Keith Kenneth Eaton

Former president British Society for Allergy, Environmental and Nutritional Medicine (b Eastleigh, Hampshire, 5 March 1936; q Edinburgh 1961), died from pancreatic cancer on 17 November 2002.

After qualification Keith Eaton entered general practice in Andover in the early 1960s and shortly afterwards met his wife-to-be, Susan Roberts, at an art gallery. Susan had recently developed asthma, had rapidly become quite seriously ill, and had come under the care of some good allergists in London. This started Keith�s lifelong fascination with allergy, and when he moved to a group practice in Bracknell he gradually took over all its allergy patients.

Keith was one of the earliest members of the British Allergy Society (now the British Society for Allergy and Clinical Immunology (BSACI)), and soon, while in full time general practice, he began to publish research papers. He was always grateful to the late Professor Jack Pepys for guiding and encouraging his first attempts at medical authorship, and in later life made a point of doing the same for his own junior (and sometimes senior) colleagues. Eventually he published some 80 papers. His main research interests were allergens, particularly those of mites and fungi. His interest in moulds may have been kindled by his wife�s intense allergy to some of them, plus a severe episode, in one house, of dry rot! He authored the Pocket Guide to Allergies (1982, 1989) and part-authored Allergy Therapeutics (1982) and Environmental Medicine in Clinical Practice (1997). He took the post of hospital practitioner in allergy at the Royal Berkshire Hospital and acted as allergy consultant to the food and pharmaceutical industries. In the mid-1980s, following the departure of E Merck Ltd (for which he had been a medical director) from the British allergy scene, he set up a singlehanded allergen-production laboratory at home, with state-of-the-art sterility procedures in the attic. He went into full time private allergy practice in 1987.

His interest in fungi led him into a critical appraisal of the ill defined condition ascribed by the popular media to "chronic intestinal candida" (or simply, but incorrectly, "candida"). To this he devoted a considerable research effort in his last decade, contributing a definitive review to the second edition (2002) of Brostoff and Challacombe�s Food Allergy and Intolerance. While accepting the clinical reality of the condition, he pleaded strongly for the abandonment of its popular simplistic name in favour of the more cautious "fungal-type dysbiosis." Ironically, he was on the verge of publishing his findings on ergosterol (which provide the first real evidence for intestinal fungal growth in the condition) when death intervened.

In the late 1970s the sober scientific world of British allergy was split by the arrival from the United States of the "clinical ecology" movement, spearheaded in this country by the late Dr Richard ("Not All in the Mind") Mackarness. To most conventional allergists, accustomed to thinking in terms of disordered antibody responses to harmless antigens, clinical ecologists were largely talking nonsense, and were practising treatment methods that were frankly ludicrous�too laughable to warrant serious attention. They would have been ignored were it not for their infuriating habit of talking about "allergy" as if it belonged exclusively to them and had nothing to do with immunology (Professor John Soothill wearily described the controversy as the war of the "blimps against the nuts"). But Keith was a consummate scientist, as well as a clinician through and through, and he wondered if in spite of their apparent disdain for immunology, there might not be something valuable to learn from these clinical ecologists.

Perceiving the firm clinical foundations and unique value of this new approach, later to be termed "allergy, environmental and nutritional (AEN) medicine," he joined the fledgling clinical ecology group (later the British Society for AEN Medicine (BSAENM)) and started preaching scientific stringency. At the same time he continued his membership of the established society, the BSACI, firmly maintaining the view that we must learn from the good of both groups while discarding the bad. Twenty years of effort helped to push the BSAENM into taking the position that only methods firmly rooted in sound science or validated by double blind trials are promoted, while methods not passing those tests are deprecated. Scientific evidence, he held, is supreme and must be followed, even if it seems to fly in the face of "commonsense". The "p value" cares nothing for prejudice; if our cherished beliefs clash with scientific evidence, in Keith�s view, it is the beliefs that must be revised.

He became president of the BSAENM in 1998. He was an amusing but firm chairman who kept us all grinning but hard at work; we all warmed to his fatherly style and learned to be dependent on him. With Keith in charge, one felt, we could stop worrying and leave everything in his capable hands. But none of us knew what changes were waiting around the corner.

With the advent of doctors� revalidation, and the realisation that, soon, none of us would be permitted to continue in practice unless we could provide evidence of effectiveness, it became necessary to consider whom we would entrust with assessing our competence. More or less singlehanded and by sheer force of personality, Keith bulldozed the BSAENM constitutionally into setting up a board of registration, empowered to train, assess, and approve (or disapprove) doctors as competent in the methods of AEN medicine, to be satisfactory to the General Medical Council and the Specialist Training Authority. In collaboration with the Institute of Biology, he had almost completed the setting up of a register of approved practitioners by the time he died. He watched with pride as the first batch of doctors completed the training and assessment process, and only narrowly missed seeing the first few registrations. Keith Eaton was the right person, in the right place and at the right time, to transform British clinical ecology from an eccentric medical hobby into a medical discipline. He did not live quite long enough to see the vision become reality, but he laid solid foundations. Probably no one else could have done the job.

Keith Eaton was an interesting and tireless conversationalist�he invariably had a view, usually a novel one. As a doctor he was loved by his patients�they too could not get a word in edgeways, but did not seem to want to either because Keith intrigued and entertained them as well as giving sound medical advice. When lecturing at formal medical gatherings he used an impish sense of humour to illustrate points that might otherwise have been difficult for doctors to comprehend, as, for example, his famous comment on the cause of atopic eczema. To judge by the prescribing behaviour of doctors, he dryly noted, it must be caused by betamethasone deficiency! He was also multitalented, and few of us saw all sides of the man. Whatever he turned his attention to he became absorbed in and became good at, whether it was painting, sculpting, or restoring vintage cars (during his general practice years he could often be seen, on dry days, driving his open-top Alvis or Gilbern around the practice to visit patients, fully kitted out in goggles, beret, and huge motorman�s gloves). He is remembered by Professor Barry Kay, a contemporary at Edinburgh Medical School, as the "bossy" stage manager of the student dramatic society play in which Kay had a walk-on part. He was a member of the Binfield Gardeners� Club and deeply committed to recycling and organic gardening. Together with his wife he took up breeding, first Siamese cats then Irish setters. Their Popeswood Kennels won many cups and prizes, he was a member of the committee of the Irish Setters Breeders� Club, and qualified as a judge for championship dog shows. For several years he served as medical officer to the Windsor and Richmond Dog Shows, being immensely popular with the exhibitors. Largely through his medical and breeding expertise, the genetic trait of progressive retinal atrophy, previously endemic in Irish setters, was conquered. Combining his dog knowledge with his allergy expertise, he demonstrated (and published) the efficacy of low-dose desensitisation for canine atopic eczema.

He opted to retire from clinical practice when he reached 65, in order to devote the golden years to caring for his wife, although he planned to continue with dog breeding and with his programme for establishing AEN medicine as a recognised medical specialty. Sadly, his wife died suddenly and unexpectedly on 1 February 2002, a couple of months after his retirement. They had no children and the bereavement was a bitter blow, but he was stoical. It was surprising, he remarked, how much company, and a sense of being needed, a few dogs can provide. But within a few months it was found that he had advanced pancreatic cancer, and his health plummeted.

He had been persuaded to stay on as president of the BSAENM for one further year after the normal three-year spell, as there was no one else capable of taking over his work on registration (which was then at a delicate stage of negotiations that required his precise personal touch). His last public appearance was the November BSAENM meeting of 2002, at which he finally stepped down from the presidency into the retirement to which he had been so looking forward. By that stage he was so wasted as to be hardly recognisable, but when he started speaking it was still the same Keith in spite of his weakness�firm, kind, forward looking, in total control. He chaired his last committee meeting as president and the following day chaired the scientific meeting and AGM, plus himself delivering a lucid 40-minute lecture on fungi, fielding questions easily and authoritatively. To the end he was still teaching us things that we didn�t know; a magnificent swansong. In recognition of his unique services, the society awarded him the Maberly medal, its highest honour and awarded (to a standing ovation) on this occasion for only the second time in its history. For the first time in the quarter-century that I had known him, I saw him somewhat at a loss. He finally said how much he wished that his wife could have been there to see it.

Sixteen days later he too was dead. He had approached his end calmly, fully prepared. One of his last remarks, when discussing his impending death with relatives, was "This is going to be a most interesting experience for a scientist."

(I thank Barry Kay, Len McEwen, Stewart Morison, Sarah Myhill, Ann Phillips, Richard and Judy Roberts, and Kate Stewart for sharing their reminiscences.) [David L J Freed MD]