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 5,000Americans 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 pediatrical-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.
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
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
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
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
