recent advances in allergy

474 Pages·2013·17.87 MB·English

RECENT ADVANCES
IN ALLERGY
(ASTHMA, HAY-FEVER, ECZEMA, MIGRAINE, ETC.)
BY
GEORGE W. BRAY
M.B., CH.M. (SYDNEY)
A.STH!fA RESEARCH SCHOLAR, THE HOSPITAL FOn.
SIC I{ CHILDREN, GREAT OR)[QND STREET, LONDON
WITH FOREWORD BY
ARTHUR F. HURST
M.A., l\f.D.(OXON), F.R.C.P.
SENIOR PHYRICIAS", GUY'S HOSPITAL: CIIAIRUAN MR1HCAL
ADVISORY COM~fITTEE, ASTHlIA RESEAROH COUNCIL 01" onE.!T BRITAIN
98 Illustrations
including 4 Coloured Plates
LONDON
J. & A. CHURCHILL
40 GLOUCESTER PLACE
PORTMAN SQUARE
1931
B. L. No 64.
Jmpnrial Institute of Veterinary Research
615 '31 e, R
Laboratory.
Library.
~.
Class.
Rpgister No. 16'.J " Room No.
,
Inward No. 16',; ,1 -, ' Shelf No.
Rrceived . ..<' .1 Book No.
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RECENT ADVANCES IN ALLERGY
THE RECENT ADVANCES SERIES
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MICROSCOPY: Biological Applications
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RADIOLOGY
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Printea in Great Britain
FOREWORD
Two distinct periods can be recognised in the history of our
knowledge of asthma. The first, beginning with' Sir John
Floyer's treatise published in 1698, culminating with the pub
lication of Hyde Salter's monograph in 1860, and ending with
the Great War, was the period of clinical observation. The
second, beginning about 1920, is the period in which intensive
laboratory investigations have been combined with the older
clinical methods. This has led fo a remarkable development in
our knowledge of the subject and to the appearance of numerous
books and innumerable papers in many languages. It has
become impossible for the ordinary man to keep abreast with
the literature, so that a successful summary of the results
of recent research on asthma is assured of a warm welcome.
Such a summary will be found in Dr. Bray's book, which has
the additional advantage of containing a first-hand account of
his own work on asthma and allied conditions in children, in
whom allergic manifestations appear in their simplest forms.
Having devoted himself for two years almost exclusively to the
investigation of this subject, he is in an exceptionally favourable
position to review the whole question. His success is the result
of his flair for research combined with hard work and clear
thinking. But some credit is due to the lay members of the
Asthma Research Council, who as sufferers from asthma them
selves conceived the idea of endowing asthma research. This
prompted the Halley Stewart Trustees to found the Fellowship
which Dr. Bray has held during the last two years at the
Hospital for Sick Children. All who read this book will agree
that the Committee of the Hospital for Sick Children has
been fortunate in its choice of a research fellow.
ARTHUR F. HURST.
v

PREFACE
., Dcr Geimpfte verhlilt sich gegeniiber der Lymphe, der Luetische
gegeniiber dem Syphilisvirus, der Tubereulose gegeniiber dem
'l'uberkulin, der mit Serum Injizicrte gegeniiber dem Serum anders
als ein Individuum, welches mit dem betreffenden Agens noeh
nicht in Bcriihrung gekommen ist; er ist deswegen noeh weit
entfernt, unempfindlich zu sein. Alles, was wir von ihm sagen
konnen, ist, dass seine Reaktionsfahigkcit geandert is~.
Fur diesen ullgemeinen Begriff der veranderten Reaktionsflihigkeit
schlage ieh den Ausdruck Allergic vor. Allos bezeichnet die Abwei
chung wm der urspriinglichen Verfassung, von dem Verhalten des
Normalen, wie in Allorhythmie, Allotropie."
(v. PIRQUET, " Allergie," ]906.)
This, in von Pirquet's own words, is how the term" Allergy"
originated, and, in the quarter of a century that has elapsed
since its inception, this idea of an "altered reactivity" has
been extended to include a multitude of conditions other than
those to which von Pirquet originally referred. So, whilst the
whole study of the subject of Allergy is a comparatively reccnt
innovation, and still regarded by many as a term in which to
cloak our ignorance of the complex mechanisms concerned, the
minute clinical recognition of such an allergic disease as asthma
dates back even to the pre-Christian era.
With Allergy, as with all other new theses; there has been
an immediate profusion and confusion of ideas. Impetuous
youth finds that the theory explains most-of.DUl' bodily ailments,
whilst staid old age regards it as a passing fad that will soon
expire as many such have done before. For this reason, with
the task before me of conducting research into the nature of
these peculiar altered reactions, it has been necessary to endea
vour to correlate, if possible, these ancient and modern views,
and so establish the basis of our present knowledge of the
subject so that further advancements can take place. In the
vii
viii PREFACE
majority of particulars conflicting views have been expresseq
which it has been necessary either to confirm or to refute; so,
where antithetic statements have appeared, I have endeavoured
to support one or other from the intensive study of some
thousand allergic children that I have investigated in the last
few years.
It may be of interest to English readers and sufferers that a
great deal of the pioneer work in allergic conditions originated
in England. Sir John Floyer, of London, in his" Treatise of
the Asthma" (1698), gave a minute description of the symptoms
and treatment to that date, and assigned the" immediate cause
of the asthma to a straitness, compression, or constriction of the
bronchia," and added some " reflections on the dissection of a
broken-winded mare." Ramadge, of London, differentiated
(1835) the nervous and symptomatic types of asthma. Salter's
" On Asthma, its Pathology and Treatment" (1860, 1868) has
remained a classic to this day. It was he who first noted the
association of asthma with the presence of animals, and who
emphasised the importance of the hereditary factor. It was
Bostock, of Liverpool, who was the first (1819) to describe
hay-fever as "summer catarrh," a disease with a definite symp
tomatology and a seasonal occurrence. From 1859-1873
Blackley, of Manchester, by a series of most thorough and
systematic experiments, proved conclusiv:ely that the pollen
of grass was a causative agent. Noon and Freeman, of London,
applied the conjunctival test in diagnosis, and in 1911 were the
first to use pollen solutions for therapeutic purposes. Histamine
was isolated by Barger and Dale, of London, in 1910, in the
same year as Hurst, also of London, first drew attention to the
analogy between asthma and muco-membranous colic.
Within recent years priority in tliis field has been ousted
from us largely by the prevalence and importance of its applica
tion in America; but with the formal- constitution of the
Asthma Research Council in October, \927, and the subsidisa
tion of various research centres throughout the British Isles
by voluntary subscription, a great impetus has been given to
the further study and elucidation of allergic conditions in this
PREFACE ix
country, and many sufferers have offered, not only funds, but
themselves, as subjects for detailed investigations.
My aim in writing this book has been to provide in a handy
and inexpensive form a ,resume of our present state of knowledge
and the trend of modern !esearch in Allergy in general and its
individual manifestations in particular. In addition, a tentative
endeavour has been made to reproduce the possible common,
hay-fever producing flora of the British Isles, which, as far as
I am aware, has been unattempted hitherto.
For the excellent opportunities that have been conferred
upon me I desire to convey my thanks to the Asthma Research
Council and the Halley St~wart Trust for a grant of funds; to
the Honorary Medical Staff of the Hospital for Sick Children,
Great Ormond Street, London, for referring their' cases unre
servedly to the Clinic for investigation; and to the individual
sufferers, both parents and children, who have' patiently
submitted themselves to tedious questionings and procedures.
Nor should I fail to express my indebtedness to Dr. W. Payne
for constant advice and assistance in biochemical matters, and
to Dr. A. Signy in the hrematologic and bacteriologic aspects.
In the actual production of the book it is a pleasure to
acknowledge the help of Dr. Arthur F. Hurst, who lias written
the Foreword and devoted much time to the tedious task of
reading through the whole manuscript !lnd tempcring it with
his wisdom and criticism based on years of experience, and, '
might I add, suffering. His numerous contributions to the
study of asthma are referred to in the text, as well as those of
Professor R. J. S. McDowall, who has rendered great assistance
in the experimental aspects and their diagrammatic representa
tion (Figs. 1 to 6). To Mr. Charles Keogh I would like to express
my thanks for his colour work (Figs. 14, 23 and 24) and sketching
(Fig. 8, 25 and 26); to S. F. Armstrong and the Cambridge
University Press for permission to reproduce most of the
British grasses portrayed; to A. R. Horwood for permission to
reproclucc the trees and weeds; to Dr. F. Knott for Figs. 45
to 48, illustrating the bacteriology of the sputum; to Mr. B.
Shires for his opinions on the radiograms of the chest (Figs. 49