father, two brothers, a sister, son and grandson suffered with ragweed hay fever.
Dr. Wyman very early confirmed Dr. Swetts observation of 1852 that in America there existed two distinct forms of hay fever. The early summer grass variety and the fall or ragweed type of hay fever.
Besides calling attention to ragweed, Dr. Wyman made his contribution to hay fever by publicizing the White Mountains and other localities that members of the United States Hay Fever Association had indicated as favorable hay fever resorts. As might be expected from the Wyman family history, he made observation of the hereditary nature of the disease. But then, so did Dr. Elliotson's lady of information.
In an attempt to assure himself of the primary cause of hay fever Dr. Wyman did a little experimenting. He took from his home in Cambridge some pollinating rag-weed, which he wrapped securely and carried to the White Mountains where he was free of his symptoms. After a few days of such freedom he unwrapped the ragweed and he and his son sniffed the plant. Both of them developed an attack of hay fever. Dr. Wyman's brother who was also sensitive did not sniff the ragweed and experienced no symptoms. The plant was then sent to some other sufferers similarly vacationing at another resort in the 'White Mountains. At the other resort seven who sniffed the plant suffered hay fever symptoms while eight who also had hay fever did not sniff it and suffered no symptoms.
Convincing results? Yes; for the average man but not for Dr. Wyman. He next took a flowering specimen of ragweed and preserved it in its dried condition in a bottle. In February of the following year at his home in Cambridge he sniffed the preserved ragweed plant, and as luck would have it, he obtained no reaction. We know now that this failure was due to the fact that the specimen contained no pollen for one reason or another. Ragweed containing pollen is capable of producing symptoms in a sensitive person at any time of the year in any locality.
After citing the above experiment and commenting that the ragweed plant may have different properties in dif ferent regions Dr. Wyman concluded that "with our present knowledge Roman wormwood (ragweed) can be regarded as only a very active and general cause of paroxysms but not a cause of the whole disease."
Because of this conclusion many writers have failed to fully appreciate Dr. Wyman's work. It is our opinion that he deserves a great deal more credit than has been granted him heretofore. Wyman investigated the disease by the medically approved case study method. His study was so thorough and far reaching that he uncovered many cases of allergic coryza or vasomotor rhinitis which even to this day are classed by some as hay fever. In his observations he cites proven instances of hay fever-like symptoms resulting from inhaling dust and smoke; eating peaches, plums, melons, chestnuts, English walnuts and buckwheat cakes; the fragrance of flowers; smelling fruits; and the presence of pollinating corn.
Some of these reactions noted by Wyman sixty-five years ago are considered novel enough by present day doctors to report them in the literature.
So we see that mixed in with Wyman's ragweed cases were those of inhalant allergy to dust First confirmed experimentally by Dr. Robert A. Cooke in 1918. Wyman recognized reactions to the odors of fruits—Only recently affirmed by controlled experiments. Wyman correctly observed cases of sensitivity to foods that appear only during the hay fever season-Experimentally indicated within the last two decades.
Thus by finding cases of inhalant allergy to dust, smoke, foods and plants, Dr. Wyman could not by any stretch of his imagination consider ragweed as the sole cause of hay fever. In the face of this evidence we can only applaud the scientific conservatism that led Dr. Wyman to conclude that ragweed was "not a cause of the whole disease." It is lamentable of course that he did not undertake an experimental program such as was accomplished by his contemporary in England, Dr. Charles Harrison Blackley.
CHARLES HARRISON BLACKLEY
To Dr. Charles Harrison Blackley goes the credit for proving conclusively that the pollens of plants were responsible for the cause of hay fever.
No idle dreamer or philosopher was Blackley. Experimentation, trial, and retrial, these were his watchwords.
The character of the man was such that no lengths were considered too great for the purpose of testing out a theory or problem. He experimented for fourteen years before he published a word of his illuminating results. Himself a hay fever sufferer, he made no effort to cure his ailment for fear that he would lose his most reliable guinea pig. Unable to obtain volunteers on whom to experiment he had to use himself as subject number one. His own case of hay fever remained severe throughout his lifetime. On many occasions he deliberately aggravated his symptoms by exposure to substances he knew to be irritating.
Walking on a road one day a cloud of dust raised by a passing carriage resulted in stimulating in him a violent attack of sneezing. To check an the dust effect he returned to the same place the following day and stirred up the dust bringing on another attack. Then in his characteristically thorough manner he took samples of the dust home and examined them under the microscope. In the dust particles he found grass pollens and satisfied himself on that score.
The extent of Blackley's experimentation in hay fever has been unsurpassed to this day. He left hardly any phase of the subject untouched. His method of approach was systematic and business-like. He first reviewed the theories of cause held by other writers. With experimental dispatch he disposed of such theoretic fancies as benzoic acid, coumarin (odoriferous substance in grass), ozone, light, and heat, all of which were postulated by others as causes of hay fever.
Testing out volatile odors of plants and flowers he obtained reactions from some of them. He even inhaled mold spores which he reported as giving him severe symptoms. The importance of mold or fungi spores was not brought up again in allergy until fifty years later. At present it is recognized as an important cause or complication of hay fever cases.
In the matter of pollen research, the length and breadth of his imagination is almost inconceivable. To illustrate the thoroughness of his methods we list here the first pollen problems as Blackley posed them for himself.
1. Can pollen produce the symptoms of hay fever?
2. Does this property belong to the pollens of all plants?
3. To which species of plants do the responsible pollens belong, if any?
4. Are dry pollens as irritating as fresh pollens?
5. To what particular substance in pollen is the irritating effect due?
To test whether pollen can produce the hay fever symptoms he applied samples of pollen grains to the mucous membranes of his nose, eyes, tongue, lips and throat. He inhaled the pollens through his nose and mouth. He innoculated his arms and legs with fresh moistened pollen.
Try to imagine, if you will, the resolute nature that induced Dr. Blackley to tender his life and limb in an effort to obtain the answers to his questions. Abrading his arms and applying pollens caused tumors two to three inches in length and three quarters of an inch high, by his own measurements. These inflictions he repeated upon his legs and arms time and time again with the same huge swellings. Thus Blackley introduced what is currently the most frequently used method for diagnosing pollen hay fever.
In answer to his five questions he proved that: pollen can cause hay fever; only some pollens cause hay fever; in England the grass pollen seems to be responsible; and dried pollen as well as fresh pollen are both potent. The last question, on the chemical substance in pollen that is responsible for the effects, he could not answer. This question has not yet been satisfactorily answered despite the efforts of modern chemists, biologists and biochemists.
Blackley did not stop here. He went on to study pollens in the atmosphere. After prolonged experimentation he invented many ingenious devices for collecting and studying pollen concentrations from day to day. He finally decided on the simple method of exposing glass slides lying horizontally under a small board shelter. With the use of his pollen slides he studied the effects of sunshine, rain, wind, and humidity, on the amount of pollen in the atmosphere. He correlated daily pollen counts with his daily symptoms. He kept charts and made graphs of the daily and seasonal pollen concentrations.
Not satisfied with observations close to the ground, Dr. Blackley decided to examine the upper atmosphere. Airplanes were not yet invented so he employed box kites. With the ingenuity of a talented engineer he constructed devices for holding the slides in place, keeping them covered until they were at the desired height and then recovering the slides before taking them down. To do this he employed the principle of a watch with a timing spring that would open the cover and expose the slide after a given period of time and then close again. With the aid of this device and tandem kites he learned that there were greater concentrations of pollen in the upper air than at the level of the earth. This observation plus his data on the effect of winds and their currents served to clarify for him the reason that persons sometimes experienced symptoms while out at sea and in other localities free of grass.
In 1898, two years before Dr. Blackley died, he wrote to the British Medical Journal that he had been experimenting with subcutaneous injections of the active portion of pollen. He indicated that he hoped to publish his results in a short while. The hay fever world has been deprived of the final endeavors indulged in by Dr. Black-ley. They were never published nor have they appeared anywhere in written form. As judged by his previous accomplishments, we cannot help but reflect that his final contribution would have advanced hay fever therapy by twenty years. Blackley's death in 1890 was indeed premature.
STAGNATION AND QUACKERY
Amazing as it may seem, Blackley's words fell on deaf ears. The medical and scientific world just wasn't ready for him. His accomplishments and contributions were neither appreciated nor applied until long after his death. A review of some of the hay fever therapies that were advised after Blackley's work will seem incredible. We deem it advisable to note them for some are still advocated by unscrupulous purveyors of patent cures.
In line with the continuing theory that a "nervous constitution" was the underlying cause of hay fever, nerve tonics were recommended. These included whiskey, arsenic, galvanic electricity, strychnine, iron, phosphorous, codliver oil, Turkish and Russian baths, opiates, belladona, iodine, digitalis, caffeine, ergot, ipecac, and chloroform inhalations. One group held to the theory that hay fever was due to an excess of uric acid. They recommended lithium salts, salicylates, and, hydrotherapy. Other useless procedures based on a variety of theories that have been discarded' by reputable medicine and which should remain in the dump heap include ice-water foot baths, cutting and cauterizing nasal parts, x-ray, ultra-violet ray, diathermy, psychoanalysis, nasal massage, chiropracty and osteopathy.
The period from 187o until 1900 might be considered the era of quackery in hay fever. The prevalence of the ailment was increasing rapidly at this time. Cures and remedies suggested by reputable physicians were largely unsuccessful. Thus sufferers were wide open for quack cures. Untested and untried remedies of every sort flourished. Hay fever- and asthma patients became one of the largest sources of prey for nostrum and pill peddlers. And this parasitic evil exists as yet. From the Bureau of Investigation of the Journal of the American Medical Association, we find that as late as 1942 patent hay fever remedies under the following names were condemned: As-Ma-Norm, Dr. Hales Method, Minus Sinus, Shackeltons In-haler, Tucker Specific, Halomist, Syn-O-Scope, Synex and others.
ATTEMPTS AT IMMUNIZATION
In 1900 there appeared what seems to be the first published record of an attempt to immunize actively against hay fever. Following the lessons of immunization accomplished by Pasteur, a Dr. Curtis used extracts of the very pollens that were causing the trouble and diluted them in water and alcohol. He called the preparations liquor Ambrosia. These he administered by hypodermic with apparent benefit to fifty percent of his cases. He shortly abandoned the injection methods and gave the doses entirely by mouth. A couple of years later Dr. Ingals employed the same hypodermic treatment and reported successful results in more than half of his cases. For some reason which is not given, he too discontinued this method of treatment. If we may venture a guess it is probable that their dosages were too high on occasion, yielding the disconcerting results of severe reactions. Both were on the right track, but were not aware of it.
W. P. DUNBAR
At the turn of the twentieth century Dr. W. P. Dunbar in Hamburg was unknowingly repeating Blackley's experiments. In the midst of his endeavors he learned, of Blackley's work. Dr. Dunbar's results were recognized as a confirmation of the findings of that incomparable investigator. Thus Dunbar was instrumental in reawakening and recalling to the scientific world the superb experimental inquiries employed by Blackley.
In this we have an interesting bit of historical parallel-ism. Just two years previous Hugo DeVries had rediscovered for the world the remarkable papers on heredity published in 186o by that immortal priest, Gregor Mendel.
From the history of hay fever progress, it appears that a prerequisite for successful accomplishment was being a hay fever sufferer. Dunbar had this qualification. Although not as sound a research man as Blackley, he was a better chemist. Dunbar extracted from pollen what he considered to be its active substance. Testing a solution of this substance on hay fever sufferers, he found that it produced symptoms in and out of the hay fever season. Tested on normals, it produced no symptoms. Here was the hay fever toxin, he figured'.
Ten years previous, Drs. Von Behring and Kitasato had taken serum from animals immunized against diphtheria toxin. This animal serum, when inoculated into humans acted as a preventive against diphtheria.
Drawing an analogy from this experiment, Dr. Dunbar injected his so-called pollen toxin into a horse. He then took blood from the horse and drew off What he believed to be immune serum. He tested the serum experimentally and found that it had the property of neutralizing the effect of pollen when applied to the skin or mucous membranes of the eyes and nose. He marketed his serum under the name "pollantin." It was supplied in two forms, as nose and eye drops, and in powder form to be sniffed into the nose.
Pollantin spread like wildfire. Better than fifty percent of beneficial results were reported. with it from physicians in America, England and Germany.
On the heels of pollantin came "graminol." This was introduced by a Dr. Weichardt. He figured that since grass eating animals are always ingesting and inhaling pollen, their blood must naturally contain antitoxin in it. There-fore he took serum from these grass eating animals and marketed it as his "graminol" hay fever cure. Reports of success with graminol were similar to those publicized for pollantin. Soon reciprocal charges of plagiarism arose between Dunbar and Weichardt. A lengthy dispute ensued between the many medical proponents of these preparations until both were finally discarded.
How was it possible for so many well-meaning reputable doctors to accept these preparations and report excellent benefits and partial benefits in thirty to sixty per cent of their cases? An explanation offered by Dr. August Thomen is that both pollantin and graminol contained a mild neutralizing property. As such they were merely palliatives with a neutralizing effect comparable to that which might be obtained with "rosa gallica." This is a beneficial remedy used at present in the form of drops to give partial relief from irritating eye and nose symptoms.
History has forgiven Dunbar his sins. Some writers have even attributed to him the credit for suggesting the idea of immunization against hay fever with pollen extract. This he actually tried but gave such overdoses that the resulting reactions scared him out of the idea into his famous pollantin debacle. Finally we must not forget the praise due him for his chemical accomplishment in extracting in fluid form the active element in pollen. This as we shall see was of extreme importance in the development of present clay immunization treatments.
NOON AND FREEMAN
The name of Dr. Leonard Noon is favorably and permanently established in the history of hay fever. He is recognized as the originator of the present methods of immunization treatment against hay fever. No fanfare accompanied this Englishman's discovery. Conservatively and professionally, he reported his methods and results in 1911 in the Lancet, which is the medical journal of England. Soon after this first article Dr. Noon died and his work was carried on by Dr. J. Freeman who is still practicing successful allergy in England. Throughout the literature the names of Noon and Freeman are coupled in any mention of the pioneer work on immunization treatments for hay fever. And so we shall refer to this foundational achievement as representative of the efforts of Noon and Freeman.
Their original procedure was both simple and interesting. They first employed the lessons in chemistry taught by Dunbar. That is, they extracted from the pollen grains the irritating substance thought to be pollen toxin. This was accomplished by alternately freezing and thawing the pollen diluted in distilled water, then filtering it, and finally boiling the dilution for ten minutes in sealed glass tubes.
Experimenting with several grass pollen extracts, they found that timothy gave the most severe reactions with the smallest quantity. Therefore all of the original patients were treated with the extract from timothy pollen. Choosing timothy was a stroke of luck. Later experimentation has shown that timothy pollen embodies the active elements that are contained in most of the other grass pollens.
Their method of treatment was to inject under the skin measured quantities of pollen extract. Since both Dr. Noon and Dr. Freeman were aware of the harsh effects that resulted from Dunbar's experience with over-dosage, they were very cautious in this matter. They started all patients with small doses. This was no simple matter of giving one or two inoculations and conferring immunity as was the case in smallpox and diptheria. They tried to gauge each subsequent dose by testing the amount of pollen extract necessary to produce inflammation when applied to the conjunctiva of susceptible patients. As a further refinement they standardized the measurements of their extracts by establishing a quantitative unit. This unit is the amount of pollen protein that can be extracted from one thousandth part of a milligram of pollen. It has come to be known as the Noon unit. It is still used by many practitioners although preferable measuring rods have been suggested.
As a result of their regulated injections Noon and Free-man noted that increasingly larger doses were needed to produce conjunctival inflammation. Thus was established by experimental test the evidence of immunity derived from injections of pollen extracts. Clinically they observed evidence of immunity in the reduction of hay fever symptoms among the treated patients.
In their results Drs. Noon and Freeman made no claim of miraculous cures. Theirs was merely a method of prevention or protection against the debilitating effects of pollen. Although greatly improved, this is the status of present day immunization treatments for hay fever.
The figures for the first reports by Noon and Freeman were encouraging but not startling. They indicated about one third of their patients as being benefited to the extent of having little or no hay fever, another third with greatly diminished symptoms, twenty percent only slightly improved and the remainder unaffected by the treatments. Since this early work many improvements have been introduced by dint of the specialized efforts of hay fever specialists. In the hands of such trained physicians we may say conservatively that the results of present day hay fever treatments are two to three times as good as was obtained originally by Noon and Freeman. A safe estimate would indicate, that with the best therapy available, eighty per-cent of hay fever patients obtain at least eighty percent of alleviation from their hay fever symptoms. The remaining twenty percent vary in symptomatic relief from no improvement to a fair degree of comfort during their hay fever season.
THE EARLY ADVANCE
The brand new immunization method crossed the ocean from England to America in less time than it takes to tell about it. American physicians did not wait for Noon's report in the Lancet. It seems that mental telepathy was the medium of transmission. Or else they received their inspiration simultaneously with Dr. Noon from the work of Dr. W. W. Jadassohn which was first reported in 1896 and which assumed new importance with the desensitization attempts of Dunbar.
KOESSLER, LOWDERMILK AND CLOWES
Dr. Karl Koessler working in Chicago started giving injections of ragweed extract in the United States before Dr. Noon's report appeared in the Lancet. He did not know of Noon's work at the time he began. Another experimenter who employed this method of therapy simultaneously with Noon and Koessler was Dr. R. C. Lowder-milk. It is reported that he treated himself with regulated doses of pollen extract in 1911. Neither of these men published their results until 1914.
The first report of inoculative therapy in America was submitted by Dr. G. H. Clowes. He treated eight cases and related that all of them showed some degree of alleviation in their hay fever symptoms. Dr. Clowes introduced a method, for precipitating pollen with acetone instead of by alternate freezing and thawing. Following Clowes' ac-count, there appeared in rapid succession the publication of results by many American physicians. Among the early American contributors to the literature on inoculative therapy who added improvements of one kind or another, are the names of Dr. Goodale, Dr. Manning, Dr. Cooke, Dr. Hitchens and Dr. Vander Veer.
With the establishment of the pollen extract treatment in hay fever, related developments in allergy took on new significance. To fully appreciate and understand these developments a glance back at some earlier contributions will prove fruitful. Participating in these earlier researches are the names of some truly great men of science.
DR. W. W. JADASSOHN
It seems that Dr. Jadassohn had been the first one ever to immunize a person against an allergenic substance. In 1 896 he had a patient in Breslau whose skin broke out in a rash whenever she took any drug containing mercury. By giving her small injections of a mercury compound over a period of time he enabled her thereafter to take mercurial drugs without experiencing any skin symptoms. Thus was established the first instance of artificial immunity to an allergenic substance even before Dr. Leonard Noon introduced his work.
DR. CHARLES RICHET
In 1898 Dr. Charles Richet was trying to immunize animals against toxins after the manner of Von Behring. But instead of becoming immune, his animals became more sensitive to the toxins with which he was inoculating them. Many of the animals showed eruptions, swellings, and symptoms of asphyxiation, upon receiving more than one inoculation. To this curious phenomenon of animals becoming increasingly sensitive and suffering dangerous symptoms from substances which were at first harmless, he gave the name "anaphylaxis." For this remarkable discovery, which later proved very significant, Dr. Richet received the Nobel Prize.
DR. THEOBALD SMITH
Experimenting in the field of diphtheria immunity, Dr. Theobald Smith made a discovery related to that of Dr. Richet. He found that guinea pigs previously injected with horse serum died suddenly when serum was injected a second time. But the death only occurred if a period of one week to ten days elapsed between the two injections. If the second injection followed immediately after the first, no severe effects were observed. This phenomenon was also classed as anaphylaxis. It was shortly explained on the basis of antibodies and sensitization. It seems that the first injection of serum, which is harmless, causes the formation of special sensitizing antibodies. This is considered becoming sensitized (see p. 91). The second injection of serum causes the explosion when it combines with the antibodies of the sensitized animal. The chemical reason for the explosion is not yet known.
It must be remembered that this concept of becoming sensitized is only a theory. There are many instances on record of anaphylactic reactions and even death resulting from a first exposure to some foreign substance. It is therefore well for allergic persons or individuals with a history of allergy in their families to be cautious about taking patent drugs without medical advice or prescription. Such individuals should also inform doctors about themselves to guide the doctor in his prescription of drugs.
DR. CLEMENS VON PIRQUET
As a child specialist, Dr. Pirquet, had occasion to give many children inoculations of horse serum in connection with diphtheria antitoxin treatments. Working with Dr. Bela Schick, of Schick Test fame, together they recognized a similarity between serum sickness in children and Smith's experimental anaphylaxis in animals. Only a relatively few children showed this strange sickly reaction to the second injection of diphtheria serum. To this reaction he gave the name "allergy" to describe the altered reaction from the first to the second injections. The term allergy has since been applied to many forms of altered reactions or hypersensitivity in humans. These include asthma, hay fever, urticaria, eczema, migraine and others.
At this time Dr. Wolf-Eisner in Germany suggested that hay fever was analogous to anaphylaxis in animals. Many differed with this theory and it is still a matter of dispute between the experts.
The next advance came when it was shown that persons sensitive to foods gave reactions to these substances when rubbed into scratches on their skin. This was of course similar to the action of pollens as employed in skin tests first by Blackley, then Dunbar, and finally everybody. Food sensitivity and pollen sensitivity came to be considered allergies in a similar class.
THE P-K REACTION
The relationship between food and pollen sensitivity intrigued two allergic allergists. Drs. Prausnitz and Kustner both had their pet allergies. Dr. Prausnitz was allergic to pollen while his friend Dr. Kustner was allergic to fish. They decided to trade samples of serum from their blood to find out what was in it that caused them to be sensitive to these substances. The serum from each was injected into the other's arm. The next day Prausnitz was tested with fish extract on the same spot where Kustner's fish sensitive blood had been injected. Sure enough a hive appeared on that spot. Injection of fish extract on other parts of Prausnitz's body gave no reaction. Reversing the process by testing Kustner with pollen they got no reaction. But subsequent experimenters tried the same test with pollen and found that it generally worked. This interesting phenomenon has come to be known as the P-K reaction.
The value in hay fever and general allergy of the P-K reaction is truly immeasurable. It definitely established that whatever causes one to be sensitive is in the blood stream and not in the mind. It enables the doctor to test you out for sensitivity on your neighbor's arm. Providing of course that your neighbor isn't also sensitive. For nervous, very busy, very sensitive, or very young persons this is an important aid to the doctor. One progressive physician recently told us that he uses the P-K reaction for diagnosing patients' allergies by mail without ever having seen them. Self-treatment by mail under his guidance is also carried out by these patients.
In this connection it is of interest to note Dr. Harley's recent report that at the St. Mary's Hay Fever Clinic in England experiments in self-inoculation have been carried on rather successfully since 1937.
Like the child who saves the best piece of candy for the last we too shall postpone the chronicle of the greatest modern researches in hay fever for the final section of this chapter. In the interest of presenting a more complete biographical panorama we shall first recount a few of the contributions of some truly outstanding men in fields of allergy encompassing hay fever as well as other sensitivities. They have left their mark in hay fever history through research and compilations.
Among the earliest of this group is that venerable gentleman, Dr. Francis M. Rackemann of the Massachusetts General Hospital. Essentially interested in asthma, he has contributed to hay fever knowledge by reports on methods for achieving optimal dosages in hay fever treatments. Through articles and his invaluable book he has guided physicians in the principles of applying hay fever therapy in the clinic.
Specializing in allergy of the nose and throat, Dr. French K. Hansel of St. Louis has helped to shed light on cases of bacterial hay fever and asthma. His researches in this field are unsurpassed. Through his efforts and those of Dr. Grove in New York we may some day come to understand completely the relationship between hay fever, sinusitis and asthma.
From Cleveland the work of Dr. M. B. Cohen on pollen filters and air conditioning in hay fever relief, fills a needed gap in medical knowledge. His researches on absorption time for ragweed pollen material has been used as a basis for improved methods of treatment.
The introduction of the perennial method of hay fever treatment by Dr. Aaron Brown in New York was a notable innovation. Many practitioners have obtained improved results by treatment with this method. However, present day allergists differ in their views on the relative merits of perennial treatment versus preseasonal and coseasonal treatment.
A name that we cannot pass over hurriedly is that of Dr. Samuel Feinberg of Chicago. Graduated with Phi Beta Kappa honors from the University of Wisconsin he has added to the general field of allergy a keen and searching mind. As director of the allergy clinic at Northwestern University he has been instrumental in providing for middle western sufferers the very latest methods in hay fever and asthma therapeutics. A member of the editorial board of the Journal of Allergy he, has helped allergists to keep pace with scientific developments by his truly monumental annual reviews of research in the entire field of allergy. More specifically Dr. Feinberg is credited with being largely responsible for our latest knowledge on mold spores as an important and common cause of asthma and hay fever.
Acting as editor and associate editor of the Journal of Allergy are Dr. H. L. Alexander and Dr. Warren T. Vaughan respectively. In this capacity these men sift the pertinent literature on allergy. They have to be acquainted with the whole field of allergy on a reading basis. Theirs is no easy task. Aside from these duties plus supervising a huge hay fever clinic in Richmond, Dr. Vaughan, has carried on the tradition of medical research laid down by his father before him. The most momentous contribution in the early experience of Dr. Vaughan was his proof of the existence of an allergic factor in migraine. In hay fever therapy he was the first to suggest coseasonal treatment. Reports from his clinic indicate good results with this method of therapy.
In California where the sun always shines and hay fever is supposedly scarce, a renowned allergist reports ample opportunity to conduct hay fever research on hay fever patients. Dr. George Piness was the first one to publish an extensive report on the important hay fever plants of California. His excellent study on the Intelligence Quotients of allergic children as compared to non-allergies has contributed toward dispelling the unfounded concept that allergic sensitivity is related to greater intellectual ability.
The name of August Thomen in hay fever is most often used in connection with Coca and Walzer. This by reason of their medical textbook on hay fever and asthma. Good books, like great women of the theatre, age gracefully. The hay fever section of this book, written by August Thomen is such a book. Once in a lifetime does one en-counter so thorough and masterful a treatise as is this book. Published in i93 i it is almost as 'current as any written up to 1940. All books on hay fever that have appeared after this book have borrowed extensively from it—"Let him who is without sin cast the first stone upon the water."