Dr Harry Morrow Brown died on 22nd August 2013, aged 96.
A year earlier he had sent us the text of a CV, subtitled 'my pre-obituary', that he had drawn up for a conference at which one of his posters was being presented. We promised to save it and use it when the time came. It now has. For a far fuller understanding of his work, check in to his extensive website, www.allergiesexplained.com; for a more personal tribute check in to the FoodsMatter blog.
Dr Harry Morrow Brown was born in Auchterarder, Scotland in 1917, qualified MB ChB Edinburgh University in 1939, and served in Royal Army Medical Corps from 1939 to 1946, mainly in India.
Post-Graduate studies in Edinburgh led to an interest in low sodium rice diet for hypertension, finally resulting in a Thesis on "Adaptation and Adaptive Dysfunction" which was accepted with commendation for MD in 1950. The main conclusion was that allergies are the most common manifestation of faulty adaptation to the environment, but there was no possibility to develop this concept in 1950.
He became a member of the Royal College of Physicians of Edinburgh in 1949, and was elected a Fellow in 1965. He received an Honorary Doctorate from Derby University in 2004, and was elected an International fellow of the American Academy of Allergy in 2006.
After a Registrarship with the Medical Professorial Unit in Dundee he specialised in respiratory medicine, and was appointed Consultant Chest Physician in Derby in 1953. He inherited a run-down clinic where the major problem was tuberculosis, but nearly all were cured by 1956, so that other respiratory diseases could be treated.
Oral steroids and asthma
In 1956 a British Medical Research Council multi-central trial of oral steroids in chronic asthma concluded that steroids were no better than bronchodilators. He could not believe this because he had treated asthmatics with oral steroids with such dramatic improvement, and his thesis had been closely concerned with the early development of corticosteroids. In 1956 consultant physician sin the National Health Service had freedom to conduct clinical trials on their own initiative, so he decided to carry out his own trial, and appealed for chronic asthmatics.
Ninety patients were treated with oral steroids. After three months sixty were greatly improved but thirty were unchanged. Suspecting that he was treating two different diseases he began sending sputum to the local laboratory asking them to look for eosinophils, but none were reported even when he was sure they should be abundant.
This negative finding was also unacceptable, so he decided to look for himself using the antique Leitz microscope he had used as a student. Developing a rapid wet smear method of looking for eosinophils in the clinic, he discovered that the sixty who had responded to steroids had many eosinophils, while the thirty non-responders had none.
These striking findings were published in the Lancet in 1958 (Lancet 1958:ii:1245) but attracted no attention whatsoever, even though this was actually the very first study to show that the presence of eosinophils indicates steroid responsiveness. It was many years before sophisticated methods of examining induced sputum confirmed his findings.
Clinical allergy research
The ability to select steroid responsive patients proved very helpful for clinical management, but Morrow Brown was not satisfied with long-term oral steroids because of side-effects and became deeply involved in clinical allergy.The result was that from 1958 onwards he built up an allergy research centre, supported by a local charity he founded, and by organising five "Charles Blackley International Symposia on Clinical Aspects of Allergic Disease" at Nottingham University between 1973 and 1984.
Research was devoted to finding the causative allergens and introducing avoidance or immunotherapy so that oral steroids could be reduced or stopped. A major interest became aerobiology and seasonal allergies, using a spore trap he made himself, so pollen and spore counts became routine. (27 years of aerobiology research:- Immunology & Allergy Practice 1992; 14: 318-329) The range of allergic conditions treated expanded to include all body systems, particularly food allergy and eczema.
In 1968 Sir David Jack and his team at Glaxo developed the very first steroid aerosol containing Beclomethasone Dipropionate (BDP), but trials in Edinburgh concluded that they were ineffective and should be discarded. Fortunately the Glaxo Medical Director heard Dr Morrow Brown talking about eosinophils, realised that the Edinburgh investigators might be treating non responsive cases of COPD, and asked him to carry out another trial for which the entry criteria were that all patients had eosinophils in the sputum and all had peak flow meters to obtain hard data.
The results were dramatic and BDP aerosols were reprieved from the dustbin within a few months. The results were announced for the first time at the European Congress of Allergology in October 1971, and published in the British Medical Journal in 1972 (BMJ 1972; i :585) soon followed by many confirmatory studies. The first study of BDP in children was published in the following year (BMJ 1973;3;161-i64) and finally a long term survey of children in 1980. (Practitioner 1980: 224: 847-51)
Dr Morrow Brown's latest publication on BDP was a letter to the editor of the Lancet in 2003 drawing attention to the importance of the change to HFA propellants which enabled the production of an ultra-fine aerosol which could reach the whole bronchial tree for the first time. (Lancet 2003:361 : 433) While appreciating the benefits inhaled steroids have given to patients world-wide, he regrets that this development has enabled any doctor to treat asthma or rhinitis effectively without even thinking about possible allergic causes!
Several years ago he produced a very large website (www.allergiesexplained.com) containing an account of his researches and clinical experience with allergy since 1958 for anyone interested, and so that the public can access this information. Good fortune and serendipidy have played an important part in his career, backed by a passion for microscopy and personal investigation.
Continuing in consultant practice since retirement from the National Health Service he conducted a successful controlled trial of SLIT for hay fever from 1986 to 1989, and a very successful open trial of Acarosan for mite allergy, both published on his website.
He has developed methods of using the patients's own housedust for skin testing, and produced several portable air sampling devices in his well-equipped workshop for investigating occupational and environmental asthma. He invented a standardised skin testing needle, a re-breathing bronchial provocation test, and a 'microspoon' to hold the right amount of grass pollen for nasal provocation.
Charles Blackley observed grass pollen grains discharging their granules on exposure to water in 1873, and a video of this phenomenon has been made, and also of the motile bacteria in rainwater first seen by Leeuwenhoek in 1670. He continues studies of the inorganic crystals, mostly pleomorphic Calcium Sulphate, which are found in profusion in the air in certain weather conditions.
Dr Harry Morrow Brown – August 2012
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