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HAY-FEVER LEONARD NooN HAY-FEVER A I(EY TO THE ALLERGIC DISORDERS by JOHN FREEMAN D.M. (OxoN) 1950 WILLIAM HEINEMANN · MEDICAL BOOKS · LTD. 99 GREAT RUSSELL STREET LONDON, W.C. 1 First Published 1950 PRINTED IN GREAT BRITAIN BY ROBERT l\!ACLEHOSE A!\D CO. LTD. THE l.l}l'IVERSITY PRESS, GLASGOW To L. N. TRIS ACCOUNT OF MY STEWARDSHIP On ne peut se flatter d'avoir le dernier mot d'une théorie, tant qu'on ne peut pas l'expliquer en peu de paroles a un passant dans la rue. J. D. GERGONNE (1771-1859) FOREWORD ur old Chief, Sir Almroth Wright, used to say to me across the Inoculation O Department tea table, ' Before your ship of life founders be sure you get al! the goods up out of the hold and onto the quay-side.' Alas, he did not manage to do that himself; he died one and a half years ago, at the age of eighty-six, leaving the philosophy book which he had been writing for fifty years in such a chaotic state that even now his grandson is having great difficulty in getting it out. Wright used to say, 'You must be warned by me, J. F.: you finish your book somehow! ' This book from first to last has taken a good twenty-five years to write, and it is certainly none the better for that. At moments of brief leisure much of it has been re-written a dozen times over in the amateur way, till I hardly know what I have left in or left out. I hereby make apologies to my wife, children and (later on) grandchildren, and to so many kind friends for countless holidays devastated by what quickly got lmown to them as 'The B.B.', i.e. that Bloody Book. They have all been very patient and helpful-when I could let them help. Leonard Noon. In 1908 Noon, my lifelong friend, began considering investiga­ tions into the cause and treatment of hay-fever and of the Isle of Wight Bee­ ciisease; in the communal spirit ofthose days these projects (together with dozens of others) were thoroughly cánvassed by all workers in Almroth Wright's laboratories. As for the bees, the favourite flippant suggestion was for immunisation by massage, a general line of treatment I was working on at that time (pp. 230-232). That Bee investigation got no further; but headway was made with hay-fever. Blackley had demonstrated many years previously the specific reaction which all hay-fever subjects gave to the pollen of the grasses when this substance was brought into effective contact with their living tissues. Blackley's great monograph ,m' Catarrhus Aestivus ', published in 1873, was Noon's spring-board for research. Noon, after a protracted illness, died ofphthisis in 1913. Perhaps the greatest , lisaster that befell the old Inoculation Department was this untimely death at :hirty-five years of age. From the research worker's point ofview, his was probably :he best brain that ever entered our famous laboratory. I was closely associated with Noon in his early experiments ; and, when alas :le fell ill, the work was entirely in my hands. This book is an account of my , tewardship. I have not tried to write an exhaustive text book on allergy by making a : e-hash of all the contradictory statements that could be found written in the literature ' of that complicated subject (hence the absence of a bibliography) ; on -he contrary, I have kept fairly closely to what has actually been done by myself vii Vlll FOREWORD and colleagues in the old Inoculation Department as we developed more and more from Noon's pregnant beginning with hay-fever. Wright's Inoculation Department. It is only just that I should say something of the novel Organisation (though unkind colleagues sometimes called it a Dis­ organisation) which not only permitted, but even encouraged, first Noon and then me to do the work which is described in this book. Wright, warned by his recent, almost insuperable. difficulties in persuading the Army Medical Chiefs to adopt his new prophylactic treatment for Typhoid Fever, saw that the necessary close collaboration bet\v-een clinic and laboratory, when adopting new methods, would hardly have a fair chance if left to the hospital set-up of his day. He did not rest content that his research laboratory should be un­ hampered by clinical orthodoxy ancl by economic pressure; his (I think) unique plan was that treatment derived from his laboratories should be applied to the sick by himselj, and (under his careful guiclance) by his young co-workers too : his new Inoculation Department was in fact, though not in name, a minute but completely inclepenclent Research Hospital living in symbiosis with the main Hospital. This 'Inoculation Department' owed its freedom to its financial independence; for forty and more years it was kept on its financiallegs by the money-earning work of its inmates-generously supplemented by rich gifts from several of our well-to-do prívate patients. Laboratories and Clinics. I should indeed have been culpably dull if I hadn't learned a great deal when working in a well equipped and live laboratory, and also with many thousands of patients-first with hay-fever ancl later with asthma or sorne other of the Toxic Idiopathies-flowing through the clinics which, little by little, we found it necessary to set up in conjunction. The success of these clinics has been m y bane, for they have attracted too many people, all needing help ; now that I am busy coiling clown ropes to leave everything shipshape at the hospital, we have each week eight or more ' Clinics for the Allergic Disorders ', and places in them are booked up for months aheacl, through thousands of practitioners all over the country. Unfortunately such work is costly in time ancl trouble ; we calculate, for example, that every case that comes to us now for ' examination and report ' uses up, all told, a full three man-hours of work-some skilled and sorne of course comparatively unskilled-before that report can be posted to the patient's doctor. Our clinics were started without any with-your-leave or by-your-leave because they were found necessary for our research and, though they have developed far beyond our neecls, and perhaps beyond our resources, I claim that they have always ministered to such research. Similarly our laboratory work has always hada practi­ ca! application in treating the sick who crowcled to us. At the present stage of development I hold that laboratories and clinics are symbiotic : they are mutually necessary if the work described in this book is to go on. Nomenclature. I have used in this book the language which I have for so long used to myself and to colleagues-including the practitioners wh.o have sent me FOREWORD IX cases for ' examination and report '. This has included sorne neologisms which I hope may be forgiven ; they were coined to meet what I thought was a pressing need in clear thinking. I have already in this Foreword used the term ' Toxic Idiopathies ', which will be defined on its introduction on p. 21. The Toxic Idiopathies are identical with these 'Allergic Disorders' of my book title, which is to this extent catch­ penny, that you can hardly put an unfamiliar and perhaps forbidding neologism into a book title and expect anyone to read that book. All the same, I am not proud of using the phrase ' Allergic Disorders ', even when decorated with inverted commas, because the word allergy is in such a linguistic mess. When it first began to creep into English laboratory conversation in its new and twisted meaning, I determined I wouldn't use it in this book because of its obvious ambiguity; then, later on, this second meaning became the more general usage in clinical circles, and it seemed Canute-like to object to its use flooding in on us in the laboratory. However, ayear ago ata meeting in Oxford to discuss the proposed ' Association of British Allergists ', I heard enthusiastic but undiscriminating medical men boasting that ' allergy covered nearly all medicine ' ; so I started to weed the word allergy out again as too dangerous for general use. I have, for example, replaced the equivoca! word ' allergic ' by ' idiotoxic ' which, though not so euphonius, can only mean what I mean it to mean. I believe the word ' allergy ' obscures more than it illumines in medicine. ' The Inoculation Department ' of St. Mary's Hospital is another of the phrases which may need excusing. That was its name from its cradle in what is now the Haematology Laboratory of the Hospital, through its lusty youth in the Clarence Wing, till its reincarnation after Wright's death as 'The Wright-Fleming Institute of Microbiology' in the new Medical School buildings. Nearly all the book was written before our research laboratories were re-christened with that new name, so I haven't made the correction. I hope I may be forgiven for that too. Medica! Orthodoxy. When should we bow in the House of Rimmon, and when should we refuse todo so? Just at what point should we risk a bite from a sleeping clog by trying to get it out of our way? I don't know the answers of course; I can rmly say what I have done that is at present heterodox in the practice of medicine. I don't as a rule examine the chests of my asthma patients (unless they ask for it) because I believe that the average medical mancan get singularly little accurate information from this procedure-and practically nothing useful from the asthmatic.

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