THE JOURNAL OF SCHOOL HEALTH 377

FOR THE MEDICAL DIRECTOR JOHN LAMPE, M.D.

Physical Activity and Diabetes in Children The physical activities of children with diabetes are occasionally the

concern of school physicians for one reason or another. A group of Finnish pediatricians recently published the results of studies they had undertaken which give some basic information useful in arriving at deci- sions in these cases. 0. Elo and his associates (0. Elo, et al, Annales Paediatriae Fenniae 11: 25, 1965) did ergometer studies on a group of normal and diabetic Finnish children between the ages of 6 and 16 years, all of whom had good glycemic equilibrium.

Vital capacity and working capacity increased with age in all groups. Vital capacity was somewhat lower in all females but there was no dif- ference between diabetic and normal children in this respect.

There were no differences between the working capacities of the smallest normal and diabetic girls, but a clear difference developed with increasing size. However, in the boys, the lower working capacities noted for the smallest diabetic individuals disappeared with increasing size. Apparently the normal physical activities of adolescent boys were less influenced by the disease than those of girls. The working capacity of the diabetic children had no correlation with the duration of the disease or with the insulin dosage.

In general, the study emphasized the similarity between normal and diabetic children, indicating that those with diabetes may be permitted more normal activity than was permitted in the past.

Why Prevent Measles? Hopefully there will come a time when measles will be as minor a

clinical problem as smallpox is today. Unfortunately such is not now the case. No physician seeing large numbers of children fails to see and be distressed by post-measles encephalitic symptoms, or the effects of prenatal maternal measles, to mention but two of the measles-associated syndromes.

The whole story of the development of understanding of the effects of measles in pregnancy by Gregg in Australia some 25 years ago is fas- cinating and worth reviewing. Of more interest a t the moment however, are two recent publications in this field. C. A. Alford and his associates a t Harvard, and David Pitt of Melbourne, Australia have recently pub- lished interesting articles.

Alford did virologic and serologic studies on human products of con- ception after maternal rubella. His materials came from the therapeutic abortions of mothers who had contracted measles during the first tri- mester of pregnancy as well as from specimens from term births after similar disease. Rubella virus was isolated from 30y0 of these con- ceptuses and a “probable rubella” virus from about 18% more. Virus was obtained up to 8 weeks after disappearance of maternal rash. The virus was isolated much more frequently from the p1acent)a than from

378 THE JOURNAL OF SCHOOL HEALTH

the fetus. Low titers of rubella-neutralizing antibodies were present in the first trimester fetal serums, and in amniotic fluid of pregnant women with and without recent rubella. High titers were present in the serums of newborns with or without the rubella syndrome. The authors suggest that, 1) maternal infection is not uniformly associated with fetal infection, and 2) persistent placental infection may be more common than fetal infection.

Pitt and his associate, Keir, did a clinical study involving 103 children at risk from antenatal rubella. One hundred of these, now between 4 and 8 years of age, have been extensively followed. Rubella infection during the first 16 weeks of pregnancy is considered the most, critical. The total incidence of major defects due to rubella was found to be 23%, with the maximum incidence occuring from infection in the first four weeks. The major defects from antenatal rubella in the first 16 weeks of pregnancy were significant bilateral deafness (15%), cardiac defects, usually pulmonary stenosis (8yo), and eye defects (40/,). There were also two cases of mental deficiency.

Comparing the motor development of normal children, unaffected children of this series, and the children with significant bilateral deafness, the unaffected children were literally “unaffected” with regard to their functional development and passed their developmental milestones at the same age as normals. However, the deaf children showed consistent delays in reaching motor milestones.

The usual tendency to low birth weight in rubella-damaged children was confirmed. The growth pattern of these children revealed that growth defects were not conspicuous in later childhood. Of the total group, only 5 were below the 10th percentile and of those with major rubella defects, only 1 of 20 was below the 10th percentile for height.

The work of both of these investigators documents the gravity of rubella infection in this particular age segment (prenatal) of the popula- tion. With the development of a vaccine such defects can be controlled.

A note appeared in the National Observer for May 2, 1966 as follows: “Government scientists last week disclosed they have developed

an effective experimental vaccine against German measles. ‘The discovery makes it possible to predict that rubella German measles and its associated birth defects can be brought under control in the not-too-distant future,’ says U. S. Surgeon General William H. Stewart who emphasizes that the vaccine is still in the testing stage. The vaccine was developed by Dr. Harry M. Meyer, Jr., and Dr. Paul D. Parkman of the National Institutes of Health in Bethesda, Md.” Please hurry Drs. Meyer and Parkman.

REFERENCES Virologic and Serologic Studies on Human Products of Conception after Maternal

Rubella-Alford, Neva, and Weller, New England Journal of Medicine, 271: 1275, Dec. 17, 1964.

Results of Rubella in Pregnancy-Pitt and Keir, Medical Journal of Australia 2: 737, Oct. 30, 1965.

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