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Address of the president
Society Procee THE
Xwm
SOCIETY
ANNUAL
s
FOR THE STI:DY OF XSTIIMA AIJLIED COKDITIOSS &ETIKG,
ddmss of the President. N. Y.
WASHINCYT~N~ ALBERT
D.
C., MAT
AND
6,
1933
J. VA;"IDEK VEER, JR., XEW
YOHK,
In surveying the field of a.llergy t,here are several points worthy of emphasis at the present time. Hypersensitiveness alzd endocrinology are the most recent subjects to enlist medical interest, and as in all newly discovered t.erritories the rush for exploration ca,rries with it not only the more sober-minded investigators but the hardy adventurous charact.ers eager to see and report some new thing. ‘We must make our observations more accurately than in the time-trodden fields of medicine, and our reports must. be conservative, for the average general practitioner lacks the experience and special training to be able to separate the wheat from the chaff. ?tTe should weigh carefully our words and above all be sure of our conelusions before me put them forth in published articles. It is easy enough to gain notoriety by claiming new methods for the relief and cure of long-exist’ing and intractable diseases. It is difficult or impossible to recall such claims when more careful study and experience have proved them orerestimated or worthless. On the other hand we have a dut,y to perform in giving wider knowIedge to the facts and principles of diagnosis and treatment in allergic disease which long experience has shown us to be true and essentia.1. Too many cases of hay fever, vasomotor rhinitis, recurring attacks of bronchitis, urticaria and migraine are still. being treated without recourse to a thorough examination by a skilled allergist. Too many cases of asthma are labeled hopeless and incnrable without competent nose and throat examination and trea,tment. We must comba,t tbe genera! attitude (which I confess seems to be gradually gaining ground) that allergy consists in scratching the skin with a few food tests and putting the patient on a weird and impracticable diet which usually accomplishes no result. We should be frank in admitting that skin tests are of little value where the clinical reaction is delayed blnt equally insistent that they be done where the clinica, reaction is im428
429
SOCIETY PROCEEDINGS
mediate and we may expect them to be of the utmost importance. The reading of these, tests and t,heir interpretation should be done by a competent allergist. Lastly, we should assert our importance in the modern field of preventive medicine. Ordinarily it is necessary to protect a dozen people that one may escape. In smallpox, diphtheria, tuberculosis, it is our aim to protect the entire populat,ion, but with us the field is narrowed to the relatively few. Our patients of tomorrow are the children of our patients of t,oday, and it is therefore easier to plan our campaign of protection. We should impress upon our patients, tactfully and above all avoiding an alarmist attitude, that with early diagnosis and care their children can be saved from many of the ills from which they themselves have suffered. We know that half or two-thirds of the children of allergic individuals will eventually manifest some symptoms along the same lines, and at the first sign of undue upper respiratory, intestinal or skin disorder they should be studied by a competent allergist. In a normal child an occasional digestive upset, slight eczema, enlarged tonsils and adenoids or a rare headache may be matters of slight importance. In a child with a hypersensitive family history they may be the forerunners of serious and crippling illness, and this should be taken into account when a line of treatment is recommended. To sum up, let us practice allergy with truth and honesty as to wha.t we can and cannot do, with boldness as t.o what it is our right to attempt to do, and with foresightedness and vision to lessen the trials and preventable suffering of the. future generation.
So-Calleld Urinary WARREN
Proteose in Individuals
T. VAUGHAN,
R.ICHMOND,
VA.
Allergic
(For
original
to Ragweed. article,
see
page 385.) DISCUSSION
DR. LOUIS TUFT, PHILADELPHIA, PA.-I am very much interested in Dr. Vaughan’s presentation because we’ have just completed a similar study on a group of 103 patients doing about 120 estimations. We used as a control, a group of nonallergic individuals and individuals with certain cardiorenal and other conditions in which allergy played no r81e. In addition Do skin tests, we attempted a quant.itative estimation by using a graduated centrifuge tube and, in a rough way, calculated the approximate amount of proteose that was thrown down. In the control group, using a percentage system, we found in 27 individuals, the amount of proteose averaged 0.22 per cent. In the cardiovascular renal cases, of which there were 18, the proteose was 0.64 per cent. In the asthmatic cases, of which there were 18, the proteose averaged 0.9 per cent which was not a great deal more, than
Xwm
SOCIETY
ANNUAL
s
FOR THE STI:DY OF XSTIIMA AIJLIED COKDITIOSS &ETIKG,
ddmss of the President. N. Y.
WASHINCYT~N~ ALBERT
D.
C., MAT
AND
6,
1933
J. VA;"IDEK VEER, JR., XEW
YOHK,
In surveying the field of a.llergy t,here are several points worthy of emphasis at the present time. Hypersensitiveness alzd endocrinology are the most recent subjects to enlist medical interest, and as in all newly discovered t.erritories the rush for exploration ca,rries with it not only the more sober-minded investigators but the hardy adventurous charact.ers eager to see and report some new thing. ‘We must make our observations more accurately than in the time-trodden fields of medicine, and our reports must. be conservative, for the average general practitioner lacks the experience and special training to be able to separate the wheat from the chaff. ?tTe should weigh carefully our words and above all be sure of our conelusions before me put them forth in published articles. It is easy enough to gain notoriety by claiming new methods for the relief and cure of long-exist’ing and intractable diseases. It is difficult or impossible to recall such claims when more careful study and experience have proved them orerestimated or worthless. On the other hand we have a dut,y to perform in giving wider knowIedge to the facts and principles of diagnosis and treatment in allergic disease which long experience has shown us to be true and essentia.1. Too many cases of hay fever, vasomotor rhinitis, recurring attacks of bronchitis, urticaria and migraine are still. being treated without recourse to a thorough examination by a skilled allergist. Too many cases of asthma are labeled hopeless and incnrable without competent nose and throat examination and trea,tment. We must comba,t tbe genera! attitude (which I confess seems to be gradually gaining ground) that allergy consists in scratching the skin with a few food tests and putting the patient on a weird and impracticable diet which usually accomplishes no result. We should be frank in admitting that skin tests are of little value where the clinical reaction is delayed blnt equally insistent that they be done where the clinica, reaction is im428
429
SOCIETY PROCEEDINGS
mediate and we may expect them to be of the utmost importance. The reading of these, tests and t,heir interpretation should be done by a competent allergist. Lastly, we should assert our importance in the modern field of preventive medicine. Ordinarily it is necessary to protect a dozen people that one may escape. In smallpox, diphtheria, tuberculosis, it is our aim to protect the entire populat,ion, but with us the field is narrowed to the relatively few. Our patients of tomorrow are the children of our patients of t,oday, and it is therefore easier to plan our campaign of protection. We should impress upon our patients, tactfully and above all avoiding an alarmist attitude, that with early diagnosis and care their children can be saved from many of the ills from which they themselves have suffered. We know that half or two-thirds of the children of allergic individuals will eventually manifest some symptoms along the same lines, and at the first sign of undue upper respiratory, intestinal or skin disorder they should be studied by a competent allergist. In a normal child an occasional digestive upset, slight eczema, enlarged tonsils and adenoids or a rare headache may be matters of slight importance. In a child with a hypersensitive family history they may be the forerunners of serious and crippling illness, and this should be taken into account when a line of treatment is recommended. To sum up, let us practice allergy with truth and honesty as to wha.t we can and cannot do, with boldness as t.o what it is our right to attempt to do, and with foresightedness and vision to lessen the trials and preventable suffering of the. future generation.
So-Calleld Urinary WARREN
Proteose in Individuals
T. VAUGHAN,
R.ICHMOND,
VA.
Allergic
(For
original
to Ragweed. article,
see
page 385.) DISCUSSION
DR. LOUIS TUFT, PHILADELPHIA, PA.-I am very much interested in Dr. Vaughan’s presentation because we’ have just completed a similar study on a group of 103 patients doing about 120 estimations. We used as a control, a group of nonallergic individuals and individuals with certain cardiorenal and other conditions in which allergy played no r81e. In addition Do skin tests, we attempted a quant.itative estimation by using a graduated centrifuge tube and, in a rough way, calculated the approximate amount of proteose that was thrown down. In the control group, using a percentage system, we found in 27 individuals, the amount of proteose averaged 0.22 per cent. In the cardiovascular renal cases, of which there were 18, the proteose was 0.64 per cent. In the asthmatic cases, of which there were 18, the proteose averaged 0.9 per cent which was not a great deal more, than