This account of the life of Dr Carl Prausnitz Giles was published in the Southampton Medical Journal,  Vol. 8 No. 2 in October 1992.

Carl Prausnitz — Father of Clinical Allergy.

 by David W. Hide, Clinical Allergy Unit, St. Mary’s Hospital, Newport. Isle of Wight . . .

Introduction A physician’s place in medical history appears to depend very much on chance. An ‘original’ clinical observation or a fortuitous laboratory finding may ensure a perpetual memory. Carl Prausnitz is remembered, at least by medical students, as part of the eponymous Prausnitz-Kustner reaction —although many would be hard put to describe it precisely. Yet Carl Prausnitz made a fundamental contribution to immunology and has been called the ‘Father’ of clinical allergy. The story begins and ends, on the Isle of Wight. In  1849 Charles Dickens took a house in Bonchurch on the south coast of the Island and brought his wife Kate and children to ‘the prettiest place I ever did see’. He enjoyed his holiday and wrote the early chapters of his own favourite, and autobiographical work, David Copperfield. He was a man of prodigious energy and walked daily to the top of St Boniface Down. He must have met many local worthies; the population of Bonchurch then was about 500— it is not much more today. One, George Giles, might have been at home for a holiday.  He was at the time employed constructing the Great Northern Railway from Gainsborough to Peterborough and before that had been helping build the Hamburg -Berlin Railway. He was in Hamburg in 1842 when that city was ravaged by fire. Giles succeeded in preventing the spread of the flames by the use of explosives. His efforts were misinterpreted by the mob and he was lucky to escape with his life. He survived and in due course his actions were acknowledged by the city Senate who made him a freeman. George and his wife Elizabeth, who came from Leicester had eleven children and the third, Edith Maria was born in Hamburg in 1846. The family’s connections with Hamburg must have remained for in 1875  Edith married Otto Prausnitz , M.D., an army physician from that city. The wedding took place in St Boniface Church, Bonchurch and according to the marriage certificates the groom’s father was a merchant and the bride’s a gentleman. Otto’s father, Heyman Prausnitz, was in fact a bookseller He, a Jew had died in Gorlitz, Silesia in 1857. Otto and Edith are described as Lutherans and their first son Carl was born at home in Hamburg on I I th October I876. He was baptised a month later and confirmed when 15. Most of Carl’s schooling took place in Hamburg where Otto was in practice following a distinguished army career in which his decorations included the Iron Cross (second class). Carl attended the Realgymnasium des Johanneums from 1891-1894. His Arbitur certificate was good or very good in all subjects except geometry (satisfactory). Many holidays were spent with aunts in Bonchurch and he probably spent some time at school in Weymouth. His bilingualism was to stand him in very good stead. He went on to school in Darmstadt before enrolling at the University of Leipzig for pre-clinical subjects which he passed in 1898. Carl Prausnitz spent a year studying at Kiel before completing his medical training at Breslau, graduating M.D. summa cum laude, the highest pass possible, in 1902.  Sadly his father died two months earlier in Hamburg. Carl had proposed to his second cousin, Margot Bruck on the last day of the nineteenth century New Year’s Eve 1899.

                Margot was the only child of the Professor of Criminal Law in Breslau and the wedding took place in Bernhardin-Kirchen Breslau on September 4th I 903. Carl took a post in his home city of Hamburg. Prausnitz recounts his early memories of the great cholera epidemic of 1892. At that time the Hamburg water supply was taken from the Elbe into which poured the sewage of Hamburg and the nearby town of Altona. Now Altona installed a sand filtration plant Hamburg wanted something better but the local dignitaries could not make up their minds exactly what they required. In later summer 1892 cholera broke out with more than 10,000 cases in Hamburg and 5,000 deaths. None occurred in Altona except in people who worked by day in Hamburg. The only exception was a small area of Altona,the Langer Jammer. This area obtained its water supply from Hamburg. Hamburg authorities asked Robert Koch to appoint a senior man as head of the Hygiene Department They were not best pleased when he appointed one William Philip Dunbar, a man of German/American parentage and only accepted him on the understanding that Koch himself would monitor the situation. Prausnitz joined Dunbar and worked at the Hygiene Institute in Hamburg from 1902-1905. Much of the work was concerned with cholera, plague, typhoid, diphtheria and tuberculosis. However Dunbar was very interested in hay-fever which he believed to be due to a toxin in the pollen. Prausnitz took the liberty of querying his chief’s opinion that hay-fever was a bacterial disease. They were both sufferers and experimented on themselves. They were unaware of Blackley’s work (reference) but found that grass pollen reproduced hay-fever symptoms in the nose and eye. When inhaled, asthma resulted and when Prausnitz injected himself with a solution of pollen extract he developed severe asthma and urticaria. Dunbar insisted the experiment be repeated on him and Prausnitz tells how the result was a near fatality. ‘At that time we had no adrenaline, no coramine, just stood helplessly at his side until he recovered’. Dunbar and Prausnitz prepared a vaccine from horses injected with pollen which they thought often effective in reducing the severity of hay-fever symptoms. Pollantin had to be abandoned when patients became sensitised to horse serum. Had they continued with this work, Dunbar and Prausnitz could now be credited for introducing de-sensitisation or immunotherapy into medical practice. In the event, Leonard Noon, in 19 I I was the first to report an open study on twenty patients with hay-fever. Perhaps the subsequent abuses of this practice, which are only now being encountered, confirm Dunbar and Prausnitz’ wisdom in abandoning this line of research. Dunbar’s testimonial to Prausnitz was glowing: ‘he would reap a rich harvest of his intellectual ability and the love of his work’

      Other scientific work in Europe at this time is relevant to this story. In the Mediterranean the Prince of Monaco was continuing his annual oceanographic cruises in the Princess Alice II. In 1901 Portier from the Sorbonne and Richet, Professor of Physiology at the University of Paris were studying the Portuguese man-of-war; Physalia, and its toxin. On their return to Paris they were unable to obtain Physalia and decided to study another coelenterate, Actinia sulcata, a  sea-anemone which also produced a neurotoxin. Two dogs Galathee and Neptune were injected with weak doses of actinotoxin. Four weeks later the dogs were described as ‘in perfect health, cheerful, active, coat shiny . On the same day Neptune was injected with 0.12cc toxin per kg. This immediately produced vomiting, defaecation, and trembling of the front legs The dog fell on the side, lost consciousness and in one half hour was dead’ Five days later Portier and Richet presented their discovery of hypersensitivity or anaphylaxis a meeting of the Society de Biologie. Richet, but not Portier; awarded a Nobel prize in I 9 I 3 for his studies of anaphylaxis.

      An Austrian paediatrician, Clemens von Pirquet, working with Bela Schick noted that some patients receiving anti-serum developed a spectrum of systemic and local symptoms they termed serum sickness. Von Pirquet was working in the scarlet fever wards of Escherich’s Paediatric Department in Vienna. A colleague, Moser had introduced  an anti-streptococcus serum. Doses of the order of 200 ml. were given Von Pirquet detailed the the syndrome of fever, skin rash arthropathy and lymph node swelling. He found earlier accounts in the hospital records, after diphtheria and tetanus antisera had been used , and concluded that serum sickness was due to antibodies to foreign proteins. He used the term allergy or altered activity, for the first time to describe what he took to be an immunological phenomenon. In the same year ,1906, Alfred Wolff-Eisner suggested that hay-fever might be a form of hypersensitivity or anaphylaxis in the nose and four years later Samuel Meltzer made a similar suggestion for asthma.

      By this time Prausnitz had come to England and was working at the Royal Institute of Public Health as a Demonstrator in Bacteriology. He was involved particularly with diphtheria, typhoid, tuberculosis and water-borne infection and teaching for the Diploma in Public Health. Possibly he had opportunity while with relatives on the Isle of Wight to visit In the Royal National Hospital for Consumption which had an been founded by Arthur Hill Hassall in 1868. Hassall, himself an eminent physician and naturalist, developed and ran hospital until I877. Hassall’s name is remembered by medical students for the cellular aggregates, or corpuscles, he described in the thymus, which bear his name. The institution Hassall founded with Royal patronage had a most distinguished history becoming the Royal National Hospital for Diseases of the Chest. It was closed in 1968; chemotherapy of tuberculosis having made chronic TB hospitals redundant. Hassall’s name is perpetuated in an acute ward at St Mary’s Hospital, Newport and the site of the hospital is now the Ventnor Botanical Gardens. For three years from 1905-1908 Carl Prausnitz was Demonstrator at the Royal Institute of Public Health in London. He also contributed a paper to the first edition., the Journal of the Society for the ‘Destruction of Vermin’ on ‘The destruction of rats on ships’. Prausnitz says there is not much to say about this time at Royal Institute of Public Health and subsequently at the Metropolitan Asylums Board  as Assistant Bacteriologist from 1908-19 10. In 1908 he took his Conjoint qualification, M.R.C.S., L.R.C.P and had his name entered on the Medical Register.  This stood him in good stead when he re-entered Britain in 1933 as a refugee from  Nazi oppression. He did meet many of the leading authorities when they came to London to lecture. He was  much in demand to translate for the Royal lnstitute’s Journal.. On one occasion Paul Erlich injured an eye on a shirt stud and was told he could not lecture. The great man told Prausnitz he must give the lecture for him. ‘I was horrified at  the idea. I was such a youngster; so inexperienced’. Ehrlich. working in the insisted, so during the night Prausnitz translated the lecture in into English and gave it the next day. He reports that Paul Ehrlich never forgot and they remained friends until the end of Ehrlich’s life. Others who came to give Harben lectures while Prausnitz was in London included Metchnikoff and Richard Pfeiffer.  Pfeiffer identified Prausnitz’ ability and in 1910 invited him back to Breslau to be head of the hydrophobia department. During the First World War Prausnitz was at first assistant to Pfeiffer who was a hygiene inspector to one of the armies. He was then appointed Hygiene Adviser to an army corps on active service in France and Belgium. He was much involved with housing, water supply, sewage etc and ran a field bacteriology laboratory. He was decorated a number of times including the Iron Cross First Class.

.          One of the more amusing war anecdotes tells how Prausnitz with Pfeiffer went to the Pasteur institute in Lille where they believed there was a supply of tetanus anti-serum. Lille had, just been captured by the German First Army  ( They belonged to the second ). On arrival at the Pasteur Institute they found Calmette and Guerin being held at gunpoint.  On the previous day a carrier pigeon had been found Calmette and Guerin were thought to be sending information.  Shortly after Prausnitz established that the pigeon was being used for the experiments that eventually led to  the discovery of  BCG. Prausnftz explained this to Richard Pfeiffer who interceded with the army governor: Calmette and Guerin were released.

      After the war Prausnitz returned to Breslau in charge of the diagnostic department. He was much in demand as a teacher and directed an Academy of Social Hygiene attended by Medical Officers of Health, school doctors etc. His own Curriculum Vitae then states ‘ I discovered the reaction that is now known as the Prausnitz-Kustner test’  This stark statement that he did not amplify, should have ensured his immortal memory for it conceals a clinical finding that established the immunological basis of much allergic disease. Kustner, a colleague, was exquisitely sensitive to fish.  Prausnitz injected various dilutions of Kustner’s serum into his own skin. The next day he injected into each place, and control areas, with fish extract, and the result showed that sensitivity  could be transferred via the serum from the  from an allergic person to a non-allergic. This was published in 1921 and within a few years the name of reagin was given to this antibody. It was to take 45 more years before the Ishisakas in the States and Johannsen and Bennich in Sweden, working independently identified reaginic anibody as Ig E.

      By 1921 Prausnitz had the title Professor. After three years deputising for the director of the Hygiene Institute  at Greiffswald he succeeded hid friend Richard Pfeiffer as Professor and head of the Hygiene in Breslau in 1926. His work was then largely bacteriology and preventative medicine. He published on undulant fever, .hydrophobia, and a large trial of Bacille Calmette Guerin - B.C.G. He became interested in industrial medicine particularly of electric shock and carbonic acid poisoning. This was followed by work on carbon monoxide poisoning - as usual with self-experimentation.

       Carl Prausnitz was by now an international figure. He became involved with the League of Nations. In 1930 he visited Hygiene Institutes in  Britain, France, Poland, Czechoslovakia, Hungary and Yugoslavia. In 1931 he visited Athens and Madrid and the following year was invited to give the ‘ Heath Clark ‘lectures at the London School of Tropical Medicine and Hygiene on the subject of  ‘ Teaching of Preventive Medicine in Europe’. He held to the view that prevention was always a better approach - though their was no suggestion of how allergic disease could be prevented in these  lectures. His fame was at its peak. He was a popular lecturer. and was favoured to transfer to the  premier Chair in Microbiology in Germany at Berlin. But National Socialism was stirring and Carl’s grandfather Heyman Prausnitz had died a Jew  A visit to Soviet Russia had raised suspicions of communist sympathies. Shortly after returning from a visit abroad he was imprisoned. He could see no future for himself in Germany and in October 1933.  He was granted leave without pay to work in England and in April 1934 was compulsorily retired from his Chair at Breslau

      Carl Prausnitz moved to Manchester with his family and with a grant from the Medical Research Council and Rockefeller Foundation worked in the department of  Professor Maitland investigating cotton spinner’s asthma This work ‘Investigations on respiratory dust diseases in operatives in the cotton industry’ has been described by Coombs as ‘a model of research in clinical immunology’. Prausnitz  concluded that ‘stripper’s asthma’ was a reaction to the very  finest dust particles. He demonstrated that patients had an hypersensitivity to the dust  and the symptoms were often worse on Monday or after any interruption to work next day Prausnitz was describing one form of allergic alveolitis - setting that subsequently was clarified by Pepys. At this time  he was offered a Chair in Zurich but declined and then took the advantage of an offer to join a boyhood friend Bruce Williamson, in general practice in Ventnor and in those days it was necessary to ‘buy in’ to the practice and Prausnitz had to borrow a substantial sum to do this, in 1935.

      He was soon a highly respected member of the community In April 1939 he changed his name by deed poll and took an oath of allegiance to the crown He became Carl Prausnitz Giles. He had to contend with some anti-German feeling at the outbreak of the war: One day in autumn 1939 the family’s game of putting, on the greens at Ventnor, was interrupted by an elderly lady asking’ What are these Germans doing here? He was dedicated to this patients and they loved him Such adoration was not given by all for he was harsh on those he suspected of malingering particularly Probably his patients were rather frightened of him. He ruled his family with a rod of iron. His daughter-in-law says his edicts were ‘by royal command’.

      Carl and Margot had three children whom the youngest, Christopher survives He was born 1917 in Breslau and worked as Consultant Pathologist in Stoke-on-Trent. Christopher gives some insight into his In father’s character by saying his first memory thrashing at age 3 for pushing a chair through a window. A few years, later in Breslau, Christopher thought he had escaped without paying his fare on a tram only to be apprehended by the conductor An informant had told the conductor ‘that young man has not paid his fare’. That informant was...his father ! Dr Giles was too immersed in his work to have much time for hobbies.  He served as Captain in the Ventnor Home Guard in World War 2 — one of the few with an Iron Cross, to say nothing of his Hanseatic Cross and the Order of Hoenzollern, third class. He was a Rotarian, a Mason and served as a town councillor but was frustrated by local politics. He was interested in photography and had been a pioneer of photomicrography

      His daughter, Anna, worked at St Boniface School and she had one daughter, Elizabeth, whom Carl adored. Elizabeth went to Manchester University but tragically was killed in a road accident at the age of 19 in 1947 Margot died in Ventnor in 1949 Carl continued to devote himself to his patients. He was worried by midwifery but thrived on the investigative side of clinical medicine The basement of his house in Ventnor was equipped as a laboratory He made the national papers at the age of 80 after climbing to the top of  St Boniface Down with his medical bag to an injured holiday maker He protested against the closure of the Royal  National Hospital in 1964.  As he became older his driving became faster and now is something of a legend One story perhaps apocryphal, tells of his taking somebody to the chemist— he literally drove in! His daughter-in-law recalled an occasion in which he was driving fast down the middle of the Undercliff road. They passed another car with a loud bang. ‘Shouldn’t we stop?’ queried his son Otto. ‘Certainly not, drunken fool’ said Carl. On arriving home they noted the driver’s door handle had bee wrenched from the car Perhaps Carl Prausnitz has not received the fame he might have had he remained in academic circles. He was awarded the Gold Medal of the Koch Institute in 1958 He said he would not return to Germany but in 1960 he went back to Hamburg to receive an Honorary M.D. He maintained some contact with allergy in the British Societies of Allergy and Immunology whose members knew him affectionately as ‘Father Giles’ He was shattered when his daughter Anna died after a painful illness in 1963 and his own death was not long delayed.  He said the years in general practice on the Isle of Wight were the most fulfilling of his life. Certainly now almost thirty years after his death, one continues to meet patients who remember him with great affection His discovery of the passive transfer of  hypersensitivity was of immense importance to the comprehension of the pathogenesis of the disorders now known as the atopic diseases, hay-fever and other allergic rhinitis, asthma, infantile eczema and certain types of food allergy. Three years after  he died the husband and wife team of Teruko and Kimishige  isolated a reagin rich fraction from the serum of patient who was very highly sensitive to ragweed. Rabbits were immunised with this fraction and produced antibodies When they mixed the ‘reagin’ rich fraction with the anti-serum the Prausnftz-Kustner activity was lost. By electrophoretic techniques a new immunoglobulin was identified. Reagin was gamma E globulin soon renamed IgE. Prausnitz never met the Ishizakas In his obituary by David Harley he is said to have a place in the select band of medical immortals’. He described himself as an old fashioned country G.P., who used to be a professor once upon a time’.. Carl Prausnitz is buried with other members of the Giles family in the Churchyard of St Boniface, Bonchurch and the grave bears the legend ‘beloved physician’. It could also say. ‘Father of clinical allergy’.

References:

.          1. .Hutchings R..J. Dickens on an island. 1970 James Brodie Ltd. Bath.

.     2. Dunbar W..P The present state of our knowledge of hay-fever. J Hygiene 1913; XIII: 105-148.

.     3. Noon L Prophylactic inoculation against hay-fever. Lancet 191I; I: 1572.

      4. May C.D. The ancestry of allergy.  Being an account of the original  experimental induction of hypersensitivity recognising. contribution of Paul Portier.  J. Allergy Clin. Immun 1985; 75:485—495.

      5.Pirquet C von. Kiinische studien uber vakzination und vakzinale allergie. MunchenerMedizinische Wochenschrift  1906; 53: 1457.

      6.Wolff-Eisner A.  Das Heufieber: Sein Wesen and Seine Behandlung Muchen.

      7.Meltzer S.J.. Bronchial asthma as a phenomenon of anaphylaxis. Journal of American Medical Association 1910; 55:1021.

      8.Gray E.A. By candlelight — The /ife of Dr Arthur Hill Hassall. 1983. Robert Hale Ltd London.

      9.Laidlaw E.F. The story of the Royal National Hospital, Ventnor 1990  published by the author

      10.Prausnitz C, Kustner H.. Studien uber die uberempfindlichkeith. Zentralblatt furBakteriologie 1921; 86:

       160—169.

      1 l.Prausnitz C. Investigation on respiratory dust disease in long delayed. operatives in the cotton industry Medical Research Council Spec., Rep. Ser. No. 212  1936.

      / 2.Coombs R.R.A. The first Carl Prausnitz Memorial Lecture. Int..Arch Allergy 1973; 45: 1—22.

      I 3.Ishizaka K, Ishizaka T.  Identification of gamma-E antibodies as a carrier of reaginic antibody J Immunol /967; 99: / /87.

      Acknowledgement. I am grateful to Dr Christopher Giles for allowing me access to his detailed family records and           photographs of Professor Carl Prausnitz. I also acknowledge the kind help of Professor dr med j Bockemulh,. Director of the Hamburg Hygiene Institute and Drs Leszek. and Wojciech Barg of Wroclaw, Poland (formerly Breslau) who helped me gain knowledge of Prausnitz the academic.  Background to Prausnitz the general practitioner was given Dr Alan Champion, general practitioner in Ventnor, erstwhile partner; and many former colleagues and patients of Carl Prausnitz Giles on the Isle of Wight.

      Note. The David Hide Clinical Allergy and Research Unit at St Mary’s Hospital, Newport, Isle of Wight,

      a Department of Southampton Medical School, was named for David,  after his death five years ago, and the library in the unit is the ‘Carl Prausnitz Library’.

      Dr Champion reproduced this article with the permission of Mrs Hide, Dr Christopher Giles and the editor of the Southampton Medical Journal.