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n e w e ng l a n d j o u r na l

Boys Drinking Milk at the Los Angeles Tuberculosis

Association Preventorium in Monrovia, California, 1927.

live a regimented life and sleep outdoors in subzero temperatures. But German physician Robert
Koch has discovered that this scourge is an infection, and Austrian physician Clemens von Pirquet
has developed a skin test that can detect tuberculosis infection before the ravages of the disease
are manifest. This is the setting for Cynthia Connollys carefully researched and informative history, Saving Sickly Children.
Connolly accurately describes the response to
these developments during the Progressive Era.
When it became clear, through use of von Pirquets
test, that infection of many children occurred at
a young age but that active tuberculosis did not
develop until years later, a movement was initiated to identify infected children who had the
highest risk of progressing to active tuberculosis.
These children were to receive state-of-the-art care
in new institutions that resembled sanatoriums.
Called preventoriums, they were designed to enhance the ability of children infected with tuberculosis to ward off incipient tuberculous disease
through diet, exercise, and education. Preventoriums had a colorful and tumultuous history. Connolly chronicles their rise and fall in the United
States and discusses the fortunes of similar institutions that took root in Europe.
In Saving Sickly Children, Connolly traces the developments that led to the founding of the first
preventorium in 1912 in Farmingdale, New
Jersey and the subsequent spread of the preventorium movement throughout the United States.
The tale is one of good intentions, money, fear,
and social class, and Connolly provides an excellent overview not only of preventoriums but also
of how the preventorium movement evolved naturally as an outgrowth of the ideals of the Pro92


m e dic i n e

gressive Era. The movement to create preventoriums declined when scientific studies failed to
support the medical theory that was central to its
mission: that a residential experience and regimented life could prevent the development of tuberculosis. With the dawn of the antibiotic era,
preventoriums, like sanatoriums, disappeared.
Connolly highlights many important features
of tuberculosis, such as the centrality of good
nursing to patient care as well as the oppressive
stigma of the disease. The story of the preventorium movement also has important social overtones because the children who were taken from
their homes and sent off to preventoriums for anywhere from 6 months to 2 years were nearly all
poor. Sending them to preventoriums was seen
as a way of lifting them out of the sordid conditions in which they lived, as well as a way of removing them from contact with adults who were
infected with tuberculosis. The air of cultural superiority that was implicit in this practice was not
unique to tuberculosis, nor to the field of health
care in general, but was part and parcel of the
Progressive Era, a time when belief in the possibility of self-improvement was shared by members
of the lower and upper classes.
Today tuberculosis remains a scourge in many
parts of the world. We have better tools to combat it than did the preventorium and the sanatorium, but we need to rekindle the energy and optimism of the progressives for the struggle. Saving
Sickly Children reminds us of how this can be done.
C. Robert Horsburgh, Jr., M.D.
Boston University School of Public Health
Boston, MA 02118

Pediatric Allergy, Asthma,

and Immunology
By Arnaldo Cantani. 1619 pp., illustrated. Berlin, Springer,
2008. $779. ISBN 978-3-540-20768-9.

illions of children worldwide suffer from allergic diseases such as asthma,

atopic dermatitis, allergic rhinitis, or food allergy.
The diagnosis and treatment of these children require special attention to the complexities not only
of childhood but also of developmental and disease processes. As a specialty, pediatric allergy
and immunology is not consistently recognized
throughout the world. Physicians and research-

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ers recently have brought attention to this area

through outstanding clinical care and groundbreaking clinical investigation.
Arnaldo Cantani has undertaken by himself the
daunting task of compiling a comprehensive book
on pediatric allergy, asthma, and immunology. As
Cantani writes in the books preface, he discovered this world, where I had the chance to revive
the significance of the three Ss: science, safety and
sympathy. Cantani understands the significance
and complexities of taking care of children of all
ages and with many illnesses. The physician must
deal with cases of extreme severity, such as anaphylactic shock, or perform ordinary jobs, such as
giving suggestions on the diets or the furnishings
of the home. The earliest beginnings of this book
come from numerous classes and lectures that
Cantani has given to medical students and postgraduates throughout his career.
The book is complex and detailed, spanning
more than 1600 pages, divided into 24 chapters,
and including nearly 1400 tables and figures.
Cantani covers a wide range of diseases, from food
allergy to pediatric AIDS. Each chapter contains
scientific information as well as practical knowledge and advice.
Such a book is much needed, but this particular book, written by only one author, leaves much
to be desired. The information on allergic diseases
has expanded greatly in the past 20 years. The
ability of one author to synthesize information
from this vast field is limited. For example, in the
chapter on food allergy, the recommendations for
diagnosis and the discussion of food challenges
(introducing a food to see if it provokes an allergic reaction) appear to have been written by a
less-than-experienced clinician, with conclusions
based on some of the published literature instead
of on practical, firsthand knowledge. Additionally, the sections in which insomnia and recurrent stomatitis are described as being caused by
foods are neither evidence-based nor in line with
current thinking. Similar examples are found
in each chapter.
Other comparable books are often written by
multiple authors, and although they sometimes
suffer from conflicting thoughts and advice, these
differences are part of the beauty of the art of
clinical medicine one learns by understanding
different opinions as well as the distinctions between established, evidence-based facts and recommendations that are made on the basis of supposedly expert advice.

Part of Cantanis impetus for writing the book

was to legitimatize the field of pediatric allergy
and immunology, particularly in Europe. The
training and accreditation for pediatric allergy
and immunology, however, differ throughout Europe and the United States, as well as in other regions worldwide. Although this field does need
appropriate recognition of the truly important
medical research and breakthroughs that have
been made in the past 25 years, the publication of
a book that does not include input from the best
and brightest clinicians and researchers is not the
ideal way to gain acknowledgment of pediatric
allergy and immunology as a specialty or to educate readers.
A. Wesley Burks, M.D.
Duke University Medical Center
Durham, NC 27710
Book Reviews Copyright 2009 Massachusetts Medical Society.

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The following conferences will be held: Contraceptive Technology (San Francisco, March 1821; Washington, DC, April
14) and Neonatal Pharmacology (Las Vegas, March 2528).
Contact Contemporary Forums, 11900 Silvergate Dr., Dublin, CA 94568; or call (800) 377-7707; or e-mail info@cforums.
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The 2nd International Epilepsy Colloquium will be held in
Lyon, France, May 36. Deadline for submission of abstracts is
Feb. 15. Deadline for early registration is March 15.
Contact the Congress Secretariat, AMSIEC 2009, 11 bd.
Henri IV, 34000 Montellier, France; or call (33) 4 67 61 94 14;
or fax (33) 4 67 63 43 95; or e-mail mail@ams.fr; or see http://

The following courses will be offered: 6th Annual Mayo
Hematology 2009: A Practical Update for Clinicians Translating Todays Clinical Excellence into Tomorrows Cure
(Phoenix, AZ, Jan. 1417); 3rd Annual Psychiatric Pharmaco
genomics (Kohala Coast, HI, Feb. 13); Mayo Clinic Genetic
Disposition and Patient-Reported Quality of Life Outcome
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Contact Mayo School of CME, 200 First St. SW, Rochester,
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n engl j med 360;1 nejm.org january 1, 2009

The New England Journal of Medicine

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Copyright 2009 Massachusetts Medical Society. All rights reserved.