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Evelyn and Sylvanus Duvall, Sex Ways: In Fact and Faith. New York: Asso- ciation Press, 1961. Pp 118ff. Geoffrey Gorer, The American People (Revised Edition). New York: Norton Company, 1964. Albert Ellis, The American Sexual Tragedy. Lester A. Kirkendall, Sex and Our Society. 1964. Warren R. Johnson, Human Sex and Sex Education.

10.

11.

12. 13.

14.

New York: Lyle Stuart, 1962. New York: Public Affairs Pamphlets,

Lea and Febiger, 1963. * * * * *

FOR THE MEDICAL DIRECTOR JOHN LAMPE, M.D.

DiagNoses in Adolescent Medicine Dale C. Gorell, M.D. of Los Angeles Children's Hospital published a

study on Adolescent Medicine in a recent issue of the American Journal of Diseases of Children. The study was a comprehensive one and covers various aspects of the field. We will mention here only his findings in relation to diagnoses. In general, the study was of the questionnaire type and the results lend themselves particularly well to presentation in tables. The following indicates the frequency of various organic diseases among the patients, who comprised some 60% to %yo of all diagnoses made:

1. Obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' 74% 2. Acne.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * 63% 3. Allergy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42% 4. Seizures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31% 5. Orthopedic problems. . . . . . . . . . . . . . . . . . . . . . . . . .31% 6. Infectious diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . .26% 7. Menstrual disorders. . . . . . . . . . . . . . . . . . . . . . . . . . .21% 8. Mental retardation. . . . . . . . . . . . . . . . . . . . . . . .21% 9. Growth and metabolic disorders. . . . . . . . . .21%

10. Normal adolescent. . . . . . . . . . . . . . . . . . . . . . . . . . . .16%

Adjustment reaction to adolescence. . . . . . . . . . . . .75%

Also included were the diagnoses of emotional disorders which ac- counted for 25y0 to 4oY0 of the overall clinic population:

1. 2. Behavior problems.. . . . . . . . . . 3. Personality pattern and trait d 4. Psychoneurotic reactions. ..... 5. Scholastic failure. . . . . . . . . . . . 6. School problems. . . . . . . . . . . . . . . . . . . . . . . . 7. Enuresis.. . . . . . . . . . . . . . . . . . . 8. Psychosomatic complaints. . . . . 9. Delinquency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19%

10. School phobia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19% While the author has not seen such figures tabulated before, they do

not seem out of line with our experience. You will note that among the emotional disorders, three (5, 6, and lo), directly relate to school. Indeed two clinics rated school problems as the most frequent diagnosis in their experience.

The article is well worth reading since it deals with a large portion of our clientele, namely, secondary pupils.

298 THE JOURNAL OF SCHOOL HEALTH

Speech Problems and the EEG An interesting article recently appeared in the French literature.

M. M. Berges reports (Revue Neurologique 3: 294, October 1964) his experience in the study of the association of speech problems and abnormal EEG tracings. The study covered some 45 children ranging in ages from 6 to 13 years. Twenty-three of the patients stuttered, 10 had problems with articulation, 11 had retarded speech, and one had aphasia.

The results revealed that the overall rhythm and organization of the EEG tracing were normal in 17, questionable in 12, and abnormal in 16. There seemed to be no correlation between the spacial organization and the type of speech difficulty.

In 11 cases there was asymmetry in the rhythm over the posterior leads. Nine tracings revealed depressed alpha curves over the left hemi- sphere while the reverse was true in 2 cases. There was a tendency for this finding to be associated with difficulty in establishing handedness, although no strict correlation could be made with the type of speech problem. In 24 tracings there were paroxymal discharges noted, with 17 of 23 stuttering patients demonstrating this abnormal finding. In these follow-up tracings, 9 showed improvement, and 7 a complete loss of their clinical symptoms. These findings suggest some correlation be- tween the activity measured by the EEG and speech pathology, at least in this series. The nature of that correlation, it’s implications and practi- cal applications remain to be elucidated. It would appear that there may be some value in arriving at the prognosis in certain cases.

Juvenile Osteochondrosis of the H i p The out-moded concept that a child is no more than a small edition

of an adult is strikingly refuted by the occurrence of juvenile osteo- chondritis of the hip. This affliction was described in our country by Legg in the early 20th century, and at about the same time by Calve and Perthe abroad. It is one of the disorders which does not occur in adult life. Age range is between extremes of 1% to 20 years with the median age of onset at about 7 years. Thus the school age population is the group affected, and the condition merits the attention and informed cooperation of school health personnel. Despite its relatively common occurrence and the passage of half a century since its original description, the etiology remains obscure. The publication ( J A M A 192: 11: 97, June 14, 1965) of the recent study of 15 years experience a t the University of Michigan Medical Center by L. H. Wilk, M.D. contains interesting observations including some on etiology. Trauma, childhood diseases, immunizations, and positive tuberculin tests were all shown to be of insignificant importance. Obesity was present in about 20% of the cases. Spina-bifida occulta was a frequent observation in this series but the importance and significance of this observation is not yet determined. In short the cause remains unknown.

Signs and symptoms are much more familiar. About 95% of the chil- dren have limp and this is generally associated with pain but not neces- sarily pain in the hip. Physical findings are generally, but not always, present, and usually consist of loss of abduction and rotation, especially external rotation. Leg length, discrepancy, and atrophy are late signs and rarely present when first seen. Signs and symptoms do not seem to be

THE JOURNAL OF SCHOOL HEALTH 299

related to severity of involvement nor to prognosis. Roentgenologic findings are technical in nature and of little importance to the school health personnel, but are well known and of paramount importance in diagnosis.

Treatment is of primary concern to school people as its implications have a good deal of pertinence for the school. The ‘sine qua non’ of treat- ment of osteochondrosis is non-weight bearing. This may be achieved in a variety of ways. While effective, bed rest or its equivalent, i.e. hip spica, is difficult because of the age and cooperation of the patients, and the relatively long period of time during which treatment is required. Some means of permitting ambulation without weight bearing is generally devised. In the Michigan study the use of an ischial weight bearing caliper seemed to give the best results.

Other methods, such as a sling and crutches, or opposite shoe lift and crutches, or a bent leg cast with crutches, are also used. The point always is to avoid weight bearing on the affected side. It is here where school health personnel should be informed and can be of material help. Children being as they are, complete cooperation cannot be assumed. If weight is transmitted through the neck of the femur serious deformity may be the ultimate result. Youngsters are prone to unfasten the sling or kneel, thus (while not touching the foot to the ground), transmitting weight in a harmful fashion. If teachers are made aware of the importance of non- weight bearing they can help the child to understand the importance and need. Also of importance is the fitting of the caliper since if the calf strap is too tight some weight may be transmitted along the shaft of the femur and thus defeat the purpose of the device. The awareness of the nurse through the physician of these considerations can ensure the coopera- tion of the teacher, thus making therapy more effective, and in addition keeping the child in school with her peers.

The prognosis in osteochondrosis is generally good provided that the diagnosis is made early and that treatment is carefully carried out. In general, results are better in children who develop the disease early as compared to those who are affected later. The usual course is of about 3

A variety of methods have been used.

years duration. In summary, juvenile osteochondrosis of the hip (Legg-Calve-Perthe’s

Disease) is of considerable importance to school health workers and a disorder in which they have a significant role.

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I ANNUAL MEETINGHOTEL RESERVATIONS

The annual meeting of the American School Health Association is scheduled for Chicago, Illinois, October 16-22, 1965. Head- quarters hotel will be The Pick-Congress Hotel. Reservations may be made by writing to the Chicago Convention Bureau at 332 S. Michigan Ave., Chicago, Ill. 60604. In making reservations request the Pick-Congress Hotel.

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