retrieval. She works one day a week in a one story office which was built more than ten years ago. Furniture, equipment, carpets, and paint are also about ten years old. Never-the-less, she recently developed headaches and nose bleeds. These regularly developed the morning after she had worked in the office. An investigation showed that the manually set air intake valve for that office building had fallen shut. As a result, all air in the office was now being recirculated. No fresh air could enter anymore. When this situation was corrected, both headaches and nose bleeds disappeared. No other person in the office developed headaches and nose bleeds. The conclusion was reached that S.H. is chemically sensitive.

The three of us combined forces in order to develop a team approach to multiple chemical sensitivity (MCS). Consultants in varying specialties are complementing the efforts of our core group.

Initially, we became interested in complaints of chemical sensitivity in our headache patients. Now, we attract an increasing number of environmentally ill patients (''EIs''). Many of them claim disability and request help so that they can get State or Social Security. Others find themselves in litigation (personal injury, workers' compensation). Therefore, an objective evaluation of all patients became mandatory.

Patients with MCS present to their physicians with a startling spectrum of complaints. These complaints are often presented in a manner highly suggestive of a psychiatric disorder. None of them easily lend themselves to measurement. General malaise and weakness, fatigue, headaches, irritability, depression, memory problems, itching, numbness, "creepy and crawly" sensations, burning sensations in the nose, sore throat, hoarseness, shortness of breath, cough, abdominal distress, are all "soft" complaints and therefore not easily documented.

Patients may arrive in the office equipped with oxygen tank, air filter, and mask. Typically, patients describe either one single or repeated exposures to one or more chemicals in the past and the development of chemical sensitivity thereafter. It is striking how similar the history is, regardless of education or walk of life or background. This consistency from one patient to another certainly suggests that we are dealing with a disease entity.

On physical examination there is striking paucity of abnormal findings. Small erythematous lesions over the skin areas exposed to chemicals come and go. On chest examination, wheezing is occasionally found. Soft signs may or may not be present on neurological examination.

Routine laboratory tests (CBC, blood chemistry) and EKGs are also usually normal. We quickly learned that chemically sensitive patients almost regularly refuse to deliberately expose themselves to chemicals. We thus abandoned the idea of exposing our patients to chemicals in a controlled environmental chamber. Instead, we waited for unintentional exposure to occur and suggested testing within a given interval thereafter. The results were then compared with base line values obtained either before or a longer time after acute exposure.

Our results led us to conclude that patients who claim MCS could and should be used as their own controls. Obviously, whenever research funds are available, this patient population should be compared to non-exposed and non-symptomatic matched controls.

A patient with multiple complaints is difficult to evaluate. Most physicians have learned that such a patient usually turn out to suffer from "psychosomatic illness". This is why even a well trained physician is easily persuaded to assign a psychiatric diagnosis to



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