COPING WITH THE MODERN ENVIRONMENT: THE ECOLOGY UNIT IN THE DIAGNOSIS AND TREATMENT OF ALLERGIES

The Ecology Unit (sometimes referred to as the Environmental Control Unit) plays an indispensable role in the diagnosis and treatment of allergies. This unit was established after many years of development.

I first started hospitalizing patients for the diagnosis of food allergy in 1950. I chose complicated patients, whose problems could not be worked out simply by testing with one food at a time in the office. (In those days I employed feedings of whole foods in the office, rather than provocative tests, as today.) These patients rarely ever achieved a “base line” of good health before any particular test against which their reaction could be measured. It was therefore impossible to tell to what extent a particular food, or other environmental exposure, was responsible for their symptoms.

At this same time, I had occasion to present some of my earliest patients with “mental” symptoms to the psychiatrists at the Milwaukee Sanitorium. Dr. Josef Kindwall, chief of staff at this well-respected institution, listened to my presentation and then suggested that I fast such patients, in order to clear the board, so to speak, of all preexisting symptoms.

Six patients were therefore hospitalized in separate rooms and fasted. Each patient soon complained of heightened symptoms and, being inexperienced, I was disturbed by their worsened condition and decided to cancel the tests. In fact, these heightened symptoms in the early part of a fast are now known to be normal withdrawal reactions to addicting foods. Thus the initial attempt to fast patients ended in failure.

In April, 1951, the chemical-susceptibility problem was first described, and so, in the winter of 1953, were the effects of natural gas on susceptible individuals. Considering these unexpected sources of reactions, it became even more obvious that in order to achieve a “base line” of health, it would be necessary to remove a patient to a sheltered environment, in which food and chemical exposures could be thoroughly controlled. This belief was reinforced by seeing an occasional patient who felt distinctly better in the chemically less contaminated environment of a hospital. Some doctors referred to this phenomenon as “hospitalitis,” an alleged “disease” in which an individual craves a protective environment, but I believed the reason lay in the effects of the nonpersonal environment on the patient’s health. In the meantime, I told Dr. Donald S. Mitchell of Montreal about my difficulties in fasting patients and about the need to do so, given the complexity of their problems. Dr. Mitchell, on his own initiative, attempted to confirm this and was able to fast patients for longer periods of time. He discovered that the withdrawal symptoms subsided by the third or fourth day and that after that, the patients generally felt better than they had in a long while.

In 1956, I therefore decided to attempt a hospital fasting program again. This time the experiment was a success, and certain food and chemical allergies were diagnosed which simply could not have been found through any of the office procedures used at that time.

This experience led to a new approach to the diagnosis of allergy-caused illnesses. Since that time, I have hospitalized, fasted, and tested over 10,000 individuals in this manner. Until 1975, such testing was done in separate hospital rooms of a general hospital. Patients did reasonably well in this environment. One problem, however, was that chemically susceptible patients were still exposed to tobacco smoke, perfumes, and other hospital fumes and odors, which interfered with the accuracy and validity of the testing. Sometimes night nurses might smoke in the nursing stations. At other times rooms were chemically disinfected and residues of such agents made certain rooms unavailable for use.

Since 1975, therefore, a separate Ecology Unit has been maintained as a section of a hospital in a Chicago suburb, and it is far more controlled than any ordinary hospital room or ward could be.1

The procedures in the Ecology Unit are an indispensable part of the treatment for allergy. Traditional diagnostic techniques are like a table with three legs. The first leg is the patient’s history, the second his physical examination, and the third his diagnostic tests. In the Ecology Unit, all three of these standard methods are employed, but in addition there is a fourth leg. Often it is this fourth diagnostic leg which provides the sound basis for an answer. Its value has been confirmed by many physicians, and about a dozen are now using this sort of hospitalization in their daily practice. Indeed, in the combined experience of clinical ecologists using these techniques in a hospital or environmentally controlled setting, approximately 20,000 patients have been observed under controlled conditions during the past three decades (see Appendix B for a list of clinical ecologists practicing in a controlled environmental hospital setting).

The basic idea of the Ecology Unit is control. For several weeks, all aspects of the patient’s physical environment are scientifically managed. The air he breathes, the food and water he consumes, and everything that might come into contact with, or enter, his body, is subjected to prior scrutiny.

This technique, in effect, borrows a page from the experimental scientist’s book. “It is a controlled clinical experiment,” Dr. Lawrence Dickey once wrote of the Ecology Unit, “using an individual patient, and has all the validity of a controlled laboratory experiment. Both require control of as many variables as possible.”

This may seem like a big job, and indeed it is. First of all, one must control what the patient brings into the hospital. Plastic suitcases, synthetic fabrics, cosmetics, and so forth must all be left behind. Patients can only wear garments made from natural fabrics, such as wool or cotton, and only those which have been washed many times or which were not originally treated with chemicals.

Patients are allowed visitors during their stay, which averages three weeks. But the visitors are warned at the door not to enter if they are wearing cosmetics or scent of any kind and not to bring in flowers, candies, or other substances that might make some patients sick or destroy the validity of the test reactions. Staff members, like patients and their visitors, are not allowed to wear any perfumes or scents.

Patients are then fasted on spring water for an average of five days. The purpose of the fast is to completely clear the digestive tract of all food, a process which is often facilitated by the use of milk of magnesia or alkali salts.

In fasting, the patient may experience withdrawal reactions in which his accustomed symptoms get worse for a few days before they get better. The arthritic patient’s joints may flare up. The person with a chronic headache problem may suffer a particularly bad attack. The moderately depressed may get a bad attack of the doldrums.

When the worst of the withdrawal reaction is over, however, the patient is tested blindly with several different waters. One of these is the local tap water, and the others are commercially available bottled water (only in glass bottles, never plastic). A new water is tested every three hours, if there has been no adverse reaction to the previous test sample. The patient rates the waters on a scale of zero to ten, without knowing which water he is receiving. He keeps a record of his reactions to the water samples, and the one he tolerates the best will be his compatible water for the remainder of his stay in the hospital. The compatible water is continued on first returning home.

After four or five days, the patient usually feels better; in fact, he may feel healthier than he has in months or years. For example, some patients who have been prostrated by fatigue are able to get up and bustle about. Others who have had pain find that they are virtually pain-free. If the symptoms do not go away, and sometimes they do not, then the fast is prolonged. There is ordinarily no hazard in this, provided that the patient does not have a medical condition which makes fasting dangerous. At all times, of course, the fast is carefully monitored by the medical and nursing staff.

Some fasts have lasted ten days or more. Of course, there are patients whose symptoms are apparently not the result of environmental exposure or for whom even the minimal exposures of the Ecology Unit are disturbing. Such patients may not improve. In the great majority of cases, however, the fast will eventually bring about a cessation of old, disturbing symptoms, and a new sense of well-being, sometimes bordering on the euphoric, will set in. Fasting breaks the addictive cycle of the sick person to the foods and other environmental substances making him ill.

The chemical environment in the Ecology Unit is particularly controlled. Just as there is an attempt to prevent the entry of potentially harmful materials from outside, so too-everything inside the unit is kept as innocuous as can be. This gives the unit a somewhat old-fashioned appearance. The couch in the lounge, for instance, is made of well-worn leather, and the chairs are fashioned from wood and metal, upholstered with cotton or felt, and covered with natural fabrics. All of the bedding is made of simple, untreated cotton, and such things as sponge-rubber pillows or mattresses, draw sheets, upholstered furniture, rug pads, or even tubing made with rubber, are forbidden.

Plastics have also been banished from the Ecology Unit. There are no mattresses with plasticized surfaces, no plastic covers on the pillows, no plastic furniture, shower curtains, drapes, slippers, or handbags.

Initially, there was a problem with the floors. Some of the patients simply did not lose their symptoms, even after a prolonged fast. We finally learned that before the Ecology Unit had taken over this particular space in the hospital, the baseboards had been sprayed with a chemical pesticide. It is virtually impossible to entirely eliminate such sprays. The baseboards and the old floor, therefore, had to go and new tile baseboards and flooring were put down. Since then, far fewer patients have failed to get rid of their symptoms on the fast.

In addition, the Ecology Unit has its own broom closet, and the cleaning personnel use only soap and water. Since there are odors and fumes emanating from other parts of the hospital, it has been necessary to seal off the stairwells, elevator shafts, laundry chutes, and ventilating systems to prevent leakage into the unit. Even the latch holes on the doors were plugged to keep out cigarette smoke. When it is time to paint, the entire floor is evacuated for a week. In addition, large and effective air purifiers are kept running most of the time, despite the fact that the Ecology Unit is located in one of Chicago’s least polluted suburbs.

Despite these precautions, chemical contaminants sometimes do get into the unit. Recently, for example, during the shooting of a film, a solvent-based marking pen was opened. Although the pen was not open for more than half a minute, at the next morning’s staff meeting one of the nurses reported that several chemically susceptible patients had gotten ill at the time of the shooting. The answer almost certainly lay in this marking pen. When the error was realized, the door and window of the room where the pen was had been foolishly thrown open, blowing the fumes across the hall and into the room opposite. The patients who had gotten ill were in this room. It is because of reactions such as this that great strictness is exercised in controlling chemical pollution of the Ecology Unit.

*95/110/2*

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