The American Academy An historical review Sheldon

G. Cohen,

of Allergy:

M.D. Bethesdu, Md.

I. Foreword

At 12:58 P.M. on Sunday, December 4, 1943, at the Waldorf-Astoria Hotel in New York, the American Academy of Allergy came into being. At that time the final affirmative actions by members of two national societies, each dedicated to the advancement of the study of asthma and allergy, were officially recorded and implemented. Both organizations voted themselves out of existence, and as a consequence of their amalgamation a strengthened, enlarged, and integrated society was to emerge. Thus, during this year of 1979 the American Academy of Allergy will reach 36 years of age. However, tracing its roots through parent organizations takes the record back some 20 years earlier. The Academy’s history can be dated to the respective foundings of the Western Society for the Study of Asthma, Hay Fever and Allergic Diseases by three California physicians in 1923 and the Society for the Study of Asthma and Allied Disorders by a New York- oriented group of 13 the following year. Four name changes later, the Western Society had acquired a wider geographic representation and evolved into the American Association for the Study of Allergy. After a highly selective metamorphosis, the original Eastern group of academically affiliated internists and immunologists went through a similar period of growth and fading regional identity. They, however, held to the consistency of a single name for their Society. Although the growth of each organization endowed it with national character, habit took precedent over correct definition and the original terms, “the Western” and “the Eastern,” were perpetuated. Eventual recognition by the Western Association Director, Immunology, Allergic and Immunologic Diseases Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health. Dr. Cohen was Historian of the American Academy of Allergy from 1963 to 1969. Vol. 64, No. 5. p. 332-466

and the Eastern Society of overlapping memberships and the common denominator of professional interests, scientific endeavors, educational objectives, and the national status each held paved the way for elimination of duplication of effort. After considerable deliberation, debate, delay, negotiations, and transition problems, the American Academy of Allergy finally emerged. This action, however, was not without its price, for the newly accepted dues structure of $15 per year quite measurably exceeded the carefully established initial assessments of $2 for the (Eastern) Society and the significantly larger amount of $5 for the (Western) Association. The day of full-time medical school faculty positions, salaried appointments, ready availability of institutional laboratory facilities, and supported research was then still some 35 years away. With the exception of the occasional immunologist at a university medical school (e.g., Coca at Cornell) or one fortunate enough to be well placed in a foundation endeavor (e.g., Cole at Rockefeller Institute), private medical practice or other means of support were necessities. Even chairmen of departments of medicine were’not spared the need for some renumerative clinical involvements. Thus, it should be appreciated that medical school teaching affiliations and clinic staff appointments were held on a strictly volunteer basis. They were eagerly sought not only as marks of prestige but also for the attendant opportunities they might offer for study and investigation. Thus, in view of allergy’s effective contributions to the medical specialties and the prestigious position of the American Academy of Allergy among professional societies today, some very special circumstances of those times should be noted. Especially evident were the dedication, inventiveness, and sheer excitement of pursuing the phenomenon of hypersensitivity that characterized the work of those who met under the aegises of the Western Association and the Eastern Society during the 192Os, 193Os, and into the 1940s.

0091-6749/79/110332+135$13.50/0

0 1979 The C. V. Mosby

Co.

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64

NUMBER

5

The American

An objective look at the Academy today offers much evidence for the wisdom and foresight of decisions made in 1923 and after. Progression from these founders of the (Western) Association and 13 of the (Eastern) Society to 272 initial members of the Academy in 1943 to the current enrollment of 2,829 Fellows and Members involves a story far more complex than a factual recitation of numbers and chronology of events. Privileged to view in retrospect the imaginative thought, vigorous leadership, spirited discussions, and dedicated interest associated with the organizational maturation and evolution of the Academy to a national society of respected stature and recognition, I have undertaken to review and share this story. By chance, the occurrence of the twenty-fifth anniversary of the Academy in 1968 was coincident with my tenure as Historian. In preparation for special events of the annual meeting held in Bal Harbour (Miami Beach), Florida, during that milestone year, I was given the responsibility of gathering historically relevant material. In the search for authoritative material to form the basis of program presentations, minute books, committee reports, and file data accumulated over 45 years were brought forth, augmented and colored by personal recollections and through visits, conversations, and correspondence

II. The American

Association

The beginning of the first of the parent organizations of the American Academy of Allergy is largely the story of three Californians who were pioneers in the practice of allergy in the far western United States, Grant L. Selfridge, George Piness, and Albert H. Rowe (Fig. 1). Grant Selfridge was a San Francisco otorhinolaryngologist trained at Hahneman Medical College who enjoyed a large, fashionable practice. He apparently had been introduced to the role of pollen in hay fever through friendship and earlier personal contacts with Joseph L. Goodale when engaged in his pioneering studies in Boston. In turn, Selfridge had managed to involve Harvey M. Hall, Professor of Botany at Leland Stanford University and Honarary Curator of the Herbarium at the University of California in Berkeley (Fig. 2), in the collection of pollens, thus enabling him to become the first physician in the San Francisco Bay area to work on the specific diagnosis and treat-

Association

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333

with some of the people who made it all happen.’ These all provided insight into past organization and fields of endeavor that had not been familiar to many who attended that twenty-fifth anniversary meeting. Thus, since a review of the Academy’s history has hitherto not been recorded in a single publication, it seemed appropriate to respond to the Editor’s request to prepare this manuscript for the fiftieth anniversary issue of THE JOURNAL OF ALLERGY AND CLINICAL IM~vIUNOLOGY.

Much of the medical history pertaining to allergy in general and to the Academy in particular is relatively recent, bordering on the contemporary era. Though visionary and imaginative, those founding and early Fellows with whom I had been privileged to speak readily admitted that they could have hardly foreseen the rapid qrowth and significance of allergy as a special field of medical practice and academic and research endeavor. Yet if we are short in terms of historical time, there is nevertheless a depth of tradition and influence to record in the pages that follow. ‘Harry L. Alexander, Horace S. Baldwin, James H. Barnard, Harry S. Bernton. Stearns S. Bullen, Leo H. Criep, Samuel M. Feinberg, Leslie N. Gay, French K. Hansel, Harry L. Huber, Richard A. Kern, Edwin P. Maynard, Howard Osgood, Royce Paddock, George Piness, Francis P. Rackemann, ouis Tuft. and Matthew Walzer.

for the Study of All ergy

ment of seasonal allergy. This interest was coincident with a developing awareness of the cause and prevalence of “hay fever. ” Attention was then being given to the possibility that this disorder was possibly responsible for disabling many outdoor workers including railway engineers, firemen, and brakemen. As a result Selfridge was given a grant by the Southern Pacific Railroad to study its right-of-way through Utah, Nevada, Oregon, and California, and with the aid of the botanist Hall he conducted what was probably the first botanical and pollen survey in the West. Although he was also known for another “first” in San Francisco, the surgical removal of tonsils, for his capacity to use “strong language” and swear in local hospital operating rooms Selfridge could only place second to a prominent San Francisco surgeon, Alanson Weeks, then known as “The Big Goddam.” In this respect Selfridge could only merit the title of “The Little Goddam.” According to a story that ap-

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FIG. 1. Founding members of the Western Society for the Study of Hay Fever, Asthma and Allergic Diseases in 1923 (left to right): Grant L. Selfridge (1864-1951) (courtesy San Francisco Chronic/e, Aoril4. 1950, and the San Francisco Public Library); Albert H. Rowe (1889-1970); and George P.ineks (1891-1970).

peared in the Sun Francisco Chronicle (April 24, 1950) when Selfridge was 80 years of age, he “had berated and babied thousands of San Franciscans who were his patients and friends . . [and] knew most of San Francisco’s great families.” George Piness happened into the evolving world of allergy quite by chance early in his professional career. In 1915, shortly after finishing his medical training, Piness was called into the office of his mentor, the fdmed New York internist Harlow Brooks of Bellevue Medical College and Bellevue Hospital, to be introduced to I. Chandler Walker of Boston. Walker, who had then begun studies with bacterial vaccines in the diagnosis and treatment of asthmatic patients, was searching for an assistant to work with him in his laboratory and clinic at the Peter Bent Brigham Hospital.’ When queried by Piness as to why he was recommended for that particular position, Brooks replied, “Nobody else wants the job.” Nevertheless, seizing the opportunity and challenge Piness, with Walker and the chemist Roger Woodehouse, learned to prepare pollen extracts for skin tests and treatment purposes. Armed with his Boston-derived knowledge, Piness moved west to settle in California. He arrived in Los Angeles without funds, and accepted a series of jobs, part-time assistant to a prominent internist, Dudley Fulton, making house calls and working in the office clinical laboratory; part-time house physician covering service needs of the Good Samaritan Hospital; and

*Robert A. Cooke is frequently credited with establishing the first clinic in the United States at the New York Hospital in 1918. However, records indicate that I. Chandler Walker’s clinic at the Peter Bent Brigham Hospital in Boston was operational in a small way as early as 1916.

a part-time job with a surgeon, Harry Voorhes, that included the administration of anesthetics. Eventually this led to a lucrative and promising career as an anesthetist. In 1919, however, partially influenced by “the reeking odor of ether in [his] tlothes,” Piness decided to begin once again, but this time in the area where his true interests lay. With an increasing appreciation of his earlier Boston experience, he reentered the clinical practice of allergy. In subsequent years his enterprise resulted in the development of a large regional practice and a clinic facility at the University of Southern California, where Piness was responsible for the training experiences of many physicians in clinical allergy and for innovative developments in the preparation of allergenic extracts. In fact, one of his early chemists employed for this specific purpose, Gordon Alles, was responsible for developing a new type of material adapted to scratch-test procedures, acetone-precipitated protein powders. After an internship in medicine under the distinguished California internist Herbert C. Moffitt, Albert Rowe pursued further training in the East at Massachusetts General Hospital. Unlike Piness, his introduction to allergy did not occur in Boston but after his return to the San Francisco area. However, groundwork for the course of his subsequent career was laid in his experiences in the chemical laboratories of David Edsall at Harvard studying the isolation of serum albumin and globulins and with Elliott Joslin in studies on diabetes. After he returned to San Francisco and took a part-time faculty appointment at the University of California, Rowe’s interest in diabetes was furthered by the encouragement and help of Moffit. This included collaborative efforts with University chemists in the production of insulin according to

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methods that had just been described by Banting, Best, and McLeod. As the first physician in the region to initiate insulin treatments, Rowe was also among the first to witness allergic reactions to its administration. There were two additional events that introduced him to the medical specialty of allergy. Stimulated by the very early work in gastroenterology of Walter Alvarez, then at the Hooper Foundation at the University of California, Rowe learned the technique of gastrointestinal roentgenography, including fluoroscopic examination. This led directly to the initiation of his lifelong interest in food allergy and in allergic manifestations in the gastrointestinal tract. Shortly after Rowe had set up a private practice in Oakland, the second event came in the form of a patient, a severely asthmatic woman referred from Moffit. Because little of the cause and management of asthma was then known and Rowe thus far had few patients, it was Moffit’s thought that Rowe could afford the time and trouble required to take on the challenge of this disorder. Thus. during the years 1916 to 1917, Selfridge, Piness, and Rowe pursued their clinical practices of allergy, each in his own manner and initially unknown to the others. It was the need for pollens with which to prepare test and treatment extracts that served as the common interest to finally bring them together. Based on his experiences in a new area in medicine and the unique information resulting from the botanist Hall’s pollen collections and surveys, Selfridge appeared on the program of a local medical meeting. The sub,ject matter of his lecture was the identification of pollens as agents of hay fever and asthma in the San Francisco Bay area. Rowe, impressed with this presentation, sought out Selfridge the very next day to inquire if it would be possible to purchase some of his pollen supply. Selfridge, “The Little Goddam,” promptly informed Rowe, in his forthright and outspoken manner, that if he was interested in gathering pollens and using them in his work, then it was up to Rowe to gather them himself. Rowe then did just that. Within three months, with the guidance of Hall, he had gathered a number of pollen species prevalent in that area. Piness, on learning of Selfridge’s work in San Francisco and of Rowe’s pollen gathering, came to Rowe’s office in Oakland with his own request, finally persuading Rowe to share his supply of pollen. Then Piness engaged the assistance of Howard McMinn, Professor of Biology at Mills College in Oakland, and was able to bring a large supply of collected pollens into his Los Angeles facility.

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FIG. 2. Harvey M. Hall, first member to be taken into the Western Society for the Study of Hay Fever, Asthma and Allergic Diseases by Selfridge, Rowe, and Piness after their initial organizational and planning meeting in 1923. As a botanist, he was the first nonphysician scientist member of a professional allergy society in the U. S. (Photograph courtesy Bancroft Library Archives, University of California, Berkeley.)

After Selfridge became aware of Rowe and Piness’s willingness and determination to gather pollens and prepare extracted materials in their own laboratories, the three became fast friends and met frequently to share experiences and information. It was four or five years later at one of their frequent dinner gettogethers at the Bohemian Club in San Francisco that the idea of a professional society of allergy first emerged. Shortly thereafter, while visiting Rowe in his Oakland office, Selfridge and Piness officially entered on record the formation of the Western Society for the Study of Hay Fever, Asthma and Allergic Diseases. Society offices were divided among themselves: Selfridge was the first President, Rowe the Secretary-Treasurer, and Piness the Chairman of the Board of Directors, which consisted of the same three. Additionally, plans were made for expansion. The first step was to convene future annual meetings of the Society in conjunction with annual meetings of the American Medical Association (AMA) one or two days immediately preceding the opening day sessions. Fortuitously, the very next meeting of the AMA was scheduled for San Francisco and lent itself conveniently to this arrangement. Immediately assuming his responsibilities as Secretary, Rowe searched out the names of physicians who had contributed articles on subjects relevant to allergy in the medical literature. He then wrote to all he could identify, inviting them to attend the first meeting of

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THE WESTERN SOCIETY FOR

HAY

THE

FEVER,

STUDY

ASTWvlA

ALLERGIC INVITES

YOU TO ATTEND THE

ST. FRANCIS FRANCISCO.

JUNE

AND

DISEASES

FIRST ANNUAL

SAN

OF

SESSION

HOTEL CALIFORNIA

25.1923

FIG. 3A. Program of the First Annual Meeting of the Western Society for the Study of Hay Fever, Asthma and Allergic Diseases.

the Western Society and to read papers on any aspect of clinical allergy that they so chose. Upon receiving acceptances to participate in the program from six and requests for membership from 15 physicians, a small room was reserved at the St. Francis Hotel for Saturday, June 25, the day preceding the opening of the 1923 AMA meeting. Apparently, at some time in advance of that first annual session in San Francisco some preliminary business must have taken place, perhaps by mail that led to the incorporation of two physicians into the roster given in the official program (Fig. 3). In addition to Hall, their botanist collaborator who had been designated a Society and Execu-

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tive Committee member by Selfridge, Rowe, and Piness, the names of William V. Mullin of Colorado Springs and E. Wood Phillips of Tucson were listed as First and Second Vice-President, respectively. The minutes (Fig. 4), however, recorded their official elections to membership during the course of the June 25 meeting subsequent to the distribution of the printed program that listed their names as Society officers. These programs containing titles of papers to be presented, names of the officers of the Society, and the date of the meeting were mailed to all physicians in the country who, according to Rowe’s search, had written on any aspect of allergy. In addition to seeking widespread coverage by announcements in the Western Journal of Medicine and the Journal of the American Medical Association (JAMA), assistance was sought from railroads that converged on San Francisco. Conductors on the Southern Pacific, Santa Fe. and Union Pacific Railroads were supplied with both posters to place in club cars and programs for distribution to physicians en route to the AMA meeting during the three-day period preceding the scheduled opening. Poster announcements of the Western Society meeting were also placed in the lobbies of all large San Francisco hotels, but despite this publicity only 14 to 18 physicians out of the several thousand who attended the AMA meetings were attracted to the Western Society sessions. An idea of the state of the art that brought these early physician allergists together can be gleaned from the topics presented on that first program (Fig. 3). At the initial San Francisco meeting, new members were elected, but the emerging group was still small, a total of only IO. Because of the interest and persuasion of the new members from New York” and Boston,‘l the founders at the 1923 meeting were encouraged to drop “Western” from the Society’s official name. However, in their optimism and haste to view future prospects on the national scene, they apparently failed to notice the semantic inference of the newly adopted name, American Allergic Society (Fig. 5). Before another year had gone by, however, someone’s perception apparently caught up with the fact that it was the members’ patients who were allergic and not their society. Accordingly, an appropriate change took place in time for the new name, American Allergy Association, to appear on the mas3MaximillianA. Ramirez,Directorof a medicaldivisionat French Hospital. ‘Edward S. O’Keefe, a pediatrician who started a clinic at Massachusetts General Hospital which is believed to be the first in the United States devoted exclusively to pediatric allergy.

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PROGRAM--CONTINUED

PROGRAM

I.

“Allergic

Direarcs in Childhood.” A. H. Rowe, M.D.,

Dijcur&x~

“The

Di.tgnoris

M.D.,

Oakland

2.

“Iray Fc~cr from rhc Boranirt’s Point of WCW.” Dr. H. M. Hall, Carnegie Institution

3.

“ACritiol

by F. M. Pot.cnger,

z.

337

Los Angcle~

and Trcxment

Studyof

*so Cases of Hay Fcvcr.”

Geo. Pinerr,

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M.D.,

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Asthma.” M. A. Ramircz,

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.\lrw

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“The

Treatment

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to Food Proteins.” 0. K. Brown,

M.D.,

E. W. Phillips,

5. 4.

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M.D.,

Phanix

Phmnix “Allergic

Rcnctions

Fed Baby, A Dietary

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Bmro~r

FIG. 38. See legend for Fig. 3A.

terhead of the printed program for the Second Annual Meeting on June 10, 1924. During the interval between the First and anticipated Second Annual Meeting, 150 invitations were sent to men throughout the country who it was thought might be interested in the field of allergy. Part of the response to this was the first indication of a counterpart group forming on the East Coast. At the second session, held in Chicago and consisting of 10 papers, the attendance of 32 physicians was double that of the previous year’s meeting. With 23 new names added, the membership roles totaled 33 as the Association entered its third year. With the election of William W. Duke (Fig. 6) of the University of Kansas and Kansas City, Missouri, the office of the President moved eastward and the organization adopted yet another name, the American Association for the Study of Allergy. This name was retained until the Association was incorporated into the American Academy of Allergy 19 years later. The annual session of the AMA in Atlantic City, New Jersey, during May, 1925, placed the Society’s Third Annual Meeting even further east, and with the newly elected members there was representation from many sections of the country. At the Fourth Annual Meeting in Dallas, attendance had again increased, with 60 people recorded present at the sessions. The Association, though still predominantly midwestern and far western in its membership, was beginning to develop a truly national image. However, to give this professional group a distinctive identity, especially

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FIG. 3C. See legend for Fig. 3A.

for purposes of differentiation from the Society for the Study of Asthma and Allied Conditions that announced its formation in 1924 in New York, the organization continued to be popularly and quite unofficially known as the “Western Association.” From its inception the apparent intent of the Western Association was to be democratic. All who wished to participate in the formal program were allowed to do so and unlimited time was provided for discussions. Within five years the work of the Association and its programs became sufficiently popular to require an increase from one to two days for the conduct of formal sessions in this open format. Rowe’s secretarial observations (Personal communi-

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OC THE AXp.ICA:l SCCIEIY FOX !I’HZ STUDY OF ALIaGY

In 1923 the Yestem Society for the study of Hay Fever, ksthna and Allergic ?%eases xas orgardzd by Drs. Selfridge, ?inosr and %rze. The first annual neetinC was held on June 25, 1923, at th% Ct. Francis Hotel, .%I Trancisca, just prior to the nesting of tie A.K.A. ‘Ihe morning session opened at ten o’clock with President, Grant Selfrkige, aresiding. Adj owned

at noon an3 resscned at two-thirty,

until

Academy

contin&g

The great importance of allergy in the diagnosis and treatment of disease, especially hay fever and asthma,has led to the organization

five.

of this society for the study and experimentaldevelopmentof allergy

was re-elected Grant Selfridze. - _ Fan ?rancisco. Colorado F$ings, first viceTresident; 1:. V. Xullin, 1.I Phoenix, second vicepresident; ?. .*. ?illips, president and Albert H. Powe, Oakland, secretary and tiecutive cornittee: treasurer. Oeorge Piness, Los Angeles; E. S. Keofe, Boston, and X. A. Ramirez, Ye!.: Yo”. The follordng applications r:ere received and accepted: C. 9. C)‘i;eefe, Scston; 3oland Cannings, Los AnSeles; 7. ;:. Duke, Kansas City; E. :s’. Phillips, Phoenix; %zual :‘atson, Tuscan: haxinilian A. .%xires, Dew York City:- . D. E. Srcwbridze. Presno. Aoolications .. xere received fron ChaPpel and Babcock b-t they xere rejected as the neGbership cor=Tittee did not feel that the;- ::ere sufficiently interested to be eligible for nenhership. he secretary was instructed to send out invitations to a grou? of men inviting then to join and to arrange fcr the 192h program.. %ing to the intere+ ShO!.ll bv Castem Ken and ;tith their oersuasion it t;as decided- to change the Society to a national cne under the nane of the Ansrican Association for the Study of Aller~. to arrange for second annual neetin;; to be held In Chicago just to the A.Ii.4.. meeting. The secretary

The American Allergic Society is the outgrowth of the Western Society for the Study of Hay Fever, Asthma and Allergic Diseases.

:ias instructed

the prior

FIG. 4. Minutes of the First Annual Meeting of the Western Society for the Study of Hay Fever, Asthma and Allergic Diseases.

in disease. Physicians who apply and who are electedto membership in this society shall be expected to actively engage in the clinical or laboratory inwstigation of aller,~. Annual meetings will be held,‘at which a symposmm of articles on this subject will be presented. FIG. 5. Announcement bearing the first name change of the Western Society for the Study of Hay Fever, Asthma and Allergic Diseases.

development” of allergy and disease. Physicians who apply and who are elected to membership in this Society shall be expected to actively engage in the clinical or laboratory investigation of allergy.

This was followed one year later by an additional statement: The American Association for the Study of Allergy desires the affiliation of all physicians who are giving special attention to the diagnosis and treatment of allergic diseases. The purpose of the Association is social as well as educational, and its primary aim-the constructive development of the science of allergy.

cation, 1967) noted that “diversity and differences in opinion were many and freedom of speech prevailed, ’ ’ and that the spirited discussions and strong opinions held by Piness led to his being termed “the firebrand of allergy. ” Though the official application information indicated that “membership was limited in numbers and that specific information would be utilized to deternine eligibility,” applicants were welcomed and open membership was the order of the day. In contrast to the academically oriented Eastern Society that was developing simultaneously, during its early days the Western Association sought members from among the ranks of practicing physicians. The purpose of the Association was summed up in a statement issued after the First Annual Meeting in 1923:

Four years later in 1929, final language adopted for the objective was “the advancement of research and clinical knowledge of Allergy and the Allergic Diseases and associated problems. ” By the time the Seventh Annual Meeting was held in Portland, Oregon, during July of 1929, membership had increased to 95 full Members including some who now held dual membership in the more exclusive Eastern Society, and I1 Corresponding Members from European countries were elected. Apparently the objective was prestige by association through a provision for corresponding membership, for among the first included in this latter group were distinguished medical scientists:

The great importance of allergy diagnosis and treatment of disease, especially hay fever and asthma, has led to the organization of this Society for the study and experimental

$Though the language is not clear, this seems to be the first indication of a need for study of experimentally induced models for investigation.

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FIG. 6. Early members of the American Association for the Study of Allergy whose continuum of leadership also provided direction for growth of the Association (left to right): William W. Duke (reproduced permission of Blood 1:455,1946, and courtesy Ann Allergy 33:54,1974); Warren T. Vaughan; and J. Harvey Black.

l

l

l

l

l

l

l

Maurice Arthus of Lausanne, the Swiss immunologist who described the phenomenon bearing his name Frank Coke of London, whose work described the prevention of sensitization in nursing infants by dietary control; author of a leading textbook on asthma Robert Doerr of Base], editor of a classic textbook on immunology Charles Richet of Paris who, with Portier, first described anaphylaxis Pasteur Vallery-Radot of Paris, dominating figure of clinical allergy in France Carl Prausnitz, Professor of Hygiene in Breslau, who, with Kiistner, described the capability of serum to passively transfer immunologic (reaginic) skin reactivity (the P-K reaction) W. Storm van Leeuwen of Leiden, who first described allergy to molds as an occurrence in the canal houses of the Netherlands

Once the organization had been built rapidly to this size, an attempt was made to effect a measure of selectivity by adopting the following constitutional provisions at the 1929 meeting in Portland. 1. Two categories of membership were created. Active Members were limited to 200 physician? “whose contributions to understanding of allergy associated phenomena were of sufficient merit or whose major interest in this field of medicine made them

6A goal not attained since Active Members totaled only 97 at the time of the WesternAssociation’s amalgamationwith the Eastern Society in 1943.

eligible for consideration after first being elected to Associate Membership.” 2. Absence from three successive annual meetings or failure of a member to produce a publication “sufficiently excellent” to meet approval of the Executive Council constituted reason for being dropped from membership. 3. Failure to present a paper, thesis, or case report on allergy or an associated subject before a regular meeting of the Association within three years following election constituted reason for automatically dropping an Associate Member otherwise eligible for advancement. 4. Members were prohibited from supplying test materials to those not qualified to use them and from selling to physicians materials for the specific (injection) treatment of patients not previously studied by that member. The manner and extent to which these requirements were monitored and enforced is not documented. However, that some action must have been taken against those who did not measure up to the standards of interest or to meet the requirements either for publication or participation in program presentations is suggested by a recorded list of “former members” who were dropped from the roster for unstated reasons. Of these it is of interest to note the names of several physicians who apparently passed through the Society en route to achieving prominence in other fields of endeavor: e.g., Harry Beckman of Marquette University, author of classical textbooks on clinical

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pharmacology, whose Treatment in General Practice (Philadelphia, 1930, W. B. Saunders Company), alone went through six editions; Joseph Eller of COlumbia University College of Physicians and Surgeons (P&S) and New York Polyclinic Medical School, at the fore of international (Pan-American) endeavors in dermatology and noted for an authoritative textbook on cutaneous tumors, Tumors of the Skin, Benign and Malignant (Philadelphia, 1939, W. B. Saunders Company); and Logan Clendening of the University of Kansas and Kansas City, Missouri, distinguished as a famed medical historian for hissource Book of Medical History (New York, 1942, Paul B. Hoeber, Inc.), author of popular medically relevant books for the layman [e.g., The Human Body (New York, 1927, Alfred A. Knopf, Inc.), which sold over a half-million copies], and syndicated newspaper columnist on health topics. In the case of men associated with commercial endeavors of that day relevant to the practice of allergy, however, definitive action is a matter of record. For reasons not stated, actions of the Association reflected some bias against commercial laboratories engaged in the preparation of allergenic extracts or perhaps against some policies they might have pursued in the sale and distribution of materials to “unqualified” physicians. Because of a constitutional amendment adopted in 1931 that prohibited membership for anyone associated with or employed by “a commercial manufacturing laboratory,” members identified with Cutter, Hollister-Stier, and Abbott Laboratories were arbitrarily dropped. Apparently, later there must have been second thoughts as to the wisdom of this action since the name of the respected botanist 0. C. Durham of Abbott Laboratories, who conbibuted so significantly to our knowledge of air sampling for pollen, was once again listed in the membership roles for 194 1. Whatever the problem, conflicting interests between private and commercial sources of prepared allergenic extracts and their distributors apparently were eventually resolved. As professional societies expanded the size and scope of their activities, increasing dependence on pharmaceutical houses for financial support became overt and increasingly pursued. Along with contributions to society programs, their purchase of exhibit space at society meetings’ had been an especially important supportive factor. The role played by the founders in the initial organizational efforts helped expand the Western Associ‘Commercial exhibitors were first introduced at the Third Annual Meeting of the American Academy of Allergy in New York, November 25 to 26, 1946.

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J. ALLERGY

CLIN. IMMUNOL NOVEMBER 1979

ation into a professional society of national scope. The forceful personality of the senior member of the three founding California colleagues, Selfridge, was clearly visible in the guidance of initial activities during his two-year tenure as the Association’s first and second President and the subsequent four to five years that he served on the Board of Directors (which later evolved into the Executive Council). However, as the group increased in size with a corresponding increase in diversity of programs, Selfridge’s interests in organizational activities and newer developments in the field of allergy apparently lessened. By 1931, at age 67, he had resigned from membership. His interests and activities were gradually directed to nutrition and to popularizing the use of “high doses” of vitamins. The specially developed “Selfridge formula” for vitamin B complex was claimed to have great therapeutic benefit in combating the effects of aging and in the treatment of allergic disorders, alcoholism, and hypertension. He led a vigorous but unsuccessful campaign to establish a governmental Institute of Nutrition in San Francisco that eventually evolved as a National Institutes of Health endeavor in Bethesda, Maryland. In contrast to Piness and Rowe who continued at the fore of clinical, investigational, and publication pursuits for many years, Selfridge dropped out of sight of his Association colleagues on the national scene. His influence as an organizer and pioneer practitioner of allergy was thus never fully appreciated by the large body of physicians emerging as specialists in allergy in the years that followed. Piness, whether serving as a member of the Board/Executive Council for 12 consecutive years, as the Association’s eighth President in 1930, or when engaged in on-the-floor or behind-the-scenes activities, remained an involved and outspoken Association member, providing leadership during his active career as an allergist. In organizational affairs, committee work, and scientific and professional endeavors of the Western Association and the American Academy of Allergy that followed, he could be depended upon to speak out on most issues, whether scientific or political. His voice was heard and his actions were felt especially in attempts to establish an independent certifying Board of Allergy when interand intraorganizational rivalries and strong personality differences colored the circumstances. Rowe served as Secretary-Treasurer for the first five years, then as the seventh Association President in 1928, and as a member of the Board/Executive Council, all while pursuing an unabating clinical interest in foods as etiologic agents in a wide spectrum of allergic disorders. He remained highly visible in

VOLUME NUMBER

The American Association for the Study of Allergy

64 5

organizational activities and effectively utilized the Association’s programs and platform to develop and present his theories and reports. As the activities of the Western Association became better known as a result of publicizing and synchronizing the annual meetings with those of the AMA, many members of the Eastern Society who held prestigious academic appointments and positions as heads of clinics were attracted to its programs and joined in membership. Some became presidents, e.g., Richard A. Kern (1932) of the University of Pennsylvania, Alfred H. W. Caulfeild (1933) of the University of Toronto and Connaught Laboratories, Francis M. Rackemann ( 1934) of Harvard and Massachusetts General Hospital, and Harry L. Alexander (1939) of Washington University, St. Louis, and first Editor of THE JOIJRNAL

OF ALLERGY.

Among other Association members who served in the office of President and achieved national reputations for contributions to this newly emerging field of medical specialization were men whose introduction to allergy or whose original organizational affiliations could be related to the forum provided by the Western Association: William W. Duke (Fig. 6) of the University of Kansas and Kansas City, Missouri; third President (1925), Executive Council member for 11 years; recognized for studies on platelets, hemorrhagic diseases, bleeding time, and the earliest description of physical allergy; member of the Western Association one year prior to joining the Eastern Society. Karl K. Koessler of the University of Chicago and Sprague Institute: two terms as fourth and fifth President (1926 and 1927). With his young assistant, Harry L. Huber (President in 1938), Koessler first described the pathology of asthma. Harry S. Bernton of Georgetown University in Washington, D. C.; succeeded Koessler as President in 1928; responsible for the establishment of an Allergens Research Division in the United States Department of Agriculture. His work with chemists in this division resulted in the description of the allergenicity of castor bean products and the definition of the allergenic fraction of cottenseed. Alfred H. W. Caulfeild of Connaught Laboratories and the University of Toronto; eleventh President ( 1933). In addition to his original investigations on allergic phe-

341

nomena Caulfeild had earned a distinguished reputation as one of the foremost pathologists in the United States and Canada. Warren T. Vaughan (Fig. 6) who, after leaving his work in preventive medicine and hygiene at Harvard, established the Vaughan-Graham Clinic in Richmond, Virginia; Secretary-Treasurer for IO years ( 1929-1938) followed by a succession of offices leading to President in 1940, author of an exhaustive textbook on allergy, and Editor of the prestigious Jourrzal qf’lahorutory und Clinical

Mcdicitw.

J. Harvey Black (Fig. 6) of Baylor University in Dallas; a former medical school dean (Southern Methodist University); Executive Council ( 1925- 1936), President (1935), Secretary-Treasurer (1938- 1942); following Vaughan’s death Black assumed responsibility for maintaining the preeminence of his friend and colleague’s classic text on allergy by preparing the second and third editions. Samuel M. Feinberg of Northwestern University in Chicago; joined the Association in 1928 and as its last President ( 1943) played an instrumental role in effecting amalgamation with the Eastern Society; author of a popular textbook on allergy. Exact reasons for seeking membership

in the As-

sociation by many who were relatively uninformed in allergy were as diverse as their backgrounds in medical practice. For some it was sheer interest and the opportunity to broaden medical horizons, or the excitement of participating in the uncovering and sharing of new knowledge. For others, it was more pragmatic; here was the expedient for changing direction of one’s medical practice by getting in on the ground floor of a newly developing specialty. Whatever the reason, the means to achieve these goals were indeed facilitated by strong, judicious, and imaginative leaders and the stimulus and opportunity for learning experiences provided by their influence. Determination, time, and effort each played a role in the course of events and progress by which the Western Association ultimately came of age. Twenty years after its founding, recognition of its organizational force could no longer be denied by the “Easterners,” whose beginnings were more deeply rooted in academic and investigational orientations. In 1943 the Association’s “Western” image was officially put aside and amalgamation with the “Eastern” Society effected.

Ill. The Society for the Study of Asthma Allied Conditions

While plans for the First Annual Meeting of the newly organized Western Society for the Study of Hay Fever, Asthma and Allergic Diseases were in progress. a similar idea was germinating within the halls of the Medical Society of the County of New York on March 26, 1932. The impetus for establishing a professional society arose as a result of discussion among the participants in the scientific program given that day, which was as follows: Management of Casesof Bronchial Asthma; Robert A. Cooke, M.D. Use of Nonspecific Protein in the Treatment of Asthma; Francis M. Rackemann, M.D. Asthma and Tuberculosis; George M. MacKenzie, M.D., and Ross Golden, M.D. Discussion by Harry L. Alexander, M.D. Robert Cooke by that time had already achieved a distinguished reputation as a physician, an investigator in clinical medicine and immunology/hypersensitivity, and an acknowledged leader in the practice and study of allergic disorders, having founded and established one of the two earliest allergy clinics in the United States (see footnote 2, p. 334). Rackemann, Alexander, and MacKenzie’s introduction to Cooke had come about a few years earlier when the three were research assistants to Warfield T. Longcope who was then Bard Professor of Medicine at Columbia University College of Physicians and Surgeons (P&S) and Director of the Medical Service at Presbyterian Hospital. As a result of their interest in studying serum sickness reactions, the Longcope group was naturally attracted to the work of Cooke and Coca on guinea pig anaphylaxis. Golden, Director of the Department of Radiology at Columbia P&S and Presbyterian Hospital, apparently was only peripherally involved as roentgenologic collaborator in MacKenzie’s studies and did not figure in subsequent organizational developments. Twelve months later, Cooke, Rackemann, Alexander, MacKenzie, and eight additional colleagues with whom the idea had been pursued in the interim met to formally launch the Society for the Study of Asthma and Allied Conditions (Fig. 7). Though March 7, 1923, was given in the minutes (Fig. 8) as the date of the first organizational meeting of the (Eastern) Society for the Study of Asthma and Allied Conditions, the year is believed to be a typographical error, based 342

and

on the following facts. ( 1) The date of the scientific session on asthma held at the Medical Society of the County of York at which Cooke, Rackemann, MacKenzie, and Alexander first discussed the forming of a professional society is recorded as March 26, 1923. The first organizational meeting developed from this plan would have to have been held subsequently and could not possibly have taken place 19 days earlier on March 7, 1923. (2) At the organizational session it was voted to have the next meeting take place in Atlantic City. Records show that the next meeting actually took place according to plan on the following May 4, 1924, at the Hotel Traymore. (3) Following the election of new Members and expansion in size of the organization, arrangements were made for initiating annual meetings the next spring. The date of May 25, 1925, is given on the program for the subsequent First Annual Meeting of the Society in Washington, D. C. (4) A relevant entry in the minutes of the June 10, 1924, meeting of the Western Association in Chicago indicated plans of “Eastern men” interested in the subject of allergy who were invited to membership but declined, “saying that an Eastern Society was to be formed. ” (5) An obituary for Cooke in THE JOURNAL OF ALLERGY (31:483, 1960) notes that the idea of forming an organization took place in 1923 but that the first organizational meeting was not held until March 7, 1924. Thus the indications are that the Eastern Society had not yet been officially launched in the 1923 to 1924 period during which Rowe had contacted some of that group by mail.x Unlike the populist approach of the Western Association for the Study of Hay Fever, Asthma and Allergic Diseases that was formed in San Francisco the previous year, this New York-oriented Society began in an elitist mold. The care and selectivity that went into choosing the founding group are reflected by the respective backgrounds of the 13 people who gathered for the organizational meeting in the office of Cooke on the Saturday afternoon of March 7, 1924. Prior to this initially recorded official society meeting, the same people had been gathering in Cooke’s office some one or two evenings a month to discuss their “Creditfor

priority in the formation of the first professional allergy society in the United States must be given to the Californians, Selfridge, Piness, and Rowe, over Cooke and his New Yorkbased colleagues.

VOLUME NUMBER

64 5

The Society

for the Study of Asthma

and Allied

Conditions

FIG. 7. Founding members of the Society for the Study of Asthma and Allied Conditions. Top row, left to right: Harry L. Alexander (1888-1969), J Alexander Clarke, Jr. (18921943), Arthur F. Coca (18751959); second row, left to right: Rufus 1. Cole (1872-1966), Robert A. Cooke (18801960), Ruth A. Guy (1890-1971) (courtesy Rockefeller University Archive Center); thirdrow, /efr to right: Warfield T. Longcope (1877-1953), George M. MacKenzie (1895-1952), Edwin P. Maynard (1892-present); bottom row, /eft to right: Royce Paddock (1889-1969) (courtesy Low Memorial Library, Columbiana Collection, Columbia University), Francis M. Rackemann (1887-1973), Oscar M. Schloss (1882-1952) (courtesy Cornell University Medical College), and Albert Vander Veer (1880-1959).

343

344

Fiftieth

anniversary

issue: Historical

review

of the American

An or3mlzatlcnal in

the study

offloe, Doctors

J. Alsxmisr

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ments conc$rnlng

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were

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Francis %nd

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Coca,

CLIN. IMMUNOL NOVEMBER 1979

interested

Thoar present

Arthur.F.

T. Lon3ccpe,

Rover Padlock,

Ysvntrl,

order

Jr.,

Clarke,

nt

J. ALLERGY

of Allergy

those

of

Avenue, Cew Ycrk City.

Ruth $uy, Zwflald

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orating

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asthma

375 Pwk

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of

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the dues be

csrrled.

FIG. 8. Minutes of the first organizational meeting of the Society for the Study of Asthma and Allied Conditions. The indicated year of 1923 is believed to be a typographical error (see text).

work and review articles appearing mainly in foreign journals. This group was composed largely of those with whose work Cooke was personally familiar as professional colleagues, as former assistants, or as associates in private practice, research, or at the Allergy Clinic of the New York Hospital. l

Robert A. Cooke of Cornell Medical College was elected first President of the Society by virtue of his acknowledged leadership and accomplishment. In addition to directing the successful and expanding teaching clinic at the New York Hospital, Cooke by then had involved himself in investigational pursuits. His interests were being directed especially to the preparation of improved allergenic extracts and techniques for skin testing and specific injection treatments. He also pursued the identification of causative factors and important environmental agents in asthma and allergic conditions. His publications appeared in quick succession and dealt with such topics as antibodies and hay fever, constitutional reactions to treatment, drug idiosyn-

crasies, familial occurrence of asthma, human sensitization, the classification of hypersensitiveness, infective asthma, and the importance of paranasal sinus disease. Harry L. Alexander, elected first Secretary-Treasurer of the Society, had been following up his experience as an assistant to Longcope at Columbia P&S. He had been exposed to the work of I. Chandler Walker in allergy during a residency at the Peter Bent Brigham Hospital in Boston (see footnote 2, p. 334). Alexander had later become physician in charge of the Allergy Clinic at Cornell University Medical College and entered private practice in Newark, New Jersey. J. Alexander Clarke, Jr., of Philadelphia was a former assistant to Cooke. During this earlier training period in allergy, Clarke maintained his home in Philadelphia while commuting almost daily to and from New York. Since then Clarke had established an allergy clinic under his own direction at Jefferson Medical College Hospital in Philadelphia. Arthur F. Coca, Professor of Immunology at Cornell,

VOLUME 64 NUMBER 5

The Society

It be

eppclnted

to

tc

ert?blleh

relationa

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345

* committee

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l

l

For legend,

was recognized as one of the leading investigators of the day in animal anaphylactic sensitization. Coca had been collaborating with Cooke both in research and in the establishment of the allergy clinic at the Cornell Division of New York Hospital. Among other attainments, Coca was the founder of the Journal of Immunology in 1916 and served as its first Editor-in-Chief. Rufus I. Cole, distinguished immunologist, physician, and member of the Rockefeller Institute for Medical Research, was recognized for fundamental contributions to the study of immunity in infectious diseases, especially pneumonia. He also served as the first Director of the Rockefeller Institute Hospital. Ruth A. Guy had been a former assistant to Cooke and Coca following training in pathology at Johns Hopkins and two years of service as an American Red Cross physician in France and Albania during the postwar years of 1918 to 1920. She subsequently joined the Department of Pediatrics at Yale University, practicing in hypersensitivity problems of children at the New Haven Hospital. Though away from New York, Guy

see page 344.

continued to communicate frequently with the Cooke group. Warfield T. Longcope, Osler Professor and Chairman of the Department of Medicine at Johns Hopkins Medical School, had left New York for Baltimore three years previously. While at Columbia, Longcope had firmly established his reputation as a distinguished physician and investigator of both animal anaphylaxis and human hypersensitiveness. A pioneer in the field of allergy, his Harvey Lecture in 1916 had suggested to the medical profession widely applicable possibilities of hypersensitiveness. George M. MacKenzie, former Longcope assistant, continued to work in this area as a member of the Columbia P&S faculty in the Department of Medicine. MacKenzie’s efforts resulted in organization of an allergy clinic under his direction at the Presbyterian Hospital. Edwin P. Maynard, a former resident in medicine at Presbyterian Hospital, had been introduced to allergy while assisting Longcope in studies on hypersensitive-

346

Fiftieth

anniversary

issue:

Historical

review

of the American

ness to arsenicals. He continued to work with MacKenzie at Presbyterian, then entered private practice in Brooklyn where he started an allergy clinic under his own direction at the Brooklyn Hospital and joined the faculty of the Long Island College Hospital School of Medicine. Royce Paddock had been a classmate at Columbia P&S and later an associate of Alexander both in private practice in Newark and on the staff of the Cornell Allergy Clinic With Alexander, Paddock had studied and written about constitutional factors in bronchial asthma. Francis M. Rackemann, a former Longcope research assistant, had organized an allergy clinic under his own direction at Massachusetts General Hospital. On the Harvard faculty he was recognized as the originator of the concept advanced in 1916 that asthma could not always be of proven allergic origin. Oscar M. Schloss had been Professor of Pediatrics at Harvard before occupying the Chair at Cornell and serving a\ Chief of Pediatrics at the Nursery and Childs Hospctal. Schloss was noted for the pioneer observation in 19 12 that certain children with digestive disturbances gave positive skin reactions to incriminated foods. He was the

recognized

for

fundamental

work

in establishing

practicality of the scratch test as a diagnostic proce-

dure

in human

studies cutaneous

in turn

forms led

of hypersensitiveness. to the

development

Schloss’s of

the

intra-

test by Cooke.

Albert Vander Veer, Jr., was Cooke’s associate in office practice and at the New York Hospital Allergy Clinic. With Cooke in 1912, Vander Veer first reported on the role of heredity in human sensitization.

Lt is pertinent to note the setting in which this group 13 Eastern physicians predominately from or relating to the New York metropolitan area (one each from Philadelphia, New Haven, and Boston) met to express their interest in a newly developing field by an organizational approach. Clinical allergy had at that time been recognized as a separate segment of medical practice for only a few years. In a letter written by one of the founders (Alexander HL: Personal communi-

01

cation, 1968), it was pointed out that no common forum had yet existed where allergists could discuss their interests.” There were many handicaps for the growth of clini-

cal allergy, one of the most important being the lack of facilities for teaching what was considered to be a complex subject. Very few medical schools included clinical allergy in their curricula because there were

“Correspondence between several of these Eastern physicians and Albert Rowe, the (Western) Association’s Secretary, is noted in Association records. However, mention or recognition of either the Western organization or any of its founders cannot be found in the minutes of an early (Eastern) Society meeting.

Academy

of Allergy

J. ALLERGY

CLIN. IMMUNOL. NOVEMBER 1979

too few teachers available who were sufficiently versed in the subject. The first clinic to accept students was established in 1919 at Cornell, and by 1923 there were nine others.“’ These, however, were able to attract only a small number of physicians who had become interested in directing their attention and work to this new medical specialty. Consequently, many of the first allergists, including those who had established the first allergy clinics, were self-taught. Clinical allergy at that time had various designations-“protein sensitization,” “human hypersensitiveness,” and “clinical anaphylaxis. ” Literature on the subject and recognition of its clinical expressions began to increase noticeably as sound investigations were launched. A need for the opportunity to exchange ideas and for free discussion became increasingly apparent. Of the original founding group, Cooke was to play the leading role in shaping the Society’s future during its formative years. His term as the first President provided only the formal beginning of his influential role and leadership. Rackemann, Alexander, Clarke, Coca, and Vander Veer each served one-year terms in the presidency during the time that Cooke’s dominance was felt. This continued during Cooke’s tenure as a member of the Executive Committee for 17 of the Society’s 19 years and in behind-the-scene activities for many years thereafter as the Eastern Society evolved into the American Academy of Allergy. Cooke’s opinion was always foremost in the most important organizational business, e.g., setting of clinic standards, certification, research, election of members, and publications. Clearly the leading American physician to champion the newly developing field of allergy as a branch of internal medicine, Cooke utilized the Society’s platform to publicize several methodologies which he had a hand in developing, i.e., hyposensitization injection regimes, protein nitrogen as the basic standardization unit of allergenic extracts, and the measurement of “blocking antibody” that was raised during injection treatments. As Director of the Allergy Clinic at the New York Hospital and in its subsequent move to Roosevelt Hospital where it emerged as the Institute of Allergy, he also involved the Society’s programs in training a generation of investigators and practitioners of allergy, many of whom went on to gain prominence in their own right. Coca, although serving his turn as the Society’s seventh President, was for the most part out of the political arena. As an experimentalist and authority on loThis number is mentioned but the namesare not given in Society records.

VOLUME NUMBER

64 5

The Society

laboratory methodology, he exerted considerable influence on scientific research in the immunologic aspects of allergy and pioneered in the development of allergenic extracts for diagnosis and treatment. Described as humble, modest, and mild mannered, Coca was a man whose accomplishments were quietly felt rather than heard. His facilities at Cornell-laboratory, library, desk and couch, and experimental animals all housed in a single room within the area of an abandoned air shaft-reflected an accepting personality. Affected by increasingly crowded space and overtly developing tensions with Cooke, Coca’s role was overshadowed by that of his collaborator. Shortly after the Society’s initial meeting, Alexander left Cornell for St. Louis to accept a faculty appointment at Washington University and began what was to emerge as a very distinguished career in clinical medicine. Meriting prominence in his own right in the subsequent years of both organizational affairs and allergy on the national scene, Alexander was heard from increasingly in later years as the first Editor of THE JOURNAL OF ALLERGY and as a leader in education and clinical research. Clarke’s role was felt in clinical endeavors in Philadelphia. He was responsible for developing the Jefferson Clinic into a popular regional allergy referral and teaching center for practicing physicians from many cities in eastern Pennsylvania. Cole continued to devote his efforts to research in infection and immunity but was not associated thereafter in the further development of the field of allergy. Ruth Guy, within a few months after the 1924 meeting, departed for China to accept a faculty position at the Peking Union Medical College and subsequently dropped from membership in the Society. At Peking during 1924 to 1929 and 1936 to 1938 and back in the United States during intervening and subsequent years, her interests centered on nutrition and infectious diseases of children. Though residing and working in New York after her return from China, there is no record of any further affiliation with the Society or contact with former colleagues in allergy. Longcope, after leaving New York for Baltimore to assume the distinguished Osler Chair of Medicine at Johns Hopkins University School of Medicine, continued active interest in clinical, investigative, and publication endeavors in human sensitization and in the establishment of the American Board of Internal Medicine Subspecialty Board of Allergy. However, the necessities and preoccupation involved in teaching and administrative duties soon took him away from active organizational pursuits within the Society. Within three years after the organization of the Society, MacKenzie left New York for Cooperstown,

for the Study of Asthma

and Allied

Conditions

347

New York, to become Chief of Medicine and then Hospital Director of the Columbia P&S- affiliated Mary Imogene Bassett Hospital. He subsequently initiated one of the first prepayment insurance plans in the United States covering hospital and medical care that antedated Blue Cross and Blue Shield by many years. Maynard’s name could no longer be found on Society listings after 1930. Just out of the environment of an internship and hospital residency, he apparently was disconcerted by the personal differences and professional jealousies surfacing within the Society and the rivalries developing with the Western Association. At that early stage of his professional career, shying away from medical politics seemed to be the judicious thing to do. Additionally, while at Presbyterian Hospital he had become especially interested in cardiology, having had the opportunity to read electrocardiograms taken on one of the first electrocardiographs in this country. From this early beginning, Maynard devoted full attention to the practice of internal medicine with a major interest in cardiology, serving on the faculty of the Long Island Hospital College of Medicine (forerunner of the State University of New York Downstate College of Medicine). At about the same time the Society was getting launched, Maynard’s work with the New York Heart Association was becoming increasingly evident. He served as Chairman of the Committee on Cardiac Clinics in 1926 and became President of the Heart Association in 1945. However, he also maintained his interest in and responsibility for the allergy clinic started at his initiative at the Brooklyn Hospital after joining the staff in 1921. Because of this early established interest in allergy as well as cardiology, he continued to work in both fields at the Brooklyn Hospital. Paddock assumed responsibility for the private practice of allergy that he had shared with Alexander in Newark after his associate left for St. Louis. He also founded and directed the first allergy clinic in New Jersey at the St. Barnabas Hospital in Newark. Though not at the fore of Society political affairs, Paddock continued as an active and participating member in program activities. Rackemann’s work soon resulted in the prominent association of his name with many organizational forces, including international associations, education, training, and certification all the while he was greatly influencing development of the specialty of allergy in New England. Rackemann’s clinic in Boston had evolved into a prominent regional teaching and referral clinical center. Schloss became outstanding among pediatricians

348

Fiftieth

anniversary

issue:

Historical

review

of the American

The Society For The Study Of Asthma Ana Aliied Conditions TROGRAhd of THE

FIRST

ANNUAL

WASHINGTON, TUESDAY, NINETEEN

ME-G

D. C.

MAY THE FlRH

HUNDRED

AND TWENTY.FIVE

FIG. 9A. Program

of the First Annual Meeting of the Society for the Study of Asthma and Allied Conditions and joint session with the American Association of Immunologists.

for his talents and inspirational abilities as a teacher and practitioner. While continuing in the role of distinguished academician, Schloss subsequently championed the cause of pediatric allergists in their own right as specialists and in controversies regarding the rightful place of allergy as a Board-certified subspecialty of pediatrics as well as internal medicine. Vander Veer, as a close associate of Cooke, greatly influenced the recognition of etiologically important factors in allergic disease. This was particularly evident in Cooke and Vander Veer’s work dealing with paranasal sinus disease and infective asthma, subjects that dominated presentations on early Society scientific programs. Invited attendance at the initial meeting in 1924

Academy

of Allergy

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was based on the selection of those whom Cooke believed to be the top people in the field of allergy. No one at that time could quarrel with his choice, for with few exceptions, the men in the East were contributing to the bulk of the relevant scientific literature. In any event, the next step was to build up membership. As the first step, each of the founding members was to survey the active workers in allergy and ascertain their qualifications for membership, with quality of work as the critical requirement. During the next two years, 1925 and 1926, membership extended to New Yorkers who fell into three categories. 1. The most promising members of the New York Hospital Clinic staff: Otelia Bengtsson, Aaron Brown, Selian Hebald, William J. Mersereau, August A. Thommen, Matthew Walzer, and a member of Coca’s laboratory staff, Ella F. Grove, who later married Coca and continued to work as the CocaGrove research team 2. The chiefs and senior members of all allergy clinics in the metropolitan area: Arthur F. Anderson (Nursery and Childs Hospital), Horace S. Baldwin (Cornell Division of Bellevue Hospital), Samuel D. Bell (Bellevue Hospital Pediatric Service), Joseph Harkavy (Mt. Sinai Hospital), Maxmillian A. Ramirez (French Hospital), W. S. Thomas, and Maximin D. Touart (both of Presbyterian Hospital) 3. Immunologists who had indicated some interest in the field of allergy: Philip Levine of the Rockefeller Institute for Medical Research who had been studying blood group erythrocyte antigens; Bella Schick, distinguished Chairman of the Department of Pediatrics at Mt. Sinai Hospital, who had described the Schick test for immunity in diphtheria and with Clemens Von Pirquet had published work on serum sickness; and Linsly R. Williams, who had recently taken on the position of Managing Director of National Tuberculosis Association after serving as Director of the Rockefeller Foundation Tuberculosis Commission in France Though the organization was an Eastern group in general and New York-oriented in particular, members were next sought to represent the beginnings of allergy in leading academic medical centers in other geographic areas. For the most part they were selected by departments of medicine chairmen as promising young men with the capabilities to learn a new branch of medicine and in turn develop appropriate connections to establish allergy clinics at their own home bases. Most of the men initially selected from New York had already been indoctrinated into the specialty as it then existed and soon developed large teaching clinics in other leading New York medical institu-

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349

FIG. 96. See legend for Fig. 9A.

tions, e.g., Walzer at Jewish Hospital of Brooklyn and Brown at New York University. However, for most of the out-of-town people singled out by professors of medicine, an invitation to the Society constituted initiation to a new learning experience. Included in this group were Louis C. B. Baldwin, University of Rochester; Howard S. Caldwell, New Haven Hospital; Hal McCluney Davidson, Emory University in Atlanta; Harry H. Donnally, George Washington University and the Children’s Hospital of Washington; Charles H. Eyermann, Washington University, St. Louis; Fred W. Gaarde, Mayo Clinic, Rochester, Minnesota; Leslie N. Gay, Johns Hopkins Hospital, Baltimore; L. Whittington Gorham, Albany Medical College; Richard A. Kern, University of Pennsylvania, Philadelphia; Nils P. Larsen, Queen’s Hospital of Honolulu; Ames S. McLaughlin, Jr., Jefferson Medical College Hospital of Philadelphia; Frank R. Menhagh, Henry Ford Hospital, Detroit; George P. Meyer, Cooper Hospital, Camden, New Jersey, and the University of Pennsylvania; Simon S. Leopold, Phipp’s Institute, University of Pennsylvania; M. J. Quinn, Cheney Brothers Hospital, South Manchester, Connecticut; Harold C. Stuart, Children’s Hospital of Boston; Fritz B. Talbot, Massachusetts General Hospital, Boston. A typical reaction was that of Gay (Personal communication, 1968) who, when invited by Longcope to establish a clinic at Johns Hopkins Hospital, protested that he “knew nothing about allergy.” He was met only by the Professor’s encouraging reply, “Nobody else [here] does.” However, there were a few others among this early group of invitees who, in addition to achieving prominence in other areas of medical in-

vestigation, had already made starts in the field of allergy and were on record as members of the Western Association established two years previously: Alfred H. W. Caulfeild (Toronto University and Connaught Laboratories of Canada), William W. Duke (the University of Kansas and Kansas City, Missouri), and Karl K. Koessler (University of Chicago and the Sprague Institute). Out-of-town immunologists were selected on the same basis as those in New York to whom membership had been offered. Included were George H. A. Clowes, Director of the Eli Lilly Research Laboratories in Indiannapolis, who had been applying his expertise in biochemistry to the study of immunity in cancer cell biology; and Sanford B. Hooker of Boston University and the Evans Memorial Hospital, whose immunochemical investigations included studies on hemocyanin and diphtheria antitoxin. Of the group offered membership as the result of action taken at the Atlantic City meeting on May 4, 1924, there were, however, two noteworthy declinations. l

Dr. Herbert Fox, Director of the William Pepper Laboratory of Clinical Pathology of the Hospital of the University of Pennsylvania, who with Alfred Stengle edited a textbook of pathology that went through eight editions. Devoting efforts to an area of unique attraction, Fox also served as Director of the Laboratory of Comparative Pathology of the Philadelphia Zoological Society and published a two-volume work, Diseases in Captive Wild Animals and Birds. Though expressing a particular interest in immunology in animals, Fox declined, feeling that he neither had the time nor was sufficiently close to clinical allergy to justify membership.

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Walker, pioneer in the study of asthma. He was one of the earliest allergists whose initial studies were concerned with reactions to bacteria isolated from asthmatic patients, treatment with vaccines, and somewhat later the importance of seasonal symptoms and hypersensitiveness to dust and animal danders. Walker was reported by one observer to be a headstrong individualist who went his own way. On the other hand, another of the Boston group noted Walker to be a shy individual without interest in groups or organizations, wanting chiefly to be left alone.

I. Chandler

In the organizational meeting of March 7, 1924, action was taken to appoint a committee to communicate and establish relations with the American Association of Immunologists (AAI). Out of this liaison developed half-day joint sessions held with the AA1 at the Society’s First Annual Meeting in Washington on May 5, 1925 (Fig. 9), and the Second Annual Meeting in Albany on April 2, 1926. However, beginning with plans for the Third Annual Meeting, the Society voted to hold future annual spring meetings in Atlantic City, New Jersey, scheduled just prior to the annual meetings of the American Society for Clinical Investigation. Adopting this change in policy rather than continuing joint sessions with the American Association of Immunologists reflected the clinically related direction the work of Society members was taking. Thus, the early beginnings of a formal association between allergy and immunology lasted for only two years. The judgments made by the two related but disparate groups to go their own ways are of interest as a reflection of the respective state of the art of each of those two disciplinary activities of that day. The initial relationship between allergy and immunology was not surprising in view of the fact that Coca, by virtue of his chair at Cornell and his position as founder and first Editor-in-Chief of the Journal of Immunology in 1916, served as the hub of both interests. Investigators concerned with hypersensitiveness had predominately been studying anaphylaxis in animals and publishing in the Journul of Immunology. This approach, therefore, brought them into close association with Coca. As a result of Coca and Cooke’s intensive laboratory and clinical collaborative research, a flow of papers on “studies of hypersensitiveness” resulted in about 40articles appearing in the Journal of Immunology alone during the next decade. Such basic contributions in this scientific and highly respected Journal constituted one of the greatest factors in giving the subject of allergy a coat of respectability. It undoubtedly prompted many immunologists to lend their names and support to the foundation of the Society. The fact that Coca, as Editor of their Journal, was backing this organi-

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zational project, in addition to Cooke’s high standing in the subject and the field, undoubtedly helped in obtaining the immunologists’ tacit approval. However, despite the listing of prominent immunologists on the Society roster, their endorsements proved to be only nominal and few of them were actively engaged in the actual workings of the Society. Their names appeared on programs infrequently and usually “by invitation.” It was reported that in the initially undertaken joint meetings the immunologists were conspicuous by their absence. Allergy at that time was still an unknown entity and the immunologists were waiting for this new upstart disciplinary spin-off to prove itself. As events had it, it took many years until the immunologic, biochemical, and pharmacologic bases of allergic mechanisms were convincingly demonstrated and immunologists were once again attracted to return to the fold. Because of the academic and investigational interests and orientation of its membership, the Society provided the earliest opportunities and means for presentation of the best of original work in allergy of the day. In turn, such experiences led to the development of present-day program formats for the American Academy of Allergy. It is therefore of special interest that the original intention of the group at the 1924 organizational meeting may have been envisioned along somewhat broader lines. The minutes record that “rather than [serving as] a medium for purely scientific discussion . . . it was the sense of the meeting that this Society should be of particular service by studying problems of asthma and allied conditions relevant to public health” (Fig. 8). However, there was an agreement that a “suitable classification” of asthma and the terminology for hypersensitiveness could be considered for study by members of the Society along with other problems recommended to them: “the relation of infections of the respiratory track to asthma, investigation of industrial asthmas, methods of preparation of materials for testing and therapeutic use, and investigation of asthma clinics.” Apparently there were some second thoughts, for by the time the formal constitution and bylaws were drawn up on May 4, 1924, a somewhat revised objective was adopted: “to further the study of asthma and allied conditions and to promote discussion of the various aspects of the subjects.” In taking stock 10 years later it was pointed out that little progress was noted toward the earlier goals concerned with public health aspects of morbidity, effects of allergic illness on socioeconomic matters, and industrial problems (Cooke RA: J ALLERGY 5:528, 1934). Of special interest were periodic expressions of foreseeable success in overcoming asthma and allergic illness for individually affected patients through the anticipated

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availability of more efficacious antigens used in desensitization treatment. Particularly heralded as a great advance toward reaching such a goal was the identification of house dust as an allergen and the availability of a derivative extract.” Until amalgamation with the Western Association in 1943, the Eastern Society continued to hold annual meetings during the spring in Atlantic City, according to the consistent pattern followed by the prestigious American Society for Clinical Investigation (ASCI) and the Association of American Physicians (AAP). The Eastern Society looked upon itself as a select group of clinicans oriented to investigation and therefore felt it quite appropriate to associate if only in a temporal fashion with the elite of clinical research endeavors in medicine. In 1931, seven years after the Society’s founding and following careful scrutiny of the doings of Piness and Rowe on the West Coast, the work of the two Californians was finally recognized as meeting the standards of the Society; Piness and Rowe were then admitted to membership in the Eastern Society. Of the other early members of the Western Association, Duke of Kansas City, Caulfeild of Toronto, and Koessler of Chicago already had established and recognized careers in medicine and thus were included in the first group to be considered and elected to membership in the Society at the First Annual Meeting in 1924. As the membership increased over the first five years from 44 in 1924 to 75 in 1929 and by an additional 19 during the next four-year interval (94 in 1934), more names from southern, midwestern, and a few far-western states began to appear on the roster. Although the few days of travel required for the train trip likely constituted a strain and sacrifice of time for some of the members from distant locations, Atlantic City provided a convenient focal point for the majority from northeastern cities whose involvements remained at the center of Society activities. Additionally, the opportunity to take in both the ASCI and AAP meetings during the same period of absence from home bases served as the priority factor. As a result an “Eastern” image for a national society was perpetuated. Unlike the more populist Western Association. the Eastern Society provided an additional opportunity for many members to convene “at home” in New York each year for a half-day session

“For a view of periodically recurring discussions of future years concerned with the practice of allergy, one has only to substitute successively the words antihistamines, corticosteroids, cromolyn sodium, and a variety of new beta adrenergic agonist preparations for “house dust extract” as the reported highly promising therapeutic agent.

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held during the fall. For those who had memberships in both organizations or who lived in or near those cities where annual AMA meetings would be scheduled, there was still an additional option-the opportunity to attend an annual Western Association meeting in a different locale each year. Criteria for election to membership was not spelled out in the Constitution. It was stipulated only that membership shall be unlimited, available to anyone with a degree in medicine or in public health service interested in the work of the Society, and require sponsorship by a Society member and election by a unanimous vote of members of the Executive Committee. However these provisions were to be interpreted, critical evaluation on a personal basis was practiced with implicit control vested in the Executive Committee. It is not apparent whether this degree of selectivity or whether a rather slow acquisition in the popularity of allergy as a medical subspecialty among practitioners was responsible for the relatively slow pace of expansion of the Society. Having attained a total membership of 75 in its fifth year ( 1929), five years later ( 1934) the total membership had only increased by eleven. In 1938, however, a second class of membership, Associate Member, was created to allow for less stringent scrutiny of new proposals and the opportunity for all new members to advance to (full) Member after demonstrable and meaningful participation in Society activities. From seven Associate Members during that innovative year of 1938, 83 Associate Members were listed on the Society roster by the time of amalgamation with the Western Association five years later ( 1943), although the total number of (full) Members had only increased by five- 107 to 112. A warning that there would be no relaxation of control by Cooke and the Executive Council is reflected in a 1929 bylaw, reinforced by resolution in 1938 (hardships of transcontinental railroad travel notwithstanding): “Any member not registering for at least one of the six (semiannual) meetings during three consecutive years, may be dropped from the Society. ” There is not, however, any record of how far restrictive policies may have been pursued other than very infrequent discussions and judgments that were necessitated as a result of questioning the ethics of some particular action or episode. A great deal of flexibility of control rested in the judgment of the Executive Committee by use of the word “may,” thereby leaving disposition to judgment and bias rather than mandatory action. Influence over the Society’s affairs by select individuals was additionally assured by the provision for a term of seven years of service for each elected Executive Committee member, with only one new replacement

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THE PECULIARITIES OF HAY FEVER AND ASTHMA INTHE SOUTH AMERICAN PAMPAS k DR. RAYMOND0 ORSETTI, JEFE DEL SERVICIS DE ALERGIA DEL HOSPITAL DE GALLARDO, BUENOS AIRES. Author of “Enfermedrdos AI&car, on Erpwial Hono V Arma”~ “Alergir o liypwrw4bilid~d”~ Lhador” and othw publicat’wa.

Fiebw

do “lot

AtNm& Doctw owdtl k M owthndltw.~, b&g cl&t of ?ha largest A!lwgy clinic in South Amoriu, he is roll known in Europe for his brilliant nswchor In Botany. He is l woute for the Royal Academy ol Tropical ElMticultun In London to dalivw a series of Essays upon tlw native grasr.r of tha Argentine Pampas.

Tbo 6oceckty Is wry fortunate In obtaining Doctor Orrptti m the guest sperkw for the dinner to be held at Atlantic City, the Rose Room of the Hotel lraymoro on Saturday wwtinp, April 30th. 1936, 7:00 p. m..Drl(ight Saving Tto. It is sincwely hoped that thpro will bo a full ottondmco.

in

LEO

Aptil

13th.

Ii. wut

CRIEP

19X

FIG. 10. Fourteenth Annual Meeting of the Society for the Study of Asthma and Allied Conditions in 1938; announcement of the evening banquet and guest speaker, later revealed as a fraud (see text).

annually. Additionally, the Executive Committee was charged with managing the general affairs of the Society, serving as a membership committee, and nominating for its own composition as well as that of President and Secretary of the Society; only two members were required to constitute a quorum to effect Executive Committee actions. The Eastern Society thus was founded, nourished, and grew to maturity in an aura of elitism, pride, scientific stimulation, orientation to teaching and investigation, and attentiveness to standards of practice mixed in with the politics of authoritarian leadership. Because of these factors, meetings were well organized and attended; formal programs provided opportunities for presentation of original studies, and controversies were aired along with other less-thanrestrained discussions on the floor. Revolt against political control of the minority did not surface until later years after the emergence of the American Acad-

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emy of Allergy from the two parent organizations. Additionally, the relatively small size of the Society and the closeness of professional and personal associations among members allowed for relaxation and levity among the 100 or more usual attendees at an evening banquet after a hard day of scientific intellectual pursuits and arguing. As a result of an incident at the annual meeting banquet (Fig. lo), the pattern of after-dinner speakers was changed after 1938. Bedecked with ribbons and medals, the “distinguished foreign scientist” guest speaker initiated his talk with an unrestrained challenge against the reported work of Coca and the dictums of Cooke, questioning loyal adherence of Society members to unproved materials and methods of diagnosis and treatment in the practice of allergy. After the generation of much heat and increasing uneasiness, developing tensions, and embarrassment among the assembled as well as the targets of accusation, the unassuming Coca and austere Cooke, the speaker confessed and revealed his true identity. As a hoax designed by and known only to the Program Committee of two, a part-time actor and insurance salesman from Boston had been carefully rehearsed to masquerade as “Professor Raymond Orsetti. ” Just that afternoon he had studied and mastered the field of clinical allergy under the tutelage of Program Chairman Leo Criep and Society President Aaron Brown. It was resolved from that point on that banquet speakers would be selected to provide entertainment rather than scientific presentations. In retrospective consideration of progress and accomplishments, it was indeed a tribute to the dedication, energy, and work of the secretaries, initially Harry Alexander succeeded by Will Cook Spain, who were able to operate Society business out of their professional offices on a personal basis and maintain Society business effectively at a dues assessment of $2.00 per annum per member as set at the organizational meeting in 1924. Though the annual dues were raised to $5.00 at an Executive Committee meeting 12 years later (May 3, 1936), the $3.00 increase was earmarked specifically to contribute to the dinners at the spring and fall meetings each year in order to make up deficits per plate and to subsidize guest speakers. While the Eastern Society considered amalgamation a reflection of the Western Association’s coming of age, for itself transition to the new American Academy of Allergy largely represented but a change in name. Though appropriate accommodations were effected, the tenor and direction of programs and activities continued undiverted from the Society’s charted course.

IV. The Eastern, the Western,

In launching their respective organizations, the founding groups of the Western Association and the Eastern Society apparently had essentially the same purposes and objectives in mind. It was only the manner in which each sought to serve the best interests of allergy, to focus attention, and to assist in developing this newly emerging branch of medical research and practice that differed obviously. The intention and approach of Selfridge, Rowe, and Piness were made known by public announcement. The subject of allergy was to be popularized and initially, at least until an available and functioning organization was built up, all those with an interest in learning or contributing were welcomed to membership. Until the specialty could grow through medical school instruction and increased postgraduate training opportunities, a national or even regional professional society could not exist without a critical number of members. Open recruitment on a national basis, therefore, was sought. However well intended the three Californians and the small group that emerged from the 1923 San Francisco meeting were, the Cooke-led associates would have none of it. This was simply not the way business of this sort was done in the sophisticated and prestigious established medical centers of the Northeast, in New York, Boston, Philadelphia, and Baltimore. From this perspective, it is possible to appreciate the reply received by the first Secretary of the Western Association from the “twenty Eastern men interested in this subject [who] declined [the Western Association’s invitation] saying that an Eastern Society was to be formed and they did not think it would be well to have a National Society.” Initially unaware of the exclusive mold in which the Eastern Society was being cast, the Western Association learned within the year that only two of its members with national reputations (Caulfeild of Toronto and Duke of Kansas City) had been elected to “the Club.” Admission was by selection rather than by open application. The following year only a New York-based member of the Western group, Rameriz, was accepted. Each organization then went about developing its own programs and activities unilaterally in keeping with its own character. It was an additional four to five years before the first crossovers occurred and steps were taken leading to joint memberships among the leaderships of both organizations. The perceptions of the Eastern leadership’s strict

and amalgamation

control over the admission process varied and interpretations depended upon the particular situation of the viewer. To members of the Western Association who believed themselves fully qualified by virtue of orientation, interest, and accomplishment, the Eastern group was considered ultraexclusive, manifesting intolerance of those who did not adhere to the viewpoints and dictums of the Cooke school. Some who believed themselves to be distinguished in other circles were turned away. To one Cooke loyalist it was important to recognize that among the membership of the Western Association there were men who either had attended only short courses or otherwise presented with inadequate training in allergy. As a result of such deficiencies it was believed that the Western Association’s programs suffered from presentation of work that often lacked controlled study and cures that were subsequently found to have been reported prematurely. Additionally, patients and family physicians were becoming so intrigued by skin tests that large “allergy” practices were built up without sufficient care or concern. It was believed justified that those at whom the finger was being pointed would first have to put their houses in order. One of the early allergists who believed his observations were without bias felt, retrospectively, that the attitude of the Cooke school was based primarily on matters of quality rather than of organizational politics. Perhaps it was pride in achievement resulting from the quantity of original work published in early issues of the Journal of Immunology, rather than pomposity and feelings of superiority that guided the viewpoint of Cooke and associates. On the other hand, the early contributions of the “Western allergists” were not prejudged solely on the basis of being clinical observations, but were held subject to suspicion because of the empirical nature of the work. It was not until perhaps 15 years after their beginnings that “Western allergists” began to turn out immunologically related publications that could stand up to the critical reviews of the time. But they eventually caught up, so that in later years this explanation did not suffice to excuse those who still opposed the joining of forces from the accusation of Society politics. No doubt it was the upgrading of mdividual abilities and expertise and the acquisition of relevant knowledge through reading, attendance at meetings, and clinical experience as part of the self-learning 353

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process that played a large role in the demonstrable improvement of Western Association programs. However, the opportunities for interaction eventually provided by dual organizational memberships served as a truly important force. Additionally, a few individuals who entered allergy via the Western Association were in position, by virtue of abilities and accomplishments, to lend their talents, provocative thoughts, and inquiring minds to critical appraisal. Such were the distinguished Professor of Experimental Medicine at the University of Chicago, Karl K. Koessler. the Editor of the Journal of Laboratory atzd Clinicul Medicine, Warren T. Vaughan, who had come from an academic background, and a former medical school dean, J. Harvey Black. Initially, it was Coca who lent his distinguished name to the Western roster in 1928. The next year one might have explained Alexander’s seeking to identify with the Western group solely on the basis of his move to St. Louis except that accompanying him in this affiliation were Rackemann of Boston and MacKenzie of New York, all members of the Eastern charter group. Among others who were taken into the Eastern Society in early years and also opted for dual membership about 1928 to 1929 were Richard A. Kern of the University of Pennsylvania (later to become Chairman of the Department of Medicine at Temple LJniversity), Leo H. Criep of the University of Pittsburg, and Matthew Walzer of the Jewish Hospital of Brooklyn, all of whom were subsequently to make major contributions to teaching, investigation, and publication endeavors in allergic disease. Samuel M. Feinberg of Northwestern University, an early Western Association member, would also be heard from in later years as a distinguished teacher, clinical investigator, and author in the transitional years during which the clinical practice of allergy emerged as a disciplinary endeavor. Apparently convinced that the Western Association was on the upgrade, by 193 1 Cooke had lent his name to the roster, even if only in token membership. About the same time in collateral moves Rowe, Piness, Vaughan, and Black were elected to membership in the Eastern Society. By then the third charter member of the Western Association, Selfridge, was about to retire, tender his resignation to the Association, and drop out of further view from clinical allergy and organizational activities. Before the Western Association and Eastern Society were to amalgamate in 1943, seven men would have served in the office of President of both organizations: Rackemann, Alexander, Caulfeild (concurrently in 1933), Kern, Milton Cohen, Vaughan, and Harry Huber.

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The rather exclusive image projected by the Eastern Society, the high regard for the work being done by some of its members, and the resultant better quality of the program presentations at annual meetings offered incentive for many members of the Western Association to seize upon opportunities to join the Eastern Society. Reasons for men from the Eastern establishment to join their Western counterpart, however, were not quite as straightforward and certainly not the same in each case. In a few instances, the move proved to be only token patronization. Others, however, genuinely sought active participating roles and welcomed the opportunity to be heard as well as to hear other viewpoints, to exert initiatives difficult or impossible to effect within the tightly controlled and politically structured Eastern Society, or to move about the country with the annual meetings held in a different city each year. While Cooke’s political leadership remained unchallenged, the bringing of “Western allergists” into the Society did result in questioning and contesting of some of his scientific tenets, especially skin-testing techniques, along with methods for preparing allergenic extracts, and the management of patients as frequent subjects for presentation and discussion on annual meeting programs. Piness, in reported “firebrand” fashion, led floor arguments championing the Westerners’ approach to diagnosis by use of the scratch test against the Cooke-school proponents of the intracutaneous technique, a major issue of the day. The May, 1927, annual meeting of the AMA in Washington, D. C., offered the opportunity for several members of the Eastern Society to stop in at the Western Association’s sessions, which both Coca and Cooke had been invited to address. Koessler, then President of the Western Association, in conversations with the Eastern President, Gay of Baltimore, broached the idea of exploring possibilities for merging the two groups. The time, however, was not considered right by Cooke and nothing came of this. Periodically thereafter, as each of the two allergy societies assumed national character, recognition gradually developed in much the same manner. Consequently, many men in both groups felt that the field of allergy would be better served by a single organization. At different times and especially at the initiative of the Western Association, the matter had come up for discussion, but it was never entertained seriously, particularly by the Eastern Society. In June, 1935, the circumstance of the AMA holding its annual meeting in Atlantic City led to the first combined meeting of the Western Association and the Eastern

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Society. Though advantages of merger were demonstrated by this event, again negotiations did not go forward. Three years later on December 3, 1938, a committee consisting of Alexander, Vaughan, and Rackemann acting for the Western Association and a counterpart committee consisting of Cooke, Kern, and Spain for the Eastern Society once again met to discuss joining forces. However, the judgment to come out of that meeting was for something less than union. The committees, while recognizing the need for more concerted action on the part of both societies in certain matters of policy of vital interest to each, nevertheless expressed the belief that it did not seem feasible at that particular time to effect a complete physical merger. It was, therefore, their recommendation that the Western Association and Eastern Society as then constituted should nominally combine to form the “American Association of Allergists.” However, this joining under a larger aegis was to be one in name only, and the two societies would continue under their own names, each conducting its own meetings and election of members as usual. The American Association of Allergists was for the time being to function only in an Executive Committee. This would be composed of four representatives from each component society for the following purposes: ( 1) working together on the Joint Committee on Standards in connection with certification and inspection of allergy clinics, (2) acting as a clearinghouse for the two component societies in matters of policy regarding education, legislation, certification of allergists, publication, and editorial policy, and (3) formulating criteria for membership and associate membership to guide the component societies. Discussions ensued and the plan was circulated to the memberships of both groups. While considered a good start by some, it did not satisfy others and apparently was neither adopted nor given the chance for implementation. However, negotiations for merger were again picked up during the next two to three years and amalgamation eventually came in December, 1943. Since there was evident incentive to work together, what then were the forces responsible for delay? Those who felt that there was probably not sufficient reason for having started two national societies tended to explain the delay in amalgamation with the same reason--the reluctance of some to surrender bases of power. The Western Association, conscious of being looked down on by the Eastern Society in its periodic approaches for amalgamation, projected that the benefits to be derived through unified membership would include improved programs and savings in expense

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and time with only a single meeting to attend. However, little if anything came of their approaches. In an after-dinner address to the Society on April 27. 1934, Cooke (J ALLERGY 5:527, 1934) is on record as believing himself correct “in saying that it has been the sense of the [Eastern] Society that we should not enter into an organized union for the reason that the majority of members would not attend meetings far afield as would be necessitated by any union with a sister society [Western Association] and would therefore be deprived of the privileges that membership in this Society sought to obtain.” Perceptive members of both groups who had no particular axe to grind believed that inherent in the Eastern’s rejections were an underlying feeling of superiority and the fear of dilution of influence. Initially, other than very early geographic sectional identifications, differences could be identified in professionally oriented issues as viewed by the academically oriented vs the clinicians. As this differentiation narrowed, other reasons were found for argumentative stances. Desires to retain influential roles and ego-related interests had to be served. Gradually, signs of capability and good judgment began to surface, especially among some of the more newly arrived, energetic, and knowledgeable younger men. The day had passed when almost complete dependence for leadership had to be placed in the hands of the very few pioneers who were responsible for btinging the specialty of allergy and particularly its professional societies into medical recognition and acceptance. But however gracious and willing, the surrender of power bases, self-serving interests, and personal control of that which one may deem best for all never comes easily. As individual differences replaced sectional differences, a major controversy continued. An argument about the advantage of one skin-testing technique over the other pitted the scratch test, with Piness as foremost proponent, against the intracutaneous method, championed by Cooke. Using the medium of letters to the Editor of MAMA, Piness further recorded his criticisms of Cooke and Coca, especially to point out that extracts prepared by their method were not adequately buffered, resulting in denaturation of protein components by the addition of phenol as a preservative. The plan for formation of the “American Association of Allergists,” representing federation under a supergoverning Board rather than genuine unification, was discussed, modified, rediscussed, and recommended for adoption by the respective executive committees, but dissipated before any workable arrangement was presented to the membership at large

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for implementation. Meanwhile, the voices for amalgamation continued to be heard periodically, often enough to demonstrate that evasion of the real issue could not be put off forever. What then were the forces that finally led to the culmination of unification efforts in December, 1943? Some would attribute it to the circumstances of the day-wartime conditions that created travel problems. It was difficult if not impossible to obtain and retain guaranteed train and hotel reservations for any one city. Attempts to successfully negotiate travel for two trips to attend two different meetings at the same time of the year could be a self-defeating experience. The 1942 episode was fatiguing as well as puzzling to those who had to travel considerable distances on less-than-convenient schedules to attend two meetings in Atlantic City a few weeks apart, i.e., the Eastern Society’s Annual Meeting on May 2 and the Western Association’s sessions in conjunction with the AMA the following June 8 and 9. The real reason, however, cannot be explained that simply. Activities arising out of interlocking memberships had done much to demonstrate the identical aims and ideals of the Eastern Society and the Western Association. Realizing that the Western Association had genuinely progressed in scientific and professional aspects, the Eastern Society could no longer put off recognition of its near-equal counterpart. Once this earlier resistance had been overcome, the validity of reasons previously advanced by the Western Association. i.e., enhancement of future programs and the economy of time and expense through membership in a single society, was acknowledged. With increasing travel problems brought on by wartime conditions, the annual spring meetings of both organizations were suspended after completion of those held during 1942. Despite the loss of the impetus to form a single society that had arisen from discussions at earlier annual business meetings, good intentions continued and plans went forward at a higher level. At a meeting of the Advisory Board of American Allergists” during July, 1943, it was recorded that various phases of activities and policies affecting the welfare of the two national societies were considered, including possible amalgamation. It was the unanimous feeling of the Board composed of Cooke, Clarke, Gay, Kern, Piness, and Rackemann that discussions to this end should be renewed and a plan acceptable to both groups perfected and if pos“Constituted by three representatives from each of the two organzations for the purpose of serving as an Advisory Committee on the subspecialty of allergy to the America Board of Internal Medicine; see section VI, “Standards and Certification.”

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sible adopted. It was their intent that after the war’s termination, when meetings would be resumed, added impetus and interest could be supplied to combined efforts developed by a single strong society. In letters to the presidents and secretaries of both organizations. the Advisory Board offered the suggestion that a committee of three from each society, the President, the Secretary, and one member at large (but expressly not a member of the Advisory Board), prepare for a meeting as soon as possible. It was hoped that such a committee might agree upon a plan and a constitution which could then be submitted to the membership for vote by mail. The wheels were set in motion promptly, and on October 3 1, 1943, a group of six consisting of Samuel Feinberg (President), J. Harvey Black (Secretary), and Milton Cohen (member) for the Western Association and Robert Chobot (President), Will Cook Spain (Secretary), and Stearns Bullen (member) for the Eastern Society met at the Hotel Blackstone in Chicago to work out a tentative plan. Preliminary communication between the two presidents, Feinberg and Chobot (Fig. 1I), exchanging and considering suggestions in both directions, had paved the way considerably. A letter from Chobot to Feinberg dated August 5, 1943, is of particular interest in that it points out a desire on the part of the Eastern Society to make the terms of union as equitable and fair as possible by offering a definite set of suggestions. 1. The President was to be nominated by one organization, the Vice-President by the other; a similar arrangement was to be made for nominations for Secretary and Treasurer. 2. Arrangements for an annual meeting place (apparently one of the prior stumbling blocks to amalgamation) could now be met due to the Eastern Society’s withdrawal of its insistence on continuing according to its established format. Admitting that it was possibly wrong in holding all meetings in the East, the Society would now be willing to schedule meetings for alternate years in the West in order to assure equitable geographic distribution of meeting sites. Additionally, the Eastern group now believed that a two-day meeting similar to that of the Western Society, together with a Forum, should be sought in preference to the Eastern format. This, however, was provided that meetings of the new society would be held during a fall month “after the hay fever season is over.” 3. The Eastern Society’s more liberal policy for Associate Membership should be continued, and without any limitation on the duration of Associate Membership. The Eastern group believed that not

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FIG. 11. Presidents of the parent professional organizations under whose leadership amalgamation was effected (left to right/: Samuel M. Feinberg, last President of the (Western) American Association for the Study of Allergy and framer of the new constitution (see text), and Robert Chobot, last President of the (Eastern) Society for the Study of Asthma and Allied Conditions and first President of the American Academy of Allergy.

only had its more liberal policy proved a success but also noted that, by avoiding time limits, the disagreeable task of having to ask an Associate Member to resign could be avoided.13 4. The Eastern Society admitted that the Western Association’s policy of automatically having past presidents serve on the Executive Committee and of Executive Committee members having definite terms probably represented a better approach than its own more arbitrary method. 5. While the Advisory CommitteeI would be continued, henceforth it should deal only with subspecialty Certification Board matters; also, it should be a rotating Committee with members other than the permanent Chairman having clearly defined terms of office.‘: Though some thought may have been expressed at the time that unification would minimize any further splintering that might arise because of the formation ‘“It is somewhat surprising to note that the more selective and scientifically critical Eastern Society held a more liberal attitude in regard to qualifications for membership. Perhaps the Western Association, in its desire to demonstrate excellence, had gone too far in developing stringent policies. “‘A Society committee known as the Advisory Committee on Allergy; in addition to having organizational functions, its members simultaneously served the subspecialty needs of the American Board of Internal Medicine as members of the Advisory Board of American Allergists. 15Again demonstrating the Eastern’s new spirit of democracy.

of a new society, the American College of Allergists led by Frederick Wittich of Minneapolis, no mention of this can be found in official records or correspondence. In their preoccupation with the general events that got things moving rapidly, five out of the six members of the group that met in Chicago came relatively unprepared to discuss specifics. One of the group noted that they apparently had “trusted to inspiration to do the job and it would have been a very poor one had not Sam Feinberg provided a suitable guide” (Bullen SS: Personal communication, 1968). Feinberg apparently saved the day on two counts. First, he was the only one who came to the meeting with a definitive format for a Constitution and set of bylaws which proved acceptable to the group. Second, he solved the problem of election of the first President by offering to step aside in favor of the Eastern Society President, Robert Chobot of New York. By this action, Feinberg, who had been installed as the Western Association’s President only five months previously, gained distinction on two additional counts. He became the only President in the recorded history of the American Academy of Allergy or its parent organizations to have served in office for less than one year. Also, because wartime travel conditions necessitated canceling the Western Association’s annual meeting for that year, 1943, Feinberg became the only President to have never had the opportunity to deliver a Presidential Address. Con-

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versely, Chobot became the only member to serve both a parent organization and the American Academy of Allergy as President and accordingly to deliver presidential addresses to each (to the Eastern Society on December 4, 1943, and the Academy on December 12, 1944). The Western Association Secretary followed Feinberg’s example by stepping aside to allow his Eastern counterpart, Will Cook Spain of New York, to continue in office. However, the gesture of sacrifice was not comparable to Feinberg’s since Black had already completed a year’s tenure in the Presidency of the Association in 1935. Another problem to be faced was the adoption of a name for the new organization. By choosing the aegis both the previously used titles of of “Academy,” Association and Society were bypassed. Bullen (Personal communication, 1%8), who was responsible for introducing and encouraging adoption of “Academy,” had purposely intended for the newly formed organization to go forward under an aegis appropriate for a learned society (academy derives from “Academia,” the plot of land in Athens where Plato inculcated his pupils with ideals.) The momentum continued. Having canceled an annual meeting for 1943, the Western Association circulated a mail ballot to the membership. Of the 97 Active Members eligible to vote, 68 returned their ballots with 67 voting for the merger. The 68th vote, while favoring the merger, indicated only limited consent on the stipulation that meetings be continued during the summer months. The Eastern Society had been able to continue regularly scheduled semiannual meetings in New York and thus could present the same plan and resolution for amalgamation to members attending the fall session. This occurred on Saturday. December 4, following the action of the group in Chicago only five weeks earlier. On the previous day, the report of activities and conclusions reached by the Committee in Chicago was reported to the Advisory Board of American Allergists12 and to the Executive Committee of the Society at its business meeting with resultant approval by both bodies. At 12:50 P.M., 38 minutes following the start of the Society’s regular business meeting at the conclusion of the scientific session, a unanimous vote approving the resolution for merger was obtained. Thus at 1258 P.M. on December 4, 1943, the Society for the Study of Asthma and Allied Conditions and the American Association for the Study of Allergy ceased to exist and the American Academy of Allergy came into existence. The following list of officers nominated by the Advisory Committee’” for the ensuing year was presented to the new Academy and their election approved.

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Robert Chobot, New York, President Oscar Swineford, Jr., Charlottesville, Vice President Karl D. Figley, Toledo, Treasurer Will Cook Spain, New York, Secretary Among important provisions of the new constitution and bylaws, in addition to those mentioned in connection with the Chicago meeting of October, were several innovative measures, including a change in the terminology for classes of membership. Active Members from either society would automatically constitute the new class of Fellow (henceforth requiring demonstration of proficiency, experience. or contributions to the field of allergy without the absolute condition for certification by a specialty board). Those otherwise qualified (formerly known as Associate Members) would constitute the new class of Member. Opportunities for broader participation by all members would be made available through the creation of several committees, e.g., for membership credentials, program, research, nominating, editorial, merit awards, education, and constitution and bylaws changes, in addition to continuing the Advisory Committee which would henceforth deal only with standards and certification. i4 On that same afternoon of December 4, 1943, at 5 P.M., Eastern War Time, the first meeting of the Executive Committee of the American Academy of Allergy was held at the Waldorf-Astoria Hotel, attended by the new officers and Committee members, Feinberg, Cooke, Walzer, Alexander, and M. Cohen (Fig. 12). A new organization entailing more extensive Committee activities and a projected enlarging membership would in turn require an increased operating budget. Accordingly, a new dues structure presenting a fourfold increase was set: $20 for Fellows and $15 for Members. This, however, included provision for the sum of $5 to cover an annual subscription fee to THE JOURNAL OF ALLERGY for each Fellow and Member. In the new spirit of an operational mold designed to encourage innovation, corresponding new plans to promote research and improvement in the field of allergy were formulated. In addition to usual functions of the society, such progress was to be encouraged by research grants, prizes, Committees on Investigations and on Standards, and organized approaches to postgraduate teaching and training. In today’s framework of activities many of these programs are within the areas of responsibility of independently functioning organizations and agencies, i.e., the American Boards of Internal Medicine, of Pediatrics, and of Allergy and Immunology, the National Institutes of Health, the United States Food and Drug Administra-

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FIG. 12. Members of the first Front row, left to right: Harry Feinberg, and Robert Cooke. (Vice-Pres.), Matthew Walzer,

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Executive Committee of the American Academy of Allergy, 1943. Alexander, Will Cook Spain (Secy.), Robert Chobot (Pres.), Samuel Second row, left to right: Karl Figely (Treas.), Oscar Swineford and Milton Cohen.

tion and its Bureau of Biologics, and the Asthma and Allergy Foundation of America. However, until the development and structure of such of those independent entities to which relevant missions could be given, the American Academy of Allergy considered such activities to fall under its purview and within its concern. Accordingly, the Academy played a major role in guiding the development, establishment, and emergence of many of today’s programs that we have come to take for granted. These are discussed in following sections dealing with publications, research, standards and certification, education, foundations, and international associations. The evolution of the American Academy of Allergy has truly been a product of the interest, orientations, and activities of its members engaged in a wide spectrum of endeavors emerging from that circumscribed area defined by the original concept of atopy and atopic disorders. As fundamental knowledge of hypersensitivity mechanisms and clinically translatable information developed from original investigations, the scope of Academy functions broadened to keep pace with the expanding horizons viewed by its Fellows and Members. Accordingly, happenings within the Academy in various stages of growth and transition can be quite properly interpreted as a reflection of times of change and progress in this discipline. The American Academy of Allergy was created with a total membership of 272 ( 149 Fellows and 123

Members). The Eastern Society contributed 228 Members and the Western Association, 134; 90 dual memberships accounted for the differences between the sum total of the two and the final count. The expansion of specialty practices in allergy and the increasing number of physicians attracted to the field seeking professional organizational affiliation are reflected in the Academy’s growth. Within five years the work of many committees and record keeping for a membership of 560 could no longer be managed feasibly in the private office of a Fellow/Secretary, regardless of dedication. Arrangements for annual meetings with parallel increases in attendance provided an additional burden that was emphasized by the 690 registrants (physicians and guests) attracted to the 1947 sessions in Atlantic City. Accordingly, the engagement of a salaried Executive Secretary and business office to provide continuity and stabilization of administration was authorized that year. Largely through the efforts of Theodore L. Squier of Marquette University in Milwaukee who was the Academy Secretary at that time (later Eresident in 1950), arrangements were made in 1948 to establish an Executive Office housed and served by the facilities of the Milwaukee County Medical Society with James 0. Kelley, Executive Secretary of the Society, serving as part-time Executive Secretary for the Academy. The following year the American Academy of Allergy was incorporated under the laws

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MONDAY,

J. ALLERGY

DECEMBER

CLIN. IMMUNOL NOVEMBER 1979

1 Ith, 1944

AMERICAN ACADEMY OF ALLERGY

Trogram

FIRST ANNUAL MEETING MONDAY AND TUESDAY DECEMBER 11th and 12th, i!w THE WALDORF-ASTORIA New York City

Astor Gdhy FIG. 13A. Program American Academy

of the First Annual of Allergy.

Meeting

of the

of the State of Wisconsin. In 1970 the Executive office was transferred from the management of the Milwaukee County Medical Society facilities to its present location in Milwaukee, continuing under Kelley’s administrative supervision. Following the death of Kelley in 1975, Donald L. MacNeil was named Executive Director and assumed responsibility for the management of Academy affairs. Three years after amalgamation ( 1946), a third class of membership was created. This move came about as a result of an increasing awareness of medical scientists, nonphysicians, and others in technical

and administrative situations who, though not engaged in the clinical practice of allergy, were nevertheless making distinctive and unique contributions to Academy programs and objectives. As an appreciation of the efforts of such people grew, provision was made to bring them into active associations as Affiliate Members and Affiliate Fellows. Some 20 years later it had become apparent that the work of basic researchers (e.g., in immunology, biochemistry, microbiology, pathology, and pharmacology) was in many instances so meritorious and relevant to the field of allergy that the interests of these scientists

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YOU are urged to sign now and mail the attached reservation card for your accommodations at Chalfonte-Haddon Hall for the 1942 Meeting of the American Association for the Study of Allergy to be held at Chalfonte-Haddon Hall, June 8th and 9th.. . . SPECIAL

CONVENTION

RATES

DAILY

T”(I0PE.N

FOR MEMBERS PLAN

*YEIlcAN

PUN

Room with bath, hvo penons . . .

$6, 7, 0, IO, I2

$12, 13, 14, lb, 18

Room with bath, on. pwwn

$4, 5, 6, 8

$7, 8, 9, II

.. .

ALL DOUBLE ROOMS HAVE SINGLE BEDS BATHS MAVE TUB AND SHOVER, HOT AND COLD SALT AND FRESH WATER FIRE-PROOF

MOTORAMP

GARAGE

ADJOINING

HOTEL

TheNewOrleansHilton / u~c*tS44

S48 $52 $56

Sb2*

mm $56 $60 $64 $68 $74* lTv.0ColDle tma,, D=‘+56 *Towers

$60 $64

$60 $74*

$250

FIG. 14. Sites of annual

meetings

of 1942 and 1979; 37 years of progress

could no longer be considered tangential to Academy functions. Accordingly, in 1968 the category of Affiliate Fellow was abolished and holders of doctoral degrees in fields other than medicine (e.g., Ph.D., Sc.D., D. V.M.) qualified by virtue of meeting the constitutional requirements for training, experience, and meritorious publications based on original experimental research were welcomed as full and unqualified Fellows. So, too, did the character of clinical interests of the Academy membership broaden in parallel fashion. Gradually the informed allergist sought to expand his purview beyond that of diagnosis, treatment, and prevention of only the classic atopic diseases, i.e., asthma, hay fever, urticaria, and eczema. Just as many clinical allergists developed special interests in other immunologic disorders and relevant aspects of respiratory, connective tissue, skin, and gastrointestinal diseases, so have physicians in other clinical specialties (e.g., pulmonary diseases, otorhinolaryngol-

and inflation.

ogy, dermatology, rheumatology, and gastroenterology) sought to further their interests in allergic and immunologic aspects of their practices through the activities and interactions provided by Academy membership. These developments and ever-expanding interests can be seen in the subject presentations at symposia, seminars, and postgraduate courses, and reports of original work presented at annual Academy meeting programs. Likewise, collateral interests of allergists are reflected by the many Fellows and Members engaged in the varied Academy committee, program, and project activities who have entered the field via internal medicine or pediatrics and whose major efforts are given to academic, research, or clinical practice. But evenhandedness in effecting balanced representation of these diverse endeavors in positions of leadership has not always been the case. An interval of 34 years had gone by between the presidencies of the first and second pediatrician-allergists to hold this office

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(Harry Donnally in the Eastern Society in 1928 and Sheldon Siegel in the Academy in 1974).i6 Then coincident with the advent of requisite resources, support, and opportunities for medical schools to engage full-time staffs, there was a period of some 15 years, from the late 1950s to the early 197Os, when with few exceptions the office of President was given to men occupying full-time academic-research positions with orientations primarily to departments of internal medicine. In the early period of Cooke’s influence. opinionative stances and philosophic differences accounted for bias in favor of the internist.i7 During the years that followed, even though dominance of the Executive Committee by an “in group” had faded from the scene, nominating committees had apparently fallen into a pattern designed by precedent and habit. To the credit of executive and nominating committees since the early 1970’s, insight and sensitivity have guided judgments so that the highest Academy offices now are held by Fellows of demonstrated capability and responsibility who additionally reflect the character of the membership, internists and pediatricians, researchers and clinicians alike. “The Pediatric Allergy movement is discussed in the section on Standards and Certification. “See section VI. “Standards and Certification.”

V. Publications:

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J ALLERGY

CLIN IMMUNOL. NOVEMBER 1979

According to design and plan, the First Annual Meeting of the American Academy of Allergy, taking place on December 11 to 12, 1944, (Fig. 13) at the Waldorf-Astoria Hotel in New York, was followed by the Second Annual Meeting at a more western site, the Palmer House in Chicago on December 10 to 1I, 1945. Facilitation of travel by air and the geographically widespread home bases of Academy Fellows and Members have allowed for the placement of annual meetings in most of the country’s major cities (Fig. 14). The rapid growth of allergy and clinical immunology and the number of physicians and biomedical scientists engaged in the many aspects of basic and clinical endeavors in the field effected parallel changes in the increasing attendance character of annual Academy meetings each year. At the 1964 annual meeting with a registration of 1,083, the total of 60 submitted papers began to exceed the feasibility of accommodating all deserving quality presentations at a single session. The following year (registration, 1,210), two concurrent sessions were instituted. At the most recent annual meeting ( 1979) an attendance of 2,702 registrants necessitated holding 6 concurrent sessions over three full days to allow for presentations of 288 reports of original investigations.

THE JOURNAL OF ALLERGY

The organizers and earliest members taken into the (Eastern) Society for the Study of Asthma and Allied Conditions in 1924 were for the most part associates, assistants, or former students of Cooke, Coca, or Longcope, or had in some other way been related to the work of these pioneer investigators in hypersensitivity. Since Coca (Fig. 15), as the founder and Editor-in-Chief of the Journal of Immunology, provided a natural focal point, it was to be expected that these accomplished people would find an outlet for publishing the products of the original investigations to which they had been skillfully indoctrinated. During that exciting and busy time in 1922 the Cooke-Coca group’s series on “Studies in Specific Hypersensitiveness” alone occupied an entire issue (J lmmunol 7:8 l-243, 1922) of that prestigious Journal (Fig. 16). With the opportunity provided by Coca’s labora-

tory at Cornell and the abundance of clinical material for study coming into the newly established Asthma and Allergic Disease Clinic at the New York Hospital, the number of papers appearing in the Journal of Immunology totaled somewhere in the neighborhood of 40 before another 10 years had gone by. From this vantage point of self-assurance, the small group that comprised the Eastern Society voted on May 4, 1925, to make the Journal of Immunology the Society’s official organ. Since there is no record of any followup, it is not known how either the Editorial Board or publisher of the Journal of Immunology or the American Association of Immunologists reacted to or disposed of the Society’s action other than to bide time. Shortly thereafter, signs of the organizational drifting apart of the allergists and immunologists began to appear. In contrast, the members of the (Western) Associa-

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tion for the Study of Allergy, having made their entrance into the field by way of clinical endeavors, were a considerable distance from the degree of manuscript sophistication being achieved by their Eastern counterparts. However, their awareness of the need to contribute to as well as benefit from the emerging literature on the newly developing subject of allergy was no less keen. Sensitive to the fact that their presentations were not up to Journal of Immunology standards, they nevertheless directed efforts and attention to exploring whatever other possibilities might be available. Against this background the following notes were entered into the minutes. June 10, 1924: “The Association [is] on record as not affiliating with any particular journals believing that if papers were printed through several journals that there would be a greater reaction through a wider group of physicians and added interest in allergy.” (Second Annual Meeting, Chicago.) April 20, 1926: “The papers and reports of the Association are to be published in any Journal that the Secretary thinks best.” (Fourth Annual Meeting, Dallas.)

The arrival of Warren T. Vaughan of Richmond, Virginia, following his election to membership in 1926 added incentive and encouragement along with facilitation of publication for the energetic Westerners. Warren Vaughan’s prestigious medical background included exposure to the work of his distinguished father, Victor Vaughan, Professor of Medicine at the University of Michigan and Editor of the Journal of Laboratory and Clinical Medicine. Warren Vaughan, as the recipient of a father-to-son transfer of the editorship, accepted for publication in the Journal of Laboratory and Clinical Medicine a group of papers presented at the Association’s Fifth Annual Meeting in Washington during May, 1927 (J Lab Clin Med 13: 16-69, 1927) (Fig. 17), and at the Sixth Annual Meeting in Minneapolis during June, 1928 (J Lab Clin Med 13:908-966, 1928; 13:997-1026, 1928). The following year, publicity was given to the forthcoming annual meeting to be held in Portland, Oregon, when the Editor (then also serving as Secretary of the Association) advanced publishing of the program (J Lab Clin Med 14:787, 1929). At the same time, in 1929, the JOURNALOFALLERGY was about to make its appearance. The Association membership then “voted, provided satisfactory arrangements could be made, to make the JOURNALOF ALLERGY the official organ of the Association.” A new combination of factors then existed to guide the Western Association in its next action. These included: (1) the opportunity for access to space in a jointly sponsored official journal that provided for

FIG. 15. Arthur F. Coca, pioneer in hypersensitivity research and founder of Journal of Immunology. His influence in the field of immunology and position as the first Editor-in-Chief of that Journal provided the initial medium for publication of reports of studies by colleague members of the (Eastern) Society for the Study of Asthma and Allied Conditions.

representation of the Association’s membership on the Editorial Board, (2) an increasing recognition that to meet the needs of the field required not only development of new information but, equally important, appropriate dissemination, and (3) an awareness of the differences in the orientations, expressions of original and scientific thought, and the research and publication accomplishments that separated the Association from its counterpart Eastern Society, all to the advantage of the latter. Likely motivated by the desire to close this gap and enhance its image as well as by genuine concern to strive for self-improvement and progress in the field, in 1931 the Association adopted a foreward-looking, but demanding requirement: “If in any three-year period a member fails to produce a publication of sufficient excellence or meet the approval of the Executive Council, he shall be dropped from membership, unless in the opinion of the Council his scientific activities have been of a sufficiently high standard. ” By the year 1929, the literature on allergy was extensive and scattered among many publications. Much of the work on experimental hypersensitivity done in this country continued to appear in the Jour-

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Academy

CONTENTS

CLIN. IMMUNOL NOVEMBER 1979

CONTENTS

iv

NUMBER 1, J.,snrn~,

J. ALLERGY

of Allergy

11122

A Study of the Virulence of Meningococci for Man and of Human Susceptihdity to Meningococcie Infection. George D. Heist, Solomon SobsCohen and Myer Sol&Cohen The Action of Various hletsllic Salts on Hemolysis. Helen A. Purdy and L. E. Wdbum G. H. South An Allergx Renction of the Tuberculous I‘terine Horn. Relationship of Various Antiorgan Sers. Moyer S. Fleishcr Baelllus Diphtherine. Immunologicnl Types; Toxin-Antitoxin Reletlow ship. W. If. Paxson and Edward Redowltz

Chid and Immunologicsl Bronchial Asthma sod Allied Conditions “bzxrvnt~or>s. Nils P. Larsen, Royce Paddock nnd H. L. Alexander Stud& an Speelfic Hyperseos~tivcnrsti 1. The Diagnostic Cutaneous ~enetion in .\llergy. Compnrisan of the Intradermal Method (Cooke) a,nd the Scrstrh Method (Schloas). Anron Brown StudiFs m SpceiBc lIypersensit,ueness. II. A Comparison of Vsrioun Pollen Extra& with Refercure to thr Question of their Therapeutic value ,n Hay Pever. Albert Vandrr Veer, Jr. Studies io Spcrifio Hypersene~ti~cneai. 111. On Constitutional Reactlone: TheDangersof the Dlagnost~crllfmiroil~Teet and Therapeutic Injection of Allergens. Ilobert.%.Cookc Studies in Specific Iiypersensltivcnrra. IV. New Etiologie Factors in Bronchial Asthma. Robert A. Cooke Studies in Speafic Hypereeneitivenesh V. The Preparation of Flud Extracts and Yolutmns for UY~ in the Dingnosu and Trentment of the Allergies, with Kotes on the Collertioo of Pollens. Arthur F. Coca Studies in Specific Hypersensitwaess. VI. Derrnatltis Venenata. W. C. Spain Studiee in Specific Hypersensitiveness 1’11. The Age Incidence of Serum Diseaseandof DermatitisVenenatsnscomparedwith that of the Natural Allergies. Arthur F. Coca Studu m Speafic Hypersen6itiveneas. VIII. On the Relative Susceptihdity of the American Indian Race and the White Xsee to the Allergies and to Serum Disease. Arthur F. Coca, Olin Deihert and Edward F. Menger

I 3s 51 4: 86

Studies in Specific Hypersensitiveneis. IX. On the Phenomenon sensitization (the Clinically Lessened Sensitiveness of Allergy). A.Cwke

of HypoRobert 219

NUMBEH 3, MAY, 1922 Immunological Studies on Types of Diphtheria Bacilli. 1. Agglutination Characteristics. II. Protective Value of the Standard Monovalent Antitoxin. William H. Park. Anna W. Wdliams and Alice C. Mnnn 243 The Relationship of Lipoids and Proteins to Serum Reactions m Tuberculosis. W. Kay-Hedge and M. F. MacLennan 253 The Toxicity of Acids Sor Leucocytea. e.8 Indicated by the Tropin Reaction. ,271 Alice C. Evans

81 97

A Serological Study of the Gonococcus Group. John C. Torrey and George T.Buckeil 34s Studies on Acute Respiratory Iafeetians. XI. A Serological Study of Alpha Streptoeocel from theUpper Respiratory Tract. AgnesGoldman. 3til

113 Nolrem 119 147

163 179

193

201

5. SEPTEMBER, I!?22

On the Photolabibty of Serum Complement. E.G. Lundberg Prophylactic Treatment for Kahies by Means of Standardrzcd Glycerinated Virus. Jamee McIlvaine Phillips A Study of the Precipitin and Complement Flxstmo Reactiona with Tubcrculous Exudatea with Special Reference to Tuberculoos Pleuritie Iaamu Ogawa. On the Origin and Nature of Alesin (Complement) m Guinea-Pig Dlood. L. F. Morrfsoo

3nQ 400

423 435

tI. W. Cromwell, 461 AStudyof theHemolyticAntib+dy-Antigen Combination. Studies 00. the Toxicity of Human Blood Plasma for Guinea-Prgs. I. Relative To&ity of Fetal and Maternal Plwma. S. A. Levineon 497 Studies on the Toxicity of Human Blood. Pl~ama for Gsmea-Pigs. II. .T‘i Coagulation Toxicity. S. i\. Levinson

iii

FIG. 16. Table of contents from volume 7,1922, issue of Journal of immunology. Titles of papers in the March issue (No. 2) reflect the state of the art of original studies in hypersensitivity viewed against the background of the immunologic research of that period published in the other bimonthly numbers. Reproduced courtesy The Williams & Wilkins Co.

nal of Immunology and that in Europe in the Zeitschrijt fur Immunita Tsforschung. However, there were no periodicals devoted to more clinical aspects of the subject. A need for a journal that would also encompass clinically relevant material was evidenced, first by the apparent void that could be filled by a publication to serve as official organ for the two national allergy societies, and second, because clinical allergy was becoming immensely popular among both the medical profession and the laity and there appeared to be some need for editorial control of the literature. In this setting THE JOURNAL OF ALLERGY was founded, largely through the efforts of two physicians in St. Louis, French K. Hansel and Harry A. Alexander. Hansel (Fig. 18), trained as an otorhinolaryngologist at the Mayo Clinic, had returned to his native St. Louis in 1922. His original intention at Mayo to specialize in ear, nose, and throat surgery was turned in another direction as a result of studies on “vasomotor rhinitis” for a master’s degree thesis. Hansel had become increasingly impressed by observations on many patients with thickened sinus and nasal membranes who did not respond to extensive nasal surgery (referred to as “nasal hysterectomies”) and the many candidates for tonsillectomy he believed to

be actually victims of allergy. Accordingly, he then turned his attention to allergic diseases with missionary zeal. Not only had he become a member of the clinical staff of the Department of Otolaryngology at Washington University but also undertook work in the Department of Medicine Allergy Clinic under the direction of Harry Alexander and Charles Eyermann. About that same time, in 1925, an outstanding treatise entitled Pathology and Treatment of the Injlammatory Diseases of the Nose and Accessory Sinuses by M. Hajek was published in German in Vienna, Austria. The C. V. Mosby Company of St. Louis had acquired the English translation rights and Hansel was chosen as a cotranslator. As a result. not only was the book published subsequently in the United States and other English-speaking countries but it also provided the medium for bringing Hansel and Mosby together. In early 1926, while undertaking the translation and editing of this text, Hansel was living at the University Club in St. Louis. During the summer of that year C. V. Mosby (Fig. 18), of the publishing company bearing his name, was also staying at the club while his family was out of town on vacation. This situation gave Hansel the opportunity to discuss with Mosby the subject of allergic diseases as well as matters re-

VOLUME NUMBER

64 5

lating to the ongoing translation. Hansel was impressed that the word “allergy” as such was not mentioned in the text but was well prepared to appreciate that the factor of allergy in the presented material could be readily recognized. In explaining to Mosby the role that allergy was believed to play in nasal and sinus disease, Hansel pointed out that allergy was becoming an important problem in medicine and suggested that a periodical devoted to this subject would be timely. Mosby, influenced by Hansel’s enthusiasm and perception, found on further exploration of the subject that Harry Alexander (Fig. 19), who was now on the Washington University faculty, held very similar views. Up to this point, Alexander had been working independently to launch a journal but had found little if any opportunity for such an undertaking. The problem was one of financial risk, for the combined membership of the Eastern Society and the Western Association, on whom initial resources would depend, was not large enough to generate the necessary underwriting. Alexander, therefore, found it encouraging to consult frequently with Mosby as he carefully explored possibilities during the following three years. By 1929 Mosby had almost arrived at the decision to embark on such a publication endeavor. At the Fifth Annual Meeting of the Eastern Society in Atlantic City on May 4, 1929, Alexander placed the subject of a journal before the Executive Committee, indicating Mosby’s intention to establish a new medical publication devoted to the practical phases of allergy. The plan was to present articles dealing with asthma, hay fever, eczema, and allied hypersensitivity states that would appeal to the general practitioner, in accordance with Mosby’s agreement on the need for such publication. Alexander further reported that he was approached by Mosby both about the possibility of his becoming Editor and inviting the Society to adopt the journal as its official organ. Articles written by members, abstracts of papers presented at meetings, and discussions recorded by a stenographer to be furnished by Mosby would be printed at no cost to the Society. Additionally, it was intended for this journal not to conflict with the Journal of Immunology, since as a new and different periodical “it would attempt to cover the field of practical work, and not the scientific phases of hypersensitiveness.” The Mosby offer was then accepted, but under the following conditions: “ 1. No expense should be incurred by the Society. “2. There would be no obligation upon members of the Society to publish in the Journal unless they so desired.

Publications:

THE

JOURNAL

OF ALLERGY

365

“ 3. There would be no obligation on the part of the Journal to accept articles [by members] if not desired [by the Editor].” Selection of a name for the journal also posed a problem since it was planned to publish articles on allergy at a particular time that the meaning of the was still in dispute. The fact that word “allergy” differences of opinion existed on the usage of the term “allergy” was dealt with in the announcement that appeared as a frontpiece of the first issue of THE JOURNAL OF ALLERGY, November, 1929 (Fig. 20). Reflecting the intent of the JOURNAL to serve as the official organ of both organizations, the first Editorial Board consisted of representatives from the Eastern Society and the Western Association: Harry A. Alexander, Editor; Alfred H. W. Caulfeild, Arthur F. Coca, Francis M. Rackemann, and Albert H. Rowe. As clinical allergy enlarged its horizons and allergists became increasingly oriented to the experimental aspects of hypersensitivity, the changing scope of THE JOURNAL OF ALLERGY as well as the composition of the Editorial Board placed the JOURNAL in a position to continue in the mainstream of events and to reflect the changes of the times. In the early formative years of publication, the Editorial Board gave its attention to ways by which the JOURNAL might enhance its service to the community of clinical allergists. One particular point of concern was the number of relevant articles being published in a diversity of periodicals. The need for the allergist to keep himself informed of developments in an expanding field and a correspondingly expanding literature became more and more apparent. Realizing that perhaps the JOURNAL was too limited in scope, a “Department of Reviews and Abstracts” was established. A few years later this innovative effort was superseded by “Selected Abstracts,” which offered extensive presentations on particular aspects of allergy. Meanwhile, a project of similar intent was independently taking place elsewhere. This endeavor of the Allergy Division of the Jewish Hospital of Brooklyn, the Allergy Abstracts, was subsequently broughtundertheaegisof THEJOURNALOFAILERGY. Allergy Abstracts, developed in 1936 as an outgrowth of monthly literature review meetings of the Allergy Division staff of the Jewish Hospital of Brooklyn, was initiated largely through the efforts of Murray M. Albert during the period of his hospital residency in allergy under Eugene H. Walzer. The first issue consisted of a mimeographed pamphlet that contained 36 abstracts of articles on allergy and related subjects culled from more than 60 current North American and foreign medical journals. Although

366

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VOLUME 64 NUMBER 5

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The American Academy An historical review Sheldon G. Cohen, of Allergy: M.D. Bethesdu, Md. I. Foreword At 12:58 P.M. on Sunday, December 4, 1943,...
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