CELIAC DISEASE

Abstract

MY FIRST duty is to express my appreciation of the honor accorded me by the invitation to deliver this lecture, dedicated to the memory of one of America's great pediatricians. Dr. Kenneth Blackfan was a man who, by his high endeavor, integrity of character and devotion to his calling, not only added lustre to this Medical School, but was enabled so to enrich pediatric knowledge that his name is respected far beyond the confines of his own country. It is a comfort to reflect that he might well have approved of the subject of today's lecture, for his long association with Dr. John Howland did not fail to rouse his interest in celiac disease, and this was in fact the topic of his last publications. In 1940, in conjunction with Charles May, John McCreary and Fred Allen he described the vitamin A absorption test and its relation to celiac disease in an article which can stand as a perfect model, not only as to the methodology of clinical research, but also as to its presentation. In the following year, and only 6 months before he died, a communication bearing his name was given to the 1941 meeting of the American Pediatric Society concerning the pathogenesis of celiac disease. It would therefore be fitting if today's lecture might be regarded as a humble attempt to quest further along the trail already illuminated by Dr. Blackfan. The original description of "The Celiac Affection" by Gee in 1888, although of commendable brevity, was so perfect a pen picture that there has been little to add to his clinical account. It is therefore worth recalling the symptoms he described; they were, first and foremost, the passage of loose, pale, bulky and offensive motions, associated with wasting, muscular atony, anemia, abdominal distention and cessation of growth. These symptoms remain today the essential criteria for making the diagnosis, for despite the passage of 70 years there is no laboratory procedure by which the diagnosis can be given the stamp of proof. Perhaps during these years we have been made more aware of the psychologic disturbances that may accompany physical disease; certainly the unhappiness of the celiac child is a very typical feature of the fully developed disease.