Tributes to Dr Alfred William Frankland

March 1912 – April 2020

Dr Alfred William Frankland, the “grandfather” of clinical allergy in the UK, has died at the age of 108.  He was respected worldwide for his contributions to allergy and particularly for his pioneering work on allergen-specific immunotherapy which has improved the quality of life of patients with severe hay fever and other allergic diseases. 

His distinguished career in allergy began after World War 2 when he returned to work at St Mary’s Hospital, London, as a survivor of an infamous Japanese prisoner of war camp. Over the next 70 years, Bill’s enthusiasm for clinical allergy remained undiminished, his mental acuity and fitness were remarkable for a man of his age, let alone someone who survived not only the prison camp but serious illnesses also. 

Bill’s career spanned a time of great advances in the understanding of the mechanisms of allergy, (IgE was not yet discovered when he started and in its treatment (non-sedating antihistamines and corticosteroids still to be introduced). His prodigious memory for details of instructive cases made him an unparalleled source of advice on the ‘difficult patient’. His curiosity about other fields such as botany (pollens), entomology (insect bite allergy) and human behaviour was forever sharp. Like all good allergists, he knew the importance of listening to the patient and of a clear explanation of the facts. 

In the 1940s for lack of other effective remedies, specific allergen desensitisation or immunotherapy was the mainstay for the treatment of respiratory allergies when it was not possible to avoid the allergens responsibly. Although introduced some 40 years previously, this method of treatment, exemplified by grass pollen immunotherapy for seasonal rhinoconjunctivitis and asthma had never been evaluated in a systematic controlled clinical trial until Bill’s landmark study, published in 1954. A similar trial, (very likely to the dismay of some of his senior colleagues), had clearly demonstrated the lack of efficacy of bacterial vaccines in asthma treatment. In the inoculation department at St Mary’s in 1945 working with Dr Freeman, allergen vaccines were produced and used in treatment. The scale of the operation was prodigious by present-day standards. It was also a major source of revenue for the Department, who prepared the vaccines both allergen and bacterial, and paid medical students to perform skin tests, and subsequently taught the patients, some as young as 15, to give their own injections. Dr Freeman had a pollen farm to produce raw material for a vaccine. One year, over 6,000 patients were given a pre-seasonal pollen vaccine. The principle of allergen immunisation was extended to include animal dander and mould spores, and it is now known that the source of the momentous contamination of a Petri dish in Alexander Fleming’s laboratory, back in the 1920s, was one of the Penicillium moulds being studied in the inoculation Department, which was situated immediately beneath Professor Fleming’s laboratory.

In contrast to that of his own teacher (Sir Alexander Fleming) at St Mary’s in the 1930s, Bill had been mainly in the clinic rather than in the laboratory. Later, Bill was to have a minor disagreement with his famous colleague on the subject of whether penicillin caused allergy. 

In 1947 Vera Walker, an eye specialist from Oxford who was interested in allergy, wrote to Dr Freeman about starting an allergy society, the first meeting of which took place at St Mary’s in 1948, the two speakers being Sir Henry Dale (a distinguished pharmacologist, later head of Wellcome Research) and Dr Freeman. Dr Frankland was appointed the new society’s first secretary, and over 30 members joined, mostly physicians.  At the time asthma was the principal allergic condition of interest. The British Allergy Society thus began in 1948 but did not have a constitution written until 1951, at which time there were 40-50 members. In parallel, a Royal Society of Medicine section of Clinical Immunology and Allergy was started up in 1965, by which time the British Allergy Society had 150 members. The Antibody Club was incorporated too, bringing it into the picture. These were the roots of the British Society for Allergy & Clinical Immunology (BSACI) and Bill was instrumental in its formation later becoming BSACI President between 1963-1966.

By 1951 Bill was organising pollen counts at St Mary’s Hospital and made weekly counts available to members of the society and to the press (on a daily basis. Theses counts were based on a pollen trap set up on the Nurses’ Home roof at St Mary’s. Miss Muriel Hay applied for the job of botanist and was appointed, perhaps partly because of her appropriate name. Bill’s friendship with another ‘elder statesman’ of the BSACI, Dr Harry Morrow Brown, dates back to 1959. Like Bill, Harry was a clinician and a practical researcher, who made important discoveries pertinent to allergic diseases, such as the role of eosinophils in allergy, and, subsequently, the demonstration of the efficacy of inhaled steroids in asthma in 1972. The well-attended Charles Blackley symposia at Nottingham was Harry’s brainchild. Another towering figure in British Allergy with whom Bill was involved to the extent of giving him his first allergy job in the UK, was the late Jack Pepys.

Bill at this time was undertaking studies to show the efficacy of antihistamines, demonstrating, incidentally, their lack of effect in asthma. By the 1960s, the Society was meeting regularly, often away from London, in Liverpool, York and Nottingham. In 1955 Bill used himself for an experiment on inducing allergy to a biting insect, Rhodnius Prolixus, which, unlike most biting insects, can induce anaphylaxis. Repeated self-inflicted bites led not only to increasing local reactions but to a severe anaphylactic reaction. This episode, in the great tradition of self-experimentation, would be difficult to do nowadays in the era of protocols and ethics committee approval.

The pollen farm near Woking produced kilogramme quantities of pollen for the production of test solutions and the pollen vaccines, and a film dealing with this was made in 1951, a copy of which is in the National Institutes of Health museum in the USA.

Early prominent figures in the history of the Allergy Society were Vera Walker, the Oxford ophthalmologist, Dr D A Williams, a Cardiff physician who had started pollen and mould spore counts as early as 1943, Rupert Bruce Pearson, a King’s College Hospital physician interested in asthma and allergy, and Blair Macaulay, a Liverpool chest physician, all of who held high office in the society.

Bill started the second phase of his allergy career when, on reaching retirement age and retiring from St Mary’s, he was invited by Maurice Lessof, Professor of Medicine at Guy’s Hospital, to take part in the allergy clinic and in the weekly meetings of the Department. Insect venom immunotherapy at Guy’s was starting up at this time, using purified bee and wasp venoms, which had recently been shown to be effective, unlike the ‘whole-body’ insect extracts previously used for skin testing and immunotherapy. The department was active in trying to find out how immunotherapy worked and how to evaluate its efficacy.

Most patients were evaluated at the hospital and started on venom, pollen or mite immunotherapy, which was continued by their GPs, but in 1986 this approach was stopped because of safety concerns. Bill then continued his weekly clinics, contributing to the academic and clinical life of the Department for 20 years, covering the retirement of Professor Lessof and the appointment of Professor Tak Lee.

He received many honours over his lifetime the highest one was in 2015 when Bill was recognised in the Queen’s Birthday honours list and awarded an MBE by HRH The Duke of Cambridge. The allergy unit at St Mary’s Hospital was named after him and in recognition of his accomplishments, BSACI named an award in his honour ‘The William Frankland Award’ which has been presented each year at the BSACI Annual Meeting since 1999 to those who have provided outstanding services to clinical allergy in the UK. 
Rarely can a single figure have been so influential in an institution and the fostering of a clinical discipline to the extent that Bill Frankland was. He was a legend in his own lifetime and many allergists of several generations have benefitted greatly from his wisdom and experience, not to mention his admirers from all over the world, including patients and colleagues. 

Bill achieved so much in both his professional and personal life and is going to be greatly missed by us all for so many reasons.