The second principle that should be kept in mind is the concept of the total body load, which tends to distort many of the body=s homeostatic mechanisms. This is the sum of all incitants that the body has to handle in order to function. This is the total of the pollutants in air, water, and food. The load principle seems simple until one perceives the amount and scope of pollution that have crept into our environment. The more important components comprising the total load are discussed in the following paragraphs.

Most public water systems are now overloaded with synthetic chemicals, potentially increasing the body load to synthetics from 1,000 to 10,000 times (Table 1). Unfortunately public water supplies are rated only as to bacterial count, the chemical content being ignored. Recent EPA studies of the 83 largest cities show all of the water supplies to be severely chemically contaminated. Apparently, our waters are now as badly polluted with chemicals as they were with bacteria years before chlorination.

The summation of all these facts, plus a polluted work environment, results in a massive increase in body load that any one individual must handle just to function daily. This often becomes too great in persons with certain hereditary and acquired tendencies; the resultant individual susceptibility thus allows inflammatory diseases to occur. This chemical overload often distorts the food handling mechanism to the point that no foods are safe for some individuals. Often individuals with chemical overload also become sensitive to pollens, dusts, and molds.

A symptom complex often occurs with recurrent ear, nose, and throat diseases. If one looks for these, he will often become aware of environmental triggering as a problem. This complex consists of acneiform lesions, petechiae, and/or spontaneous bruising and purpura, peripheral coldness and cyanosis, and peripheral and periorbital edema.

The acneiform lesions usually occur on the face and shoulders, ranging in number from one to thousands. They have been reproduced in patients by injection of 0.05 ml of the food extract (usually the Number Two dilution) followed by ingestion of the same food. If the patient is supersensitive to the food, an acneiform lesion develops at the injection site within 24 to 36 hours. It has been possible to reproduce lesions in this manner using numerous foods and phenol. Localized edema or hives occasionally occur, but the more generalized peripheral and periorbital edema is much more common. However, this is often subtle and may be overlooked. People almost accept as normal swelling of their fingers to the point that rings cannot be removed, and expect cyclic edema to occur around the eyes and feet. If blood vessels leak further, extravasation of red cells causes bruising, purpura, and petechiae. Peripheral spastic phenomenon in the absence of cold occurs when challenge with chemicals and foods is performed. If the ear, nose, and throat physician keeps in mind the possibility of involvement of any or all four of the smooth muscle systems, he will be better able to diagnose and treat environmentally triggered disease.

AirCThis parameter is the most difficult to assess because little attention has been directed toward air analysis of indoor pollution and because the outside air in the United States has become so polluted. According to some authorities, there has been no fresh air here for 15 years.

In order to study the environmental problem better, the Brookhaven Environmental Unit was created taking into consideration the aforementioned facts and principles using material constructed with meticulous detail. A description of the Unit follows so the ear, nose and throat physician may use the principles in his office practice. Inattention to controlling the ambient air of an office often results in misdiagnosis, and, therefore, inappropriate treatment.

A wing of the hospital was used in order to exclude contaminants from other areas. A firewall excluded all other possible pollutants. Double doors were used so that an air lock could be obtained to prevent outside air from entering the adjacent building. Air conditioning was installed in window units using all-metal coolers. Heat is of a local nature and presented a much more difficult problem because many chemically susceptible individuals are also sensitive to many types and sources of heat. Approximately 90% of 400 consecutive chemically susceptible patients are sensitive to the fumes of natural gas, which correlates with Randolph=s findings. In addition, many patients are also sensitive to fumes emanating from different electric devices. Copper radiators with aluminum fins are satisfactory only for 50% of patients. Steel and cast iron radiators appear to be better tolerated but rely on a central blower, which presents a different problem. Radiant glass and ceramic are also available and are tolerable to many individuals. High temperature wires appear to be the most offensive form of electric heat (Table 6). Solar heat, when available directly, seems to be acceptable.

Currently, we use sequences of filtration, e.g., cotton or fiberglass as a prefilter followed by aluminum oxide impregnated with potassium permanganate. Then, a loose charcoal filter is used as the final pathway. These filters should all be enclosed in metal cages. Many patients have become sensitive to charcoal from its pure coconut or bituminous coal origin. Ideally, cotton, marbles, and dechlorinated water should be used to remove the charcoal particles.

Basically, rooms can be constructed from any inert material. However, only four or five are easily available:

FoodCSince there are now large amounts of additives, preservatives, pesticides, and herbicides in commercial food, testing must be done with chemically less contaminated foods. In our center, an organization had to be started to foster the acquisition of such food. Farmers were contracted to grow the food in a safe manner. No herbicides, pesticides, or artificial fertilizers are used in growing this food. Food must be stored in uncoated cellophane and glass in order to prevent contamination. Cooperatives are necessary in order to have available safe food and also to monitor the food to insure a chemically less contaminated form. We have seen several examples of contaminated food found by this method. At one time many individuals began reacting to pork. The individuals knew they should have no reaction to pork and that, therefore, the meat must be contaminated. The farmer who supplied the pork informed us that he had acquired six-week-old pigs from another farmer and placed them on the usual feeding regime. Apparently, the gestation time and first six weeks= feeding on chemically contaminated food was enough to contaminate these pigs severely. A second example was when many individuals reacted to cantaloupe from a recent lot. Chemical analysis showed the presence of two parts per billion of dieldrin and chlordane. By using such a network of analysis, one can constantly monitor and help to prevent food contamination.

WaterCIt has become evident that many individuals are increasingly sensitive to water. Recent studies show that most of our largest cities have severely chemically contaminated water supplies. We are now at the point of chemical contamination in water where we were 75 years ago with bacteria before the onset of chlorination. Little is recognized of the potential harmful effects of the chemical contamination of the water supply by the average layman or physician. In the Environmental Unit, acute cause and effect for water contaminants can be ascertained in approximately two days. Double-blind studies using tap, charcoal-filtered, and numerous spring and distilled waters have revealed approximately 90% of the chemically sensitive patients to be intolerant of tap water. Some patients are very sensitive to distilled water, while others may be sensitive to many of the spring waters. Spring water appears to be the best of the alternate waters, a finding which correlates well with Randolph=s studies. In an office practice, use of spring water in glass bottles is practical in working out patients= problems.