Authors: Molly Birnbaum
RICHARD DOTY BEGAN
with mice.
A PhD student in clinical psychology at Michigan State in the late 1960s, he worked with a professor who kept a colony of rodents in his lab. There were more than fifty different species of mice there—big and small, black and gray and white. Doty, who once told me half facetiously that he prefers the company of animals to people—“for the most part”—was immediately entranced.
“I was interested in the differences of the worlds of all sorts of animals,” he said one afternoon from behind a mound of papers at his desk at the University of Pennsylvania Hospital. He smiled. “I really fell in love with those mice, though.”
More important, he fell in love with the way these mice experienced their environment, one that they processed in ways very different from our own. One dependent on smell.
“These animals lived in a world that we don’t relate to,” he said. “We don’t
know
the experience of how a bat uses sonar to see the environment. We don’t
know
the experience of animals that depend on smell.” It was a world he wanted to understand.
Doty spent years studying the mating behavior of mice and then dogs as he moved from Michigan to California, earning his living by teaching at the University of California, Berkeley; San Francisco State University; and the University of San Francisco. In these early years, he lived in a room on a hill overlooking town, broke but happy, frying steaks and drinking beers on his deck. In 1973, however, he headed east. He began at the Monell Chemical Senses Center, where, for the first time, he began to work on the human nose, as director of the newly minted human olfactory program. Human olfaction was—and still is—a small field. In 1980, Doty and a group of colleagues opened the Taste and Smell Center at the University of Pennsylvania with funding from the National Institutes of Health. There, Doty became intimate with the dysfunction of the nose—and its possibility. He became the gatekeeper of the lost and found, director of a world based on an absence.
The convergence of medicine and smell has been studied for hundreds of years. Nonetheless, it’s a field that today still seems to be in its infancy. “Smell is the orphaned sense,” Doty told me. “It’s been forgotten by medicine.”
In the ancient world, aroma was strongly correlated to health. Stench came with disease, especially before the rise of universal hygiene, and these rank odors—of body, of decay, of death—were often seen as the cause rather than the result and strong, pleasant scents were used to combat illness.
As a result, herbs, plants, and flowers distilled into oils as well as spices were traded internationally in part for their health benefits. Widely used despite the fact that the specifics of the medicinal properties of these fragrant materials could not be known—indeed, are still debated to this day. Pliny the Elder, a prolific Roman naturalist and author, wrote of the use of scent as curative in his book
Naturalis Historia
around
A.D.
77. Thyme aids epileptics, he wrote. Pennyroyal protects against heat and cold, as well as lessens thirst. In ancient Greece, soldiers carried olive oil perfumed with myrrh into battle to help treat their wounds. The Persian physician Ibn Sīnā (also known as Avicenna, who lived from 980 to 1037) is credited with perfecting the technique to distill essential oils, while incense and herbal medication has been in unbroken use in China since thousands of years before Christ. Aromatherapy, certainly not developed solely to modulate mood, first came to wide appeal in Europe when the French chemist René-Maurice Gattefossé burned his arm, healed it with lavender oil, and then began the research to write a scientific paper published in 1928 that culled the term
aromatherapie
.
In the late 1300s, the Black Plague hit Europe and its smells filled the cities with rank odors. Puss, boils, waste, decaying flesh. Scents were used for both protection and prevention, writes Annick Le Guérer in her book
Scent
:
The Mysterious and Essential Powers of Smell.
Agreeable scents were used in order to stop the contamination or spoilage of perishable food—in essence, masking the rot with the spice cabinet. Incense and herbs were the principal weapons against bodily and atmospheric pollution. While the connection between scent, bacteria, and illness would not be made for hundreds of years, society avoided foul smells in order to remain healthy. They quarantined illness, rubbed food with spice, breathed in man-made scent. It was the only way, they believed. Incense was burned and “plague waters”—strong fragrances made to be poured onto handkerchiefs, including the original
eau de cologne
—were inhaled to ward off sickness. In many cases, the poor could not afford the time or materials to ward off foul smells or clean their own bodies of odor, and scent became a mark of class, as well as health. As Constance Classen writes in
Aroma: The Cultural History of Smell,
“Put succinctly, putridity engendered putridity, with smell constituting the primary agent of contagion.”
Scents and their effects remained mysterious, partly due to the simple lack of understanding of how the nose worked. For hundreds of years, the theory touted by Galen, the ancient Greek physician, held fast. Like Hippocrates before him, Galen believed that the body contained four substances, which he called humors: black bile, yellow bile, phlegm, and blood. The fluid in the nose, he believed, represented a purging of the brain, which percolated through the base of the skull out the nose. Galen likewise believed that odor molecules entered straight into the brain through pores in the bone at the top of the nose, to be processed in the ventricles of the brain. It wasn’t until the mid-1600s that it became known that glands release the mucus of the nose. It wasn’t until the 1860s that the existence of olfactory neurons was widely accepted.
But then, as now, smell was an important part of the medical profession and could be used in diagnosis. Neuroscientist V. S. Ramachandran writes in his book
Phantoms in the Brain
about a medical professor who taught him to identify disease by smell alone—“the unmistakable, sweetish nail polish breath of diabetic ketosis; the freshly baked bread odor of typhoid fever; the stale-beer stench of scrofula; the newly plucked chicken feathers aroma of rubella; the foul smell of a lung abscess; and the ammonialike Windex odor of a patient in liver failure. (And today a pediatrician might add the grape juice smell of
Pseudomonas
infection in children and the sweaty-feet smell of isovaleric acidemia.)”
According to Doty, the first description of anosmia was by the Greek philosopher Theophrastus in the third century
B.C.
, who said that it is “silly to assert that those who have the keenest sense of smell inhale most . . . it often happens that man has suffered injury [to the organ] and has no sensation at all.” Galen himself supposed that the loss of smell could be for one of three reasons: too much mucus in the nose, blockage of the bone to the brain, or disease of the ventricles.
It wasn’t until the late nineteenth century that disorders of smell were tackled in earnest. One of the first doctors to concentrate on the lack of smell was William Ogle. In 1870, he published a paper titled “Anosmia, or Cases Illustrating the Physiology and Pathology of the Sense of Smell,” in which he detailed three case studies of patients. “This I do not merely because such cases are comparatively rare; but because I think they may perhaps throw some light on the physiology of a sense which has been less studied than any other,” he wrote. But even that didn’t make much headway within the scientific literature so dominated by sight, sound, and touch. In 1822, the English writer John Mason Good summed up the prevailing scientific views well: “The evil here is so small that a remedy is seldom sought.”
Today, there is only a small number of taste and smell clinics in the United States. Most are run in a similar fashion to Doty’s in Pennsylvania. They are there for research, for information, to learn. Treatment is not common.
That isn’t for lack of trying. Some treatment options by doctors in the field have been found to help. For his patients, Doty commonly recommends taking over-the-counter drugs like alpha-lipoic acid, a compound that occurs naturally in the human body, which has been shown to aid in recovery in studies done on patients who lost their ability to smell through upper respiratory infections. Studies have been done on the potential of zinc, without viable or concrete results. Vitamin A, for a time, was thought to be a potential help—a theory since deemed unfounded. For patients with problems such as sinusitis or nasal polyps, Doty can recommend other doctors who will prescribe steroids or even conduct surgery to reduce blockage and to clear inflammation.
Others have taken a more radical approach. Robert Henkin, a doctor at a private clinic in Washington, D.C., has generated debate within the field. Believing that many dysfunctions of the nose are a result of the mucous glands in the olfactory epithelium, and not the movement of the olfactory nerves, he has published studies on the benefits of transcranial magnetic stimulation and drugs such as theophylline, a medication often used for respiratory disease, one with side effects similar to overdoses of caffeine. He claims theophylline can cure, though his results have not yet been replicated, and the drug is not approved by the FDA to treat anosmia. “Henkin did bring attention to the field,” Doty once told me. “And he’s certainly a creative man. But he’s quite controversial.” Mick O’Hare, an anosmic from the United Kingdom who recovered after being treated by Henkin, however, did not care. “I know my recovery could have been a coincidence, but I am ecstatic that I can once again appreciate every smell, however nasty, and every meal, however ordinary,” he wrote in an article for
New Scientist
magazine in 2005.
I spoke with Henkin on the phone. He believes there is a huge problem in the way taste and smell clinics are run today. They are too focused on research, he told me, his words loud and angry. Henkin prides himself on following up with his patients. “This whole concept is missing—there is no systematic way to see patients,” he said. “They see them once, and never again. They say: Your smell is gone; your nerves are done. That’s it.”
Doty has hope, however. He believes in the future of olfaction. It’s a science that can be conquered, he says, and when it is, it will improve the study of medicine for future generations. He has found links between Parkinson’s and Alzheimer’s disease and smell in his research. There have been links to schizophrenia and epilepsy. Computerized “noses” have been developed to help diagnose diseases like cancer and diabetes. There are even scientists working on techniques to use a small and specialized piece of the olfactory system called ensheathing cells, which are necessary to guide the regeneration of the axons of the olfactory neuron, to help cure human patients with spinal cord injuries. “This type of work is where the future is,” Doty said. “This is where we can make our mark.”
In the first years after my accident my world had shrunk into the distorted sensory present, dependent on the minute and invisible, the tiny cues and individual neurons in my own brain. It never occurred to me that I was, in effect, part of something so much bigger. The scope of the nose and the systems underlying its health—and dysfunction—shocked me with their grandeur. As Lewis Thomas, the former dean of Yale Medical School and celebrated author of
The
Lives of a Cell,
once said: “I should think that we might fairly gauge the future of biological science, centuries ahead, by estimating the time it will take to reach a complete, comprehensive understanding of odor. It may not seem a profound enough problem to dominate all the life sciences, but it contains, piece by piece, all the mysteries.”
MILLIONS OF PEOPLE
in the world have a lost, distorted, or severely muted sense of smell. It is an underreported disability, an invisible but pervasive absence. I visited the Taste and Smell Center, on and off, for two years following my first trip. The anosmics that I met there are aberrations to the rule: most people never seek treatment. Their preface is ubiquitous: I’d rather see and hear than smell.
After all, many anosmics told me, it’s an easy absence around which to navigate. One does not
need
to smell the earth freshly churned by cleats at a child’s Saturday morning soccer game. No one
needs
to reflect on the powdery vanilla of a birthday cake just out of the oven. But the absence of smell runs deeply over time. And if I learned one thing at the Center, it was that this could come with disastrous effects—ones that amass slowly, painstakingly, over years.
I knew that smell, central to both identity and experience, can leave a deep hole in the perception of the world when it has melted away. The absence of smell, for me, was a vicious, monotone thing. At the clinic I began to see how for others, too, it could leave depression and anxiety, disordered eating, and a lack of sexual desire. Memories are flung to the wind and familiarity, ungrounded. Something much deeper than the thick salt-fat scent of a chicken roasting in the kitchen is lost without the ability to smell. It could be a memory of childhood, a cue to hunger, a feeling of home. It’s an indefinable, often un-word-able, but nevertheless integral measure of self and identity—past, present, and future.
I wondered how many people, really, were struggling just the same. I began to search for and contact anosmics outside of the clinic. I found them online—on Facebook, where groups like “Anosmics of the World, Unite!” had more than five hundred members. I found them on community listservs, like Yahoo!’s Anosmia group, where messages were sent between those with lost or distorted senses of smell from around the world every single day. I found hundreds of people. Thousands, even. It struck me that I was never alone. The majority of people like me, however, feel as if they are.
I met people who were depressed. The texture of their worlds had vanished. Thabiso Mashape, an anosmic in South Africa, missed the scent of the air, “just taking in the intoxicating freshness of life,” he wrote me. Joanne Cordero, who was hit by a car as she walked home from Penn Station in New York City, felt vulnerable and isolated. “I miss the smell of my children, my dog, hugging someone and smelling the warmth of life,” she told me. “Mood, memory, emotion, mate choices, we communicate by smell without knowing it. I have burned dinners, sat next to drunks, been around fire and smoke and felt insecure. I don’t go to restaurants; I don’t want to pretend or waste money on food I can’t taste.”