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CHILDREN WITH INTRACTABLE ASTHMA?╟÷ STEEN During this period considerable literature about the Southwest climate and its role in (the treatment of chronic disease increased considerably. REVIEW OF LITERATURE Stevenson,1 in discussing the climate of Arizona, felt that an ideal climate is one which enables people to be out of doors as much as possible. He pointed out that the southern part of Arizona has abundant sunshine, great warmth, little precipitation, low humidity, comparatively stable barometric pressure and slight storminess. He considered that southern Arizona had a basically stable climate. A striking effect of the low humidity is the lability of daily temperatures. Heat is largely derived from direct radiation of the sun, but the ground retains little heat and cools rapidly at night. This nocturnal cooling effect provides pleasant relief from the often excessive warmth of the day in summer. Mills2 pointed out that it is in the stormy winter season and in the storm regions of the earth that respiratory and rheumatic infections most severely afflict mankind. At no time of the year do major storm centers pass over the southwestern part of the United States, of which Tucson is a part. Baldwin3 reported on sixty-two patients in 1944, all of whom were known to have been in Arizona not less than four years. Forty-four per cent had been completely relieved of asthma for two or more years. Patients will benefit most whose disease has been dependent upon climatic violence and associated respiratory infections. The patient should fully understand what he is to expect from the climate and what he must contribute to the attainment of his health. Cook4 stated that children with recurrent infections certainly do better in regions where they may run and play outdoors, avoid sharp changes in weather and get a maximum of sunshine. L. T. Tuft5 thought that asthmatic patients are more comfortable where the temperature is high but even, and the humidity low. Unger6 felt that climate is overrated and that many patients are sent to other areas when removal of the irritating substance at home would have given better results. He felt that great care should be taken to study the patient before a move was suggested. Metzger7 felt that the allergic patient presents a highly individual problem. Changes of climate should be predicated on the knowledge of sensitivities of the patient as well as the distribution of allergens and also the suitability of climate to the patient. Unless these things are done, he felt that justice was not being done to the patient. Smith8 has quite an extensive monograph on the climate of Arizona and discussed it very thoroughly, especially with regard to all its factors of latitude, altitude, mountain ranges, remoteness from bodies of water, and rainfall. Peshkin9 in 1930 reported on a study of asthma. He felt that the im- Volume 17, November-December, 1959 865 CHILDREN WITH INTRACTABLE ASTHMA?╟÷STEEN portant thing in treatment of children with asthma was separation from home (parentectomy). He felt that climate played no role in the treatment of this condition. In answer to his plea, the Jewish Home for Asthmatic Children was established in Denver in 1940. Peshkin and Abramson10 at the First National Seminar of Regional Medical Consultants, reviewed the development of the Jewish National Home for Asthmatic Children and its operation at the present time. In 1957 H. S. Tuft11 reported on the Jewish National Home for Asthmatic Children. He stated that in 500 children between the ages of five and fifteen years, 50 per cent were free from asthma upon or a few days after admission and had no further asthma during their stay. Gottlieb,12 in his review of climatotherapy and institutional care, refers to Hallowitz's report on the benefits of residential treatment at the Jewish National Home for Asthmatic Children in Denver which contends that many of the benefits stemmed from separation from the family and home environment. Gottlieb also refers to comments by Huet from the Netherlands that two-fifths of a series of asthmatic children remained free from asthma after entering the Asthma Center in the Netherlands. These apparently were milder cases. Marks13 sent out questionnaires to pediatricians and allergists in the state of Florida and also to out-of-state specialists. Among the out-of- state specialists there was a division of opinion concerning the therapeutic value of climate. The Florida pediatricians and allergist's felt that children who came to Florida improved to a certain point, but that the improvement depended upon the type of existing allergy. It was believed that improvement in southern Florida was largely due to the reduced incidence of upper respiratory tract infections as well as freedom from northern pollinosis. In the last analysis, every allergic child must be managed on an individual basis. An editorial14 in the Journal of Allergy points out that despite the progress in treatment of asthma, one of the oldest approaches to the problem, change of climate, remains popular. As in the past when Egypt was recommended as an ideal winter climate, so Arizona is often suggested for the asthmatic patient today. Although climatotherapy falls short of universal efficacy, the editorial points out that such persistent popularity must have a basis of fact. That there is a real need for the care of asthmatic patients of limited means in areas of good climatic conditions (such that people making a change of climate may do so on a trial basis) is self-evident. There is a plea made hoping that more sanatorium beds for the treatment of tuberculosis may be available for treatment of asthma. Klotz and Bernstein15 discussed environmental therapy in bronchial asthma and point out the various factors to be considered in determining whether an environmental move should be made. An editorial16 considers the subject of people going to a dry, warm climate in a high altitude especially for the treatment of chronic intractable 866 Annals of Allergy