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Measles dominate childhood illnesses in tropical Africa with a variety and severity of complications virtually unknown in the West. There is no apparent continental variation in measles virus but environmental factors vary widely. The frequent association of severe measles with malnutrition and recent studies indicating impaired humoral, cellular, and mucocutaneous immunologic function in the malnourished may explain this perplexing disease. Prevention of early malnutrition combined with lasting and economic early immunization with heat-stable vaccine, currently unavailable, are needed to halt this frequent costly, and often fatal African scourge.

Acute epiglottitis, considered primarily a disease of infancy and early childhood, is seen rarely in adulthood but may be increasing in incidence. Although it may appear more slowly in adults, it is imperative to establish a rapid diagnosis and promptly assure care for this life-threatening disease. Epiglottitis may cause total obstruction of the upper airway, and it often falls to the primary care physician to discriminate this disease from the many self-limiting infections of the upper airway. The diagnosis should be considered if dysphagia and sore throat are not accompanied by hoarseness. Management of the airway is the first priority, but intravenous antibiotic use is justified.

Aseptic necrosis of the capital femoral epiphysis occurred in a polio-wasted leg and was undiagnosed for over one year. The diagnosis was overlooked because of a pre-existent limp. Exacerbation of an existent limp or persistent knee or leg pain should always prompt a thorough search to exclude chronic and acute causes of hip disease in young children. Aggressive and individualized care is indicated for Perthes' disease and may include non-surgical means such as recumbency and bracing in the very young or traction with abduction and various bracings in the older children. Surgical approaches may include femoral and/or pelvic osteotomies in a variety of approaches. Older children may refuse treatment and those with milder femoral head involvement may recover with minimal head asymmetry. Early and appropriate management is generally successful in avoiding deformity.

Gangrenous stomatitis and noma as complications of measles are regularly seen in certain tropical nations. The progression of the frequently seen, simple stomatitis to oral stenosis is a serious complication requiring surgical intervention to prevent starvation.

In the important interface of assuring safe care for the pregnant mother and her developing child that falls to the family physician, current knowledge of drug risks in pregnancy is essential. A recent survey showed that an average of 4.5 drugs are taken throughout the pregnancy. Eighty percent are self-prescribed, and a positive correlation was shown between the incidence of congenital anomalies and drug intake. Numerous recent reports of previously unrecognized fetal complications of commonly prescribed and self-used drugs and heightened public awareness makes it imperative that family physicians know the risk principles of major drug groups and be able to recognize drug-induced symptoms and signs in the older infant as well as in the infant.

Confronted with the inability to offer access to trained mental health personnel to their remote rural community, a private medical group practice in California recruited and integrated psychiatric social workers in their clinic. The rapid acceptance of these newer mental health professionals by community members of all economic levels and by group physicians confirms the success of this program, now in its fourth year, and rising community interest in mental health services. The group practice prototype affords a unique opportunity for innovation in community health care delivery in outlying areas with their traditional difficulties in attracting health care professionals.

Chondroectodermal dysplasia is a rare autosomal recessive disorder characterized by short extremities, short stature, polydactyly, and nail hypoplasia. Dental abnormalities, congenital heart defects, and thoracic abnormalities impending respiration are seen in many patients. Virtually all previous reports of the classic disorder have been in Caucasians. In the following case report, chondroectodermal dysplasia is described in a black Cameroonian infant.

King City, California, a small remote town among thousands in the nation, has demonstrated that private physicians and federal funds can jointly develop effective health care delivery mechanisms to serve residents of all incomes with a full complement of hospital and outpatient services as well as community health programs. Young health care professionals can be drawn to the traditionally difficult-to-serve rural areas. Unanswered is the problem of developing and maintaining an adequate funding base for health services in rural communities in the face of a disproportionately large number of poor people with a sub-optimal job future. The dollar resources in the rural community are often simply inadequate to buy needed health and social services.