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Predictions that measles would be eradicated through vaccination have not been fulfilled. The reasons for this failure are analyzed in this paper, and the possibilities for successful action against measles are outlined. [ABSTRACT FROM AUTHOR]

The factual basis for therapy and family advice urging "leveling" in the sense of giving free expression to aggressive feelings is reviewed and the results of a study of 385 couples presented. The study tested the hypothesis that verbal aggression is a substitute for physical aggression. Opposite results were found: the more verbal expression of aggression, the more physical aggression. A similar analysis of "intellectualizing" marital conflicts found that such an approach is associated with low amounts of physical violence. These results apply most strongly for working-class couples. Historical and social trends which could account for the popularity of leveling approaches to marriage, despite considerable evidence suggesting the opposite, are discussed. [ABSTRACT FROM AUTHOR]

New antimalarial drugs are required, partly because of the emergence of drug resistant strains of malaria parasites and partly because better compounds are needed to cure relapsing tertian malaria. In reviewing the diverse modes of action of currently used anti-malarials, against a background of the pathogenesis of malaria, attention is drawn to deficiencies in our knowledge. Even less do we understand how the malaria parasite becomes resistant to certain drugs, in particular chloroquine. New approaches to the problem include the application of combinations of existing antimalarials, and the search for new drugs on an unprecedentedly vast scale. Out of over a quarter million compounds that have recently been screened, a handful are now in clinical trial and are showing great promise for the treatment of multiple resistant falciparum malaria. The paper concludes by summarizing current recommendations for the prophylaxis and therapy of malaria due to drug resistant parasites. [ABSTRACT FROM PUBLISHER]

The growing abundance of therapeutic alternatives can present exceedingly complex sequences of medical treatment decisions and treatment plans. Extensive and systematic clinical treatment evaluation, which necessarily involves the aid of electronic computers, is indicated in the solution to these problems. The primary purpose of this paper is to discuss precise mathematical formulations of these problems and to describe computer aids to their solution. First, the use of dynamic programming is discussed as an approach to the mathematical formulation of the diagnostic-treatment cycle. Then the use of Bayes' formula will be discussed as an aid to the collection of treatment-evaluation data. Finally, a computer system for an outpatient clinic is described. It is important to note that although we suggest basic mathematical characterizations of these problems, each particular medical specialty, and frequently each particular treatment, requires specific adaptations of the methods in order to take care of special problems that frequently arise. [ABSTRACT FROM AUTHOR]

The article presents information about therapeutic group approaches in community mental health. This paper deals with the varicolored spectrum of group influence attempts that lie outside the more strictly clinical range of group psychotherapy. Recognition is the proved potency of these approaches in counteracting the noxious influences noted and in enhancing mental health and rehabilitation need not lead to an obliteration of the distinction between them and traditional group psychotherapy. One could argue to the contrary that a comprehensive view of all treatment modalities in the framework of planned intervention measures aimed at restoring adaptive in place of maladaptive social functioning only heightens the need for concise diagnostic assessment and treatment methods. This has been demonstrated in relation to crisis intervention and short-term psychotherapy in which "an orderly and integrated series of concepts" and methodology are considered even more necessary than in long-term treatment. The greater the need for flexibility in goals and innovations in methodology encountered in the context of a community mental health center, the greater the necessity for conceptual and methodological clarity and order.

The article presents information about three approaches to the casework treatment of narcotics addicts. This discussion of casework approaches to the treatment of narcotics addiction is not meant to be all-inclusive, but rather to describe the three treatment modalities with which the writer has had direct experience. In the current stage of our knowledge about addiction, there can be no single approach to "the addict," since there are different kinds of addicts for whom different approaches are indicated, which will also vary with the agency setting and goals. It is only through research and evaluation that it may be possible to accumulate the necessary scientific information and eventually develop a typology of addicts and suitable treatments for each category. This paper will highlight only the focal points of research on addiction that have served as a framework and potentiator for the offering of the traditional treatment services. Before the casework approaches used in these various modalities are described, some of the assumptions and concepts on which the writer's work has been based will be out-lined. Over the last decade, many treatment and rehabilitation methods have been utilized in the area of narcotics addiction. Treatment modalities have included hospitalization with detoxification, at times augmented by aftercare services, work by voluntary and religious groups, specialized rehabilitation centers, parole and probationary controls.

Patients diagnosed as borderline are appearing in increasing numbers in all types of social agencies, yet at the same time "classic" neurotics are showing up in fewer numbers. The goal of this paper is to suggest a casework approach to help the patient adapt more successfully to his environment. First it shall describe the behavior and personality characteristics of the borderline patient. Then it shall attempt to describe how specific aspects of the therapeutic situation lend themselves to the use of certain techniques. This will include a description of general treatment considerations and various sources of potential change. The borderline state is a stepchild of diagnostic thinking. There are some who regard it as a point on the classic continuum between neurosis and psychosis while others regard it as a separate entity. In the second view, the borderline state is seen as a stable, precise diagnostic entity which, while it resembles both neurosis and psychosis, has features that clearly differentiate it from both.

Treatment of illness in the Admiralty Islands was related to the assignment of illness to one of four main categories: (1) interpersonal, soul damage by extra-human agents, (2) interpersonal, cursing within group, (3) interpersonal, sorcery outside of group, and (4) impersonal, organic damage by an immanent impersonal agent. The first two causal assignments persist as explanations for illness with implications for traditional cures in every instance. Three and four vary inversely with one another in priority of resort to native or European curative practices. This paper offers an analysis of factors in the allocation of cases between European (acculturative) and native (counter-acculturative) curative agents. [ABSTRACT FROM AUTHOR]

C. Andre St. Pierre, in his article "A Treatment Program for the Drug-Dependent Patient" in the October 1969 issue, creates the erroneous impression that the Drug Addiction Rehabilitation Program at Boston State Hospital is run on the lines he describes. The Boston State Hospital program was initiated in July 1964 and the Boston City Hospital program around August 1966. The orientation of the program is a drug- free environment, with Methadone used in the withdrawal of heroin abusers. The milieu is that of a therapeutic community, with intensive group confrontation of the "here and now". One-to-one therapy is rarely used during the early phase of treatment.

Segal's recent review of the effectiveness of social work interventions is discussed in terms of (a) his analysis of the available empirical data and (b) important issues which are relevant to the assessment of all forms of psychological treatment. Re-examination of Segal's analysis per se reveals the use of some questionable statistical procedures and further suggest that his argument in favor of the relative efficacy of short-term (vs. traditional) interventions is not supported by the data. Several issues are raised which question Segal's final conclusion that the trends in the data on the therapeutic efficacy "point strongly in the negative direction." It is concluded, however, that Segal is correct in asserting the equivocality of such evidence, though for reasons not addressed in his review. Some suggestions for both the design of future work in this area and the most fruitful sorts of questions that need to be addressed are discussed. [ABSTRACT FROM AUTHOR]

Consider a clinical trial to compare two treatments where response is dichotomous and patients enter the trial sequentially. This paper investigates the conduct of such a trial where the "Play the Winner Rule" (PWR) is used to assign patients to the different therapies. The implementation of the PWR in a clinical trial tends to place more patients on the better treatment. Both theoretical and numerical investigations show that over a wide range of situations this rule leads to near optimum results when used in a two-stage manner. Furthermore, these results are insensitive to optimum sample size requirements. [ABSTRACT FROM AUTHOR]

The idea of a medical care price index based on the average costs of treatment of specific illnesses rather than on prices of selected items of medical care as is the Bureau of Labor Statistics medical care price index has been in the air for quite a while. This paper has a twofold purpose, first to explore if it was feasible to estimate average costs of treatment of specific illnesses and second if it was feasible, to estimate the average costs of treatment of a number of illnesses in two different periods and compare their cost changes with the price changes indicated by the medical care price index. Data on treatment and costs were collected from the medical histories and financial records of Palo Alto Medical Clinic and of Palo Alto-Stanford Hospital where patients of Palo Alto Medical Clinic physicians are treated when they need hospitalization. Many physicians have maintained that the medical care price index has overstated the increase in costs by not taking account of changes in treatment, citing the decline in the average length of hospitalization as their main evidence.

The article informs that it is well established that hypogammaglobulinacmia is often found in Cushing's disease and after long-term steroid therapy. It has not been documented, however, whether or not all the-classes of immunoglobulins are reduced. Experiments on germ-free animals have clearly shown that exposure to antigens constitutes the major stimulus for normal immunoglobulin formation. The factors responsible for the remarkably constant immunoglobulin levels in healthy individuals are not yet understood, but a homeostatic mechanism can be postulated.

Group treatment of depressed clients has been found to be therapeutically advantageous. As the group members relate to each other, they tend to be less manipulative of and dependent on the worker. In this paper three stages of treatment are identified—mutual mourning, ego reactivation, and mastery—and the rationale for specific therapeutic interventions and case examples are given. A group treatment approach, based on the integration of casework and group treatment methodology, is suggested. [ABSTRACT FROM AUTHOR]

Nowadays a significant amount of writing related to the treatment of emotionally troubled persons is devoted to examining the broad base of human experience. On this count the existentialist writers and professional people have enlarged the understanding of the range and scope of human potentialities and capacities. Thus, many members of the helping profession have not been satisfied merely to refine their therapeutic techniques, or to accumulate psychodynamic information, they are now addressing themselves to an understanding of the human condition. During recent employment in a psychiatric outpatient clinic, the worker worked with a 31 year old single man on a weekly interview basis over an eight-month period. The patient had two previous experiences with therapy in clinic settings that, according to him, had not been helpful. Specific innovations in therapy seemed called for because of the nature, chronicity, and extent of the patient's problems, the type of defenses he employed, his capacities and strivings, and the failure of more traditional psychotherapeutic methods.

The article presents three therapeutic levels. This paper discusses cases where parents brought their children for evaluation or therapy but finds out that therapy was not after all needed. Reassurance of the methods applied in child care and rearing is the most immediate need these parents seek. They need to reassure themselves that their child is not growing differently from other children. Mental hygiene has aroused anxieties in parents and so often they need to be constantly reminded of the facts of child behaviors by a professional. These therapeutic levels are discussed more thoroughly in this presentation.

Over the past three years, the agency has been going through a process of skin-shedding, like the perennial snake in search of lighter and more functional baggage. The introduction of new staff, new programs of service and new techniques coupled with training programs for both graduate and undergradute social work students has led to a critical appraisal of ways of operating that had long been taken for granted. A number of novel approaches to the treatment process have emerged from this self-analysis, two of which will be covered in this brief note. The tools to be discussed are (1) the chart pad and (2) the treatment contract. Moving from a casework base that has been heavily influenced by both Freudian and neoFreudian theorists, social work has long relied on forms of verbal therapy. While the treatment focus was on insight and action leading from that insight, the insight to be gained was viewed almost exclusively as verbally gained. Over the past three years the agency has been utilizing an adjunct to strictly verbal therapy.

One hundred and ten clients of a psychiatric clinic were interviewed to discover why they had decided to undertake psychotherapy. To study this depth decision an accounting-scheme technique was used consisting of five stages, the first of which, recognition of an emotional problem, was the focus of the study. Four typical ways of discovering that one had a problem were found: being told by others, experiencing painful physical symptoms, being unhappily married, and simply feeling diffused unhappiness. These types were found to differ with regard to their definition of the problem, their use of mass media, and their response to treatment. Those who recognized their problem through introspection and could change their self-image from that of a normal to a disturbed person had the best chance of being accepted by the clinic and of continuing their treatment. [ABSTRACT FROM AUTHOR]

The article reports on the uses of atomic energy in the medical field. Radioactive isotopes were discovered to be helpful in the treatment of certain diseases. There are two elements whose isotopes are studied and proven to be therapeutically useful. The two elements are iodine and phosphorus. These elements are useful in the treatment of non-cancerous medical disorder and a form of cancer. The radioactive isotopes of iodine helps in the treatment of a thyroid gland disorder while the radioactive isotopes of phosphorus helps in the treatment of leukemia.

Immunological competence in sarcoidosis was measured by in vivo and in vitro immunological testing of eighteen subjects who had never been treated with prednisone, and eleven subjects treated with prednisone. Three of the latter group had been studied before steroid therapy. Cutaneous delayed hypersensitivity was assessed by intradermal skin testing with five antigens. Thymus-derived 'T' lymphocytes and bone marrow-derived 'B' lymphocytes were enumerated and the ability of lymphocytes to respond to stimulation with phytohaemagglutinin (PHA), Candida albicans and allogeneic irradiated lymphocytes (mixed lymphocyte reaction) was measured and compared to results obtained with lymphocytes from healthy subjects. The non-steroid-treated and the steroid-treated groups did not respond as well as a control group to intradermal challenge. The responses of lymphocytes from patients with untreated sarcoidosis to PHA and Candida albicans was normal but the response to allogeneic lymphocytes was reduced. In comparisons stimulation indices for lymphocytes from the group who were receiving steroids were significantly reduced, with eight of eleven individuals having abnormal responses. Significant reduction in T lymphocytes was observed in only three of eleven of the non-steroid-treated subjects and five of ten of the steroid-treated subjects that were studied. Studies on patients before and after steroid therapy suggest that steroid therapy and not sarcoidosis was responsible for the poorer responses of the steroid-treated group. The most striking findings of this study was the marked disparity between the cutaneous reactivity to Candida albicans, which was abnormal, and the in vitro lymphocytes response to this antigen which was normal. This suggest that the anergy of sarcoidosis cannot be attributed to an inherent lymphocyte dysfunction or to a depletion of these cells. [ABSTRACT FROM AUTHOR]

The number of times individuals diagnosed as schizophrenic are hospitalized varies greatly. Four theoretical models are proposed to account for the variation. The positive reinforcement model proposes that individuals are positively reinforced at each episode, and is consonant with theories of institutionalization. The negative reinforcement model proposes that individuals are negatively reinforced at each episode, and is in aggreement with the idea of therapeutic efficacy. The heterogeneity model proposes that individual differences account for the variation. The pure random model proposes that the differences are explained by a random process. A negative binomial distribution, consonant with both the positive reinforcement and the heterogeneity model, is fit to the distribution of numbers of hospital episodes of schizophrenia for a cohort from the Maryland Psychiatric Case Register. Correlations between occurrence of episodes in early years with occurrence of episodes in later years also suggests that the pure random and the negative reinforcement models are not operative. Further analysis suggests that the heterogeneity model is the correct one. [ABSTRACT FROM AUTHOR]

Results of therapeutic trial of diazepam in tetanus are presented. The trial included 200 cases of tetanus—167 non-neonates and thirty-three neonates. The patients were divided into two groups and were matched as regards age, sex and severity of the disease. The cases of group I received standard treatment while the cases of group II received diazepam in addition. Over-all mortality in group I was 54% and in group II, 26%. The results were statistically significant in non-neonates and in severe degree of tetanus. The drug was well tolerated and side effects were not observed. [ABSTRACT FROM PUBLISHER]

Eleven severely hypertensive patients, median age 54 years, were treated with intravenous (i.v.) clonidine hydrochloride (Catapres). In nine there were life-threatening complications: severe left ventricular failure (LVF), hypertensive encephalopathy, cerebral haemorrhage, dissecting aortic aneurysm, renal failure, and severe epistaxis. In two patients there was pronounced, but uncomplicated, elevation of blood pressure. 0·15 mg or 0·3 mg clonidine was given every 40 min with electrocardiographic (ECG) monitoring. The mean systolic and diastolic blood pressures in the eleven patients were respectively 266 and 165 mmHg before treatment falling to 165 and 109 mmHg after treatment ( < 0·001). The mean decrease in heart rate was 26 beats/min ( < 0·001). Doses of clonidine required for control ranged from 0·15 mg (one ampoule) to 0·9 mg (mean 0·56 mg), although one patient received a total of 0·9 mg without an adequate response. The presenting condition caused the eventual death of two patients. There were no serious side effects, except for one transient episode of sino-atrial heart block. It is concluded that clonidine is effective and safe in the treatment of hypertensive emergencies. [ABSTRACT FROM PUBLISHER]

The article focuses on the level of mental health services offered at hospitals and health departments in the U.S. It assess the interest of health planners and administrartors in the development of mental health services. The author has identified the significant community, organization, and personal variables associated with different implementation levels. Services and activities selected for study include outpatient diagnosis, treatment services, inpatient diagnosis and treatment services, follow-up care after hospitalization, integration of mental health services with other health services and the use of indigenous workers for case-finding and information dissemination.

This section presents a list of books and papers about the therapeutics of infancy and childhood.

Rather than viewing psychotherapy with teen-agers as essentially a holding operation and waiting until adult years when self-defeating patterns have become rigidified, the period may be considered as offering a unique opportunity for facilitating change and focusing on new directions in the life of the client. One workable psychotherapeutic procedure, a team approach involving Diagnosis and Planning, Bargain-Setting, Psychotherapy Proper, and Termination, is briefly described. Involving the parents is seen as being of major importance. Other special concerns briefly examined and illustrated are interpreting closeness, establishing controls, and exercising flexibility. [ABSTRACT FROM AUTHOR]

Psychotherapy with individual patients is central to the objective of resolving children's psychological problems. Clarification is needed of the term "psychotherapy" and of the field it encompasses. The relationship between psychotherapy and the patient's environment is considered, and the importance of transference in the patient-therapist relationship is illustrated by the case history of a child receiving therapy. [ABSTRACT FROM AUTHOR]

The article presents information on changes related to mental illness and its treatment. It concentrates on the areas of mental illness and personal maladjustment. It focuses on whether folk beliefs concerning causes of mental disorder, folk attitudes toward the victims of disorder, and folk prescriptions for treatment give way to concepts and attitudes based on modern science. It analyzes changes that are taking place in generations of people and the conclusions be drawn by sociologists, social workers, and psychiatrists. It is concluded that the public have become more open to accepting modern and scientific viewpoints about mental illness. It is stated that the psychiatrist is being considered by the public as a logical person to handle cases of mental disorder.

Suppression of the primary immune response by treatment of mice with carbon 1 day before initial immunization markedly interfered with development of immunological `memory', since such mice responded to a subsequent Challenge injection of RBCs by formation of mainly IgM PFCs and serum antibody. Appearance of IgG PFCs and 2-ME resistant antibody was delayed several days in these carbon treated animals, indicating failure of a typical secondary response. The immune response of these animals was similar to that of a primary response of control animals to a single injection of red cells. Reticulo-endothelial cell blockade with colloidal carbon suspensions interfered with development of a normal secondary type immune response to sheep red blood cells,, as assayed on both the cellular and humoral levels. Fewer antibody PFCs, mainly 19S IgM but also 7S IgG, appeared in spleens of antigen primed mice treated with carbon 1-3 days prior to a challenge injection of red cells, as compared to control primed mice injected with erythrocytes alone. However, the peak day of antibody response was the same for both control and carbon treated animals. Mice treated with carbon 1-3 days before secondary immunization had much lower peak serum litres, mostly susceptible to 2-ME inactivation. The time of inoculation of carbon in relation to immunization was important since carbon treatment 1-3 days before secondary RBC Immunization resulted in maximum suppression. Injection of carbon 5-7 days before resulted in only a slight effect, whereas Injection 30 days before had no detectable effect. Injection of carbon simultaneously or after RBC injection had little effect The dose of carbon used for immunosuppression, as well as the concentration of sheep erythrocytes used for immunization affected the number of antibody PFCs and the serum titres in control as well as carbon treated animals. [ABSTRACT FROM AUTHOR]

A patient with chronic mucocutaneous candidiasis and cutaneous anergy has been studied and found to have a circulating plasma factor capable of quenching in vitro lymphocyte responses of leucocytes of clinically well donors to monilia and other specific mitogenic stimulants. After instituting systemic amphotericin B therapy, the patient exhibited rapid clearing of cutaneous and mucosal lesions and the plasma inhibitor was no longer demonstrable. Loss of the plasma inhibitor was followed by appearance of strong cutaneous hypersensitivity and in vitro leucocyte responses to Candida albicans and streptococcal products. These clinical immunologic studies have pointed meaning in relationship to current views regarding immunologic reconstitution vis-à-vis systemic antifungal therapy in treatment of chronic candidiasis. [ABSTRACT FROM AUTHOR]

When examined by immunoelectrophoresis and double-gel diffusion, gastric acid-stable esterase (VI A) and human intrinsic factor (IF) behaved as different substances. The VI A migrated in agar-gel electrophoresis mainly as a β2/β1- globulin and IF as β1/α2-globulin. Both showed overlapping migration and diffusion near the starting point. On DEAE-chromatography IF was eluted together with VI A at 0.05-0.075 M, pH 7.0. In gel filtration experiments with Sephadex G 100 and G 200, the IF from in vivo neutralized gastric juice (NGJ) and from gastric mucosa (GM) was eluted in a definite range according to its molecular weight of 60,000. No IF was found in acid gastric juice (AGJ). Two immunologically identical variants of VI A were eluted at two different ranges when NGJ and GM were used for gel filtration. The variant of VIA with the lower molecular weight was eluted together with IF. When AGJ was used, only the VI A with the higher molecular weight was found and in an elution range quite different from that for IF. Of the purified substances, only IF showed vitamin B12-binding, which could be inhibited by serum from a patient with pernicious anaemia, and only heteroimmune serum against this B12-binding fraction contained IF antibodies of the blocking and binding types. IF and VI A proved to be biochemically and immunologically distinct proteins. [ABSTRACT FROM AUTHOR]

Pretreatment diagnostic renal biopsies from fifty Nigerian children with the nephrotic syndrome were investigated by immunofluorescence for immunoglobulin classes, complement and specific antigens. Nineteen of these were re-examined after an interval of 10-15 months. Forty-eight first biopsies were positive for bound γ-globulins, usually IgM and IgG but sometimes for one of these alone; was not detected. Thirty-three were positive for bound complement (C3 component). IgM was associated with granular deposits and complement, IgG with both granular and continuous deposits, the latter usually lacking complement. Plasmodium malariae antigen was found in nine of thirty-six cases examined; no P. falciparum or streptoiysin-O antigens were observed. Immunoglobulins G and M were found in tubules in seventeen of the fifty patients, in five together with complement. P. malariae antigen was observed in tubules in eleven of thirty-six eases. Repeat biopsies from four patients who had recovered were negative with all reagents. Patients on anti-malarial therapy only. and those responding poorly to steroids or cyclophosphamide, showed no significant change in glomerular fluorescence, but a higher incidence of tubular fluorescence was noted in second biopsies. In patients with a poor response to Imuran treatment the pattern of glomerular fluorescence changed from granular to diffuse and tubular staining was not observed. In some patients increased levels or antiglobulins (rheumatoid factor type) were detected in later sera. The nature of the bound immunoglobulins was confirmed by elution of complexes and immunodiffusion. It is suggested that an antigen-antibody complex with F. malariae antigen can produce renal damage with liberation of autoantigens which have the capacity to initiate self-perpetuating autoimmune disease. [ABSTRACT FROM AUTHOR]

The action of 0.05 M DL-penicillamine (DL-P) and α-mercaptopropionylgIycine upon immunoglobulins, both in their native serum and after isolation, has been studied. IgM was always affected, apparently with breakdown of 19S polymers and release of 7S sub-units. This depolymerization leads both to a change in electrophoretic mobility and to increased diffusibility in gels, as well as to decrease in serum viscosity. IgG, as a rule, is not affected when studied in whole serum. The exception to the rule is provided by monoclonal proteins of the IgG3 subgroup. The observed are variable, and may consist of an increase in the electropositivity of the molecules, the release of light chains, or the splitting into Fab- and Fc-like fragments. IgA was irregularly affected. The results suggest that several types of action may be present: depolymerization of high molecular weight polymers, which seem to be more resistant to the action of DL-P than its IgM counterparts, unfolding of 7S molecules with increased electropositivity, and breakdown of 7S molecules into halves, each containing both H and L chains. Precipitation of cryoglobulins was inhibited by both thiols, both when added serum or isolated proteins. [ABSTRACT FROM AUTHOR]