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PEDIATRICS ABROAD

A

PEDIATRIC

ALLERGIST

VISITS

THE

UNION

OF

SOVIET

SOCIALIST

REPUBLICS

Douglas E. Johnstone, M.D.

I)epart:ncnt of Pediatrics, Unicersity of Roe/tester School of Medicine 071(1 Dent istrij

CONTRIBUTORS’

SECTION

PEoIsTiucs, April 1961

F

011 ‘FHE past few years, ai)Out 5,000

Americans annually have toured Russia.

Some are (lelegations of pilysicists,

astrono-mers or governmental officials. Some go

ill(lividuallV OF in groups as tourists, out of

curiosity. Iii November, 1958, I visited the

U.S.S.R., spoiisored by the Rockefeller

Fotitidation. I i101)ed to learn sometiling of

ISOW RllS5idIl I)llYsici1n5 treat allergic

cliii-(Iren, \Vilat Russian medical students are

taught aI)OlIt tile theory and clinical

man-agement of allergic disease, and what sort

of laboratory or clinical iIlvestigatiOns are

i)eing carried Oil ill

tue

field of pediatric

al-lergv. Tilese hopes were Outlilled in letters

to the Director of the Academy of Sciences

l1i(l the Deputy Nlinister of Public Health

of the U.S.S.R. My plans were also known

to I)r. Sanluel Feinberg of Chicago, wilo

was the president of the Third InterIlatioIlai

Congress of Allergology. There had i)een

SOI11C 1)reviotls correspondence from tile

(Ii-rector of the State Library in Leningrad to

till’ Presi(leIlt of tile International Congress

of Allergology requesting exchange of

lit-erature ill tile field of allergy and

immu-nologv. I)r. Feinberg asked me to represent

ililil in LeIliIlgrl(1 ill order to complete the

details for exchange of such literature.

Before going to Russia, I met several

Soviet scientists while attending tile Tilird

International Congress of Allergology in

Paris. Dr. Andrei Ado, a member of the

Rhlssiall Academy of Medical Sciences in

\loscow, \‘I/ilo is known for his imaginative

researcil OIl the effect of tile central nervous

system on immune mechanisms, exchanged

polite greetings with me. Like most other

ADDRESS: Rochester 20, N.Y.

Russian delegates to tile Congress, ile

seemed to prefer that the conversation be

kept on a general level ratller than to

cx-change specific information. He answered

all questions curtly, and asked few. Our

conversation, carried on in German, left me

Witil tile impression that he felt rather

un-comfortable speaking with an American in

a conspicuous public place. After hearing

of my plans to visit the Soviet Union.

Prof. Ado assured me that I would he able

to visit clinics and other medical facilities.

All I needed to do was to request

permis-sion for these visits in person at the

Acad-emy of Medical Sciences in Moscow. When

asked if I could visit his laboratory, he said

tilere were many interesting laboratories in

Nloscov besides ilis. He assured me,

how-ever, that I could also visit his laboratory,

wilicil I subsequently did.

Dr. Tareev, head of the Russian

delega-tion to tile Congress of Allergology, met me

(luring an intermission in tile scientific

pro-gram to discuss my re(luest for assistance in

acquiring introductions to Russian scientists

(luring my trip to the U.S.S.R. He gave me

a list of names of clinicians and scientists

who were interested in ilypersensitivity.

This list included the following: Prof. 0. D.

Sokulova-Ponomareva, a pediatrician who

is (lirector of the Institute of Pediatrics in

Moscow; Prof. Davidofsky, a pathologist;

Prof. Zdrodofsky, a microbiologist; Prof.

Bandasoroff, a ilematologist; Prof.

Miasni-koff, an internist interested in asthma; Prof.

Nieskieroff, a rheumatologist; and Prof.

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clinicians and scientists through an

inter-pneter and then dismissed the interpreter

so that we could finish our

convensa-tion in English. He seemed genuinely de-lighted to hear that I planned to fly to

Rus-sia in a Russian commercial jet airplane. He

assured me that it would be an enjoyable

trip and kindly advised me to look him up in Moscow if I needed further assistance.

After an exciting flight from Brussels

aboard a Russian commercial Aeroflot jet TU 104, we landed at Vnukovo airport in Moscow on November 1. We were met by an interpreter who directed us to our hotel.

In the following week, I visited the

Acad-emy of Medical Sciences, the Institute of

Pediatrics, elementary school P. S. 702 in

Moscow and the University of Moscow,

which is (ledicated to the memory of

Mik-ilaii Vasilievich Lomonosov, who might be

considered a Russian Benjamin Franklin. Lomonosov founded the Russian Academy of Sciences in 1726.

Probably the most valuable meeting of

the trip was a visit to the Institute of Pedi-atrics. This combination of research insti-tote and hospital was said to have been built during the period of Catherine II.

The buildings reminded me of some of the

older medicai institutions of New York State. The method of swaddling infants there fascinated me. I saw one mother enter

tile hospital with what I thought to be a

bundle of laundry wrapped in a quilted

blanket. As she passed by me, a little face peered out from one end of the bundle.

Prof. Olga Sokolova-Ponomareva, direc-ton of the Institute, was very friendly. She

had traveled in the United States and

men-tioned the names of several American pedi-atnicians she had met and clinics she had visited. My interpreter pointed out that Prof. Sokolova, as she wished to be

ad-dressed, had previously been a professor of

pediatrics in a medical school in Siberia for 30 years before coming to the Institute of Pediatrics in Moscow. She arranged for me

to meet a group of clinicians and scientists.

From her preliminary remarks, it appeared

to me that clinicians and scientists live and

work in different spheres of interest and

have relatively little contact with each other. The clinicians present at the meet-ing either directed units of tile Institute of

Pediatrics on were clinical teachers. The sci-entists consisted of an immunologist, a pa-thologist and a rheumatologist. The latter group pointed out that the’ were engaged only in research and had no connection with medical students.

Prof. Zimbien, a clinical pediatrician in the Medical School of the University of

Moscow, began tile discussion by poiIlting

out that he knew of no allergists in Moscow

or anywhere else in Russia. He pointed out that the clinical aspects of eczema and bronchial asthma were taught by pediatri-cians and internists as part of their nespec-tive specialty. When asked what medical students were taught about the treatment

of bronchial asthma, Dr. Zimbler listed the

treatments as follows : lots of fresh air, sun-shine and breathing exercises. He e ited other “nonspecific” measures which are used

elsewhere in Russia. In the First Medical Institute of Leningrad, thena1w of bronchial

asthma consists of (1) ionized air inhala-tions, 15 minutes a day, three times a week

for 6 weeks, (2) ilypllosis once a week, and

(3) radiologic therapy to tile head and

chest. I did not see any of these treatments in operation.

After a brief review of the work of

Amer-ican pediatric allergists in tile field of

prophylaxis of allergic disease in potentially

allergic children by dietary manipulations of pregnant women and their offspring, I

inquired if there ilad been any systematic study of the problem in Russia. Dr. Zimbier replied that he knew of no sucil study. lie then spoke of his beliefs in tile importance

of “conditioning” in allergic responses. He cited an exemplary case history of an

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pos-sible explanation of the facts in the case ilistory. I inquired about possible

differ-ences in climate, diet, clothing, housing,

type of heating system used, opportunity

for exercise and possible differences in

cx-1)5tire to inhalant allergens in the two

cities. These factors seemed unimportant to

Dr. Zimbler. He felt the explanation of the

course of tile boy’s asthma was obvious. It

\‘tS SiIilI)’V Illatter of how tile child ha(1

1)eefl conditione(1 by his parents!

Next, we discussed tile use of skin testing

aiid attempts at s1)ecific hyposensitization

measures. All the clinicians present agreed

that the’ neither used skin testing nor

be-lieved in the efficacy of hyposensitization

treatment. One clinician summed up his

‘iew by saying tilat these procedures had

been tried and were “found to be very

com-plicated and caused big reactions.” They

were tilougilt to be “not safe, not practical.”

A review of the experiences of the Englisil

allergist, Franklin, and of our own clinic in

Roch ester, \Vitil double-blind controlled

stti(lieS of tile efficacy of pollen

ilyposen-sitization, did not appear to change his

opinion.

Then followed a discussion of the most

recent methods of treating status

asth-maticus in Russian cllildnen. For this

sub-lect, Prof. Sokolova called on Prof. Sofia

Zvvagentseva, director of the Institute of

Asthma in Children in Moscow. This

In-stitute, whose address is “number %, the

Square of the Uprising, Moscow,” is the

only hospital in Russia exclusively devoted

to the care of asthmatic children. Prof.

Zvyagentseva said that she had cared for

over 1,000 asthmatic children in her

hos-pital in the past 2 to 3 years. Of these, she

felt that oiil’ two were due to sensitization

\Vitil a specific allergen; one to contact with

fur, the other to exposure to fresh paint.

Both children improved after these

offend-ing sul)stances were removed from their

en-vironment. Tile remaining children were

thougiit to he stiffening from “nonspecific

lStilITIttiC bronchitis. Tests to rule out

tui)erculosis and foreign bods’ aspiration

were clone on all tilese cilildren. At this

In-stitute, there are specialists in “physical cul-tune therapy” who teach the children

spe-cial breathing exercises. She said these fa-cilities are available for asthmatic chil-dren only in the Moscow area, and that the parents are not changed for these services. She also enumerated the drugs used for

symptomatic, “nonspecific” treatment in her

Institute. They included epinephnine,

ephednine, benadryl and occasionally injec-tions of nonspecific “hydrolyzed proteins.” After reiterating her belief that most of hen asthmatic patients were not tllougllt to have “true allergic disease,” she said that from 35 to 45% of them required prednisone or

cortisone to control the worst episodes. A

majority of them also received antibiotics. These drugs were available for asthmatic children only on an inpatient basis.

Cer-tam palliative drugs such as a mixture of codeine and soda, she explained, can be purchased at low cost without a doctor’s

prescription at local apothecanies.

At a subsequent meeting for discussion at the Pediatric Institute, I made inquiries

about what medical students are taught

concerning the pathologic dynamics of

al-lergic disease. Prof. Zimblen began by

reciting the details of a “classical”

expeni-ment, attributed to Dr. Karminefsky of Leningrad in 1939. In this experiment, a dog was given an injection of horse serum. After a suitable interval of time, the injec-lion was repeated to the accompaniment of a ringing bell. Many months later, the same

animal was subjected to the ringing of the

same bell without an injection of horse

se-rum, whereupon the dog had an

anaphylac-tic shock-like reaction. Dr. Zimbler an-nounced that Dr. Andrei Ado and Prof. Tareev were currently doing conditioned-reflex experiments to show that allergic pile-nomena resulted primarily from such central nervous effects. When I bypassed my inter-preten and spoke in German to a Russian immunologist present, asking his opinion of

the data presented and of the conclusions

drawn, he answered that he was an

investi-gator and did not have dealings with

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as to whether he believed a

conditioned-reflex experiment could produce anaphy-laxis by bell ringing, he remarked that he

did not believe it but had not been called on to state his belief since he had no teaching responsibilities. Dr. Zimbler added that

there were two points of view on this sub-ject; namely, that anaphylaxis may result

from a conditioned-reflex stimulation, or from an anamnestic antibody response to

antigenic stimulation. He agreed that Rus-sian investigators were divided on this point, but he felt that more of them now

fa-vored the second theory. He was interested in knowing if I believed that inheritance played a role in allergic disease and was pleased when I replied in the affirmative.

On another day, a meeting was arranged

at the Academy of Medical Sciences in Mos-cow with “doctors interested in

immunol-ogy.” There I was introduced to Dr. Andrei

Ado, whom I had met 2 weeks previously at the Congress of Ahlergology in Paris. He

de-scnibed some of his previous experiments on the role of the central nervous system in anaphylaxis. They concerned the role of

sympathetic and parasympathetic effects of anaphylaxis at varying times after injection of antigen. He then discussed studies on the

effects of epinephrine in animals with and without hypophysectomy. His discussion

next concerned the regulation of all protein metabolism by the central nervous system,

and he seemed very interested in my work on effect of the role of thyroid function on antibody production and catabolism.

On November 6, I went to Leningrad, where a meeting was arranged with V. Borashenkof, director of the Leningrad State Library. We discussed the possibility of exchanging journals, books and

mono-graphs on immunology, allergy,

rheuma-tology and related fields. At this meeting,

I represented the president of the

Interna-tional Congress of Allergology. The scien-tists present at this meeting seemed eager to read western scientific literature. They

cx-pressed hopes that there would be better relations between the United States and the U.S.S.R. Several of them urged closer

scientific cooperation and exchange of in-formation between the two countries.

Walking through the state library with my guide, two things impressed me. One was the presence of armed militiamen in the main entrance hallways and the other was the number of people busily reading and studying. The concentrated zeal on the part

of so many people and the absolute silence

was impressive. Everyone seemed in dead

earnest. I was told that there are 392,000

libraries containing over 1,300,000,000 hooks in the U.S.S.R. The Saltykov-Shchednin

State Library in Leningrad alone is said to contain over 12 million books. My hosts at the library described a vast scientific and medical literature abstracting service which sounded very impressive. This service has

been in operation since 1953. Its object is to make anything of scientific or medical value published in the world available in Russian within a few months after its onig-inal publication. There are two

organiza-lions set up to accomplish this, tile All-Union Institute of Scientific and Technical Information and the Institute of Scientific

Information. These operate under the

Acad-emy of Sciences. The former publishes a

journal of abstracts called

“Express-Infor-matsia,” 48 times each year. The subscribers are mostly laboratories and institutions in Russia. The second organization publishes

equally voluminous material containing oven 400,000 abstracts in 1 year’s edition. These

two organizations subscribe to 8,000

for-eign periodicals yearly from 80 countries. Over a million dollars a year is spent for American scientific journals and books.

Because the physical sciences seem to take precedence over the social and

bio-logic sciences in the U.S.S.R., efforts are still being made to enlarge tile scope of

their abstract services in such fields as hematology, rheumatology, allergy and

chin-ical immunology. Dr. Borasilenkov wanted to know how many books, journals and pe-niodicals in these fields the American

repre-sentatives of the Internal Congress of

Al-lengology were prepared to exchange and

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I was somewilat embarrassed to admit that as yet I did not know how large a budget

\‘as available from private or public sources

for sending literature. Dr. Bonashenkov

seemed surprised that financing would be

aIls’ problem. He told me that any Russian

medical literature provided in the proposed

excilallge voul(l, of course, be supplied by

the Academy of Sciences without cost to

the Congress of Ailergology. A tentative

list of journals available in the fields

dis-cusse(l ‘as exchanged. We agreed to

cx-change t inore complete list of available

1)OOks, monographs and penio(licais and to

indicate tue type of literature each iloped to

receive ill excilailge.

CONCLUSIONS AND IMPRESSIONS

From my brief visit, it appeared that

there is a distinct difference in tile

profes-sional level between practicing pilysicians

in Russia and the relatively independent

sci-eIltific investigators in the field of medical science. Although allergy as a separate specialty of medical practice is nonexistent

in Russia, and although some of the

teacil-ens I interviewed seem to hold rather

un-usual concepts of allergic disease, there are

many first-rate investigators carrying on

projects and using techniques which equal

many western workers in tile fields of

im-munology and immunochemistry. These

sci-entists seem more secure tilan tile clinical

teacilers and apparently enjoy more

aca-(lemic freedom. In general, it appeared to

me tilat the Russian biologic and medical scientists do not share the same degree of

prestige with their colleagues in tile

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1961;27;669

Pediatrics

Douglas E. Johnstone

SOVIET SOCIALIST REPUBLICS

PEDIATRICS ABROAD: A PEDIATRIC ALLERGIST VISITS THE UNION OF

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1961;27;669

Pediatrics

Douglas E. Johnstone

SOVIET SOCIALIST REPUBLICS

PEDIATRICS ABROAD: A PEDIATRIC ALLERGIST VISITS THE UNION OF

http://pediatrics.aappublications.org/content/27/4/669

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American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

References

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