‘THE JOIJRNAL 0 1 7 SCHOOL HEALTH 269

FOR THE MEDICAL DIRECTOR JOHN LAMPE, M.D.

EPILEPSY AND TELEvisioN-Television has come to be .such a factor in American life that it might be guessed that sooner or later it would be incriminated as the precipitating cause of some truly organic illness. Such indeed has come to pass, with the illness being epilepsy. I t has been known for many yrars that photic stimulation may cause wizures in certain susceptible individuals. Gowers in 1881, and, in more detail, Holmes in 1927, dcscribed the effects of light, particularly inter- mittent flashes, on patients with seizures. In fact. photic stimulation is used like over-breathing in some EEG laboratories in the study of electrical activity of the cerebral cortex. As early as 1952 Livingston’ reported cases in which the flicker from a television set precipitated seizures. Morc recently there havc been a t least two articles in which teltlvision has been the well substantiated cause of convulsions.2* In susceptible individuals flashes occurring between ten and twenty times per second have caused both pctit and grand mal. It is further known that some children with seizures have discovered this phenomenon themselves and are able to precipitate seizures a t will by moving their extended fingers between their eyes and the light s o u r c ~ . ~ While no known cases of such self-induced seizures have been reported from a classroom, with the number of television sets being used for educational purposes, and the number of children viewing them, it seems logical that such have or will occur.

References 1. S. Livingston. American Journal of Diseases of Children, 83: 409, 1952. 2. C. Pallis and S. Louis. Lancet, 1: 188, 1961. 3. C. Mawdsley. Lancet, 1: 190, 1961. 4. E. G. Robertson. Brain, 77: 233, 1981.

ENCICPHALOPATHY I~OLLOWING ~ M A L L P O \ ; ~ A C C ~ I N A T I O N - ~ ~ ~ ~ the number of smallpox vaccinations which are done annually in schools, it is well to bc alert to the complications that can arise. Certainly there are a variety of complications but with propcr trchnique and screening most are, fortunately, relatively rare. Such complications as infection, vaccinia vaccinata, and a gamma globulinuria are mentioned only in passing and ar(1 not to be discussed here. Brcausr of the recent puhlication of a paper’ concerning encephalopathy following smallpox vaccination, a brirf review seems in order. Dr. Dick Hoclfnagel of Boston reported on four Cases seen a t Boston’s Children’s Hospital. The ehildrrn w r r all infants, the oldest bring 16 months, and all rracted t o thrir first vaccination. All werc normal, hcalthg goungstrrs without known ncurological discasr prior to vaccination. .I11 reacted i n wven to ten days with brief irritahility and drowsinvss, then went on to scvere, prolonged, generalizrd scaizures. . i l l were free of any c~vitlence of meningeal disease and all showrtl a rapid recovery.

270 THE JOURNAL OF SCHOOL IIEALTH

The author describes various neurological findiiigs in detail and warns that not always can such a fortunate outcome I F expected. The pathology was considered to have been i n the brain per se. Different types of reactions have been noted in the literaturc including encephalitis, triggering of other CNS disease, cerebellar pseudo-tumor (edema) as well as the type of encephalopathy seen in these four cases. None of these complica- tions are common and thcy usually occur in young children, however in our own experience, we have had one school age child with L similar syndrome. Long term follow-up in Hoefnagel's cases showed the paticnts to be quite normal and free of CNS disease after two to five years.

As these cases relate to school vaccinations, it does not appear that they could have heen predicted nor prevented. However, knowing of such cases might have value for the school physician under certain circumstances.

1. nation, Dick Hoefnagel, JAMA, 180: 7: 525, May 19, 1962.

References Acute Transient Encephalopathy in Young Children Following Smallpox Vacci-

OBESITY IN C h i I L u R m - I t is perhaps symptomatic of our society that we should be concerned with obesity in children. Certainly it is a common problem in a school setting with referrals from teacher to nurse to school physician becoming commonplace. Two recent articles in the pediatric literature come to mind and are the subjects for comment here. Both contain thoughts which are somewhat different than the usual. The first article' by Dr. Cayler of Oklahoma concwiu children with the so-called Pickwickian syndrome (named after Mr. Pickwick, the rotund hero of Charles Dickcns' famous book) which usually aff ccts boys prior to adolescence and is characterized by extreme ohesity. There are other components of this syndrome and indeed the full blown picture is rather rare. The point is that C'aylcr descrihes two boys who were so obese that they were in sevcrc cartiio-rc.spiratorg distress with cyanosis, lethargy, and congestive heart failure. Hv attributes this to hypo- ventilation. not11 children cvidenrcd complete clearing of symptoms with weight reduction. To bc sure, thwe are extremtl cases and rather dramatic, but surely lesser dcgrces exist. This is h i t one (.sample of thc physiologic effr3cts of obesity and emphasizes the fact that it is not a simple benign condition.

The second article2 by Dr. Albert Stunkard of Philadelphia concmis studies done on activity of obese 10-13 year old girl:, at a summer camp. The situation was rather closcly structured so that general conrlusiotih can be questionod but the study was wt4l controlled and tlw rcwilth statistically significant. I t showed that tlie olmw girls, who avc~ragcd 37(% overweight, did more work than tlie avcragv weight control girlh. This is surprising since the classic imprcssion of thc fat child is on(' of relative inactivity. I t supports the premise that olmity has a c o m p h cltiology, the I)ttsi< of which is prolml)ly psychological rat1ic.r than physio- logical.

I t is quite cvident that we are not aware of the anhwers concerning obese children and that their problem5 lieconic> more complicated as we Iwgin to look Inor(' clo.;cly at them.

THE JOURNAL O F SCHOOL HE.41,TH 271

References 1. 2.

G . C. Cayler, J. Mays, and H. D. Riley, Jr. Albcrt Stunkard and Joan Pestka.

Pediatrirs 2 i : 237, February 1961. A~nerican Journal of Diseases of Children 103:

6: 812, June 1962.

SMOKING IN HIGH ScHooL-Sometimes it is a sore temptation to reply: “Yes son, smoking will stunt your growth.” Obviously the reasons why a high school student smokes are varied and the approach to counselling on the subject has most effect if it is well thought out. Simple scare, whether it be that of retardation of growth, or carcinoma of the lung, or what have you, is not enough. A bit more ammunition in the battle appeared in the May 1962 issue of Pediatrics (Vol. 29, No. 5, page 780) in which Eva J. Salber, M.D. and associates of Harvard report on a study they did in Newton, Massachusetts. The study was a well olanned one and is worth reading a t leisure. For those who haven’t ihe time, the author’s summary stGes:

“A survey of the smoking habits of 7,SlO students (9ly0) of the high school population of the public school system in Newton, Massachusetts was carried out in November 1959 by means of signed questionnaires. Data on I.Q. and academic achievement were obtained from school records. In all grades, mean intel- ligence levels of children who did not smoke were higher than those who did smoke. Among smokers, mean I.Q.’s were lower for the heavy than for the light smokers. Mean grade achieve- ment in the academic year preceding the survey was substantially higher for non smokers and for light smokers than for heavy smokers. These differences were particularly striking among boys. A greater proportion of non smokers than of smokers achieved the upper academic curriculum a t high school, and within that curriculum were placed in advanced classes. Within restricted levels of achievement there was no consistent difference between smokers and non smokers in mean I.Q. However, the inverse association between achievement and smoking habits was evident within all categorics of I.&. level examined. Higher academic achievements for non smokers than for smokers was evident within all social classes, as determined from the father’s occupation.”

The conclusions to be drawn and the usage made of the study best left up to the reader.

are

QUESTIONS-The >chool physician is asked and expected to answer a variety of medical and paramedical questions that might amaze some of his colleagues. Even more amazing perhaps is the fact that after some years of experience he can answer most of those asked. This puts him always on the alert for newer and morc knowlcdge. IfrFquently the bits and snatches from a conversation with another physician, a paragraph from a journal, a ca>e once seen, or sonic obscure item dredged up from the unknown past fits the bill and tlie good doctor basks in the glory of a dilemma solved. Thrrefore it is with apology (or tongue in check) that we ask, “What diagnosis is suggested when a first grade child per- sistently or frequently walks on tip toe?”, or “What might be the trouble

272 THE JOURNAL OI? SCHOOL HE.\I,TH

with an S year old who whirls repeatedly on the playground?” Our experienced school physician will know, of coursc, that there may indeed I)e nothing wrong with either child as such Ixhavior is normally sceti in early grade school ymrs and certainly is not pathognomonic of any specific clisorder. Howevrr, if the behavior is persistent or is exaggeratcd hvyond what i n his cxpcJricncch is “normal”, he will do wcll to consider schizo- phrenia. As with so many symptoms the wisc clinician cncountcrh tliow of stereotyped, repetitious behavior must he evaluated in light of the cntirc picture but such actions as toe walking, whirling, rocking, or clinging have bccn noted many times (by Benjamin Spock for oxample), as motor associatives of childhood schizophrcnia. A good study and review of tliv suhjwt appearcld in the July 1961 number of the American ,Journal of Diseases of Children by E. G. Colbert, M.D. and associates (102:1:25). I lr . Colbert reported on a reasonable sample of normal youngsters, diildren with schizophrcnia, and children with other CNS dysfunctions and found in such I)rhavior-toe walking, rocking, whirling, and clinging-distinct differences in frequericy among the groups. To be sure the school physician will evaluate the youngster, the behavior, and the circumstances carefully in each case, but sceniingly trivial and inconsequential behavior may be the key to helping answer another of the many questions whirti he i.4

asked. * * * * *

An APHA SPONSORED VISIT TO SAN JUAN, PUEKTO IIICO, AND ST. THOMAS, VIIIGIN ISLANIIS, has been planned to follow the Association’s 90th Annual Meeting in Miami Beach, October 15-19.

ASHA members arid their friends are invited to accept an official invitation from the Puerto IZico Public Health Association, the De- partment of Health, and the Nuclear Energy Center. Dr. Guillermo Arbona is appointing a reception commit tee and promises a warm welcomc.

The cost of the tour per person is $298.40 based on sharing a twin bedroom with bath a t hotels, and $323.40 based on occupying a single rooin with bath. Included in the cost are: round trip jet tourist class air transportation between Miami and the islands via the route of the itinerary (members wishing to return directly to New York from San Juan should add $25.50 to cost of trip); accom- modations a t I,a Concha Hotel; all meals from arrival to departure, San Juan, cxcopting luncheon on day of departure; all transfers necessary to complete the itinerary; sightseeing as specified; tipping for nieals and baggage handling only; services of an experienccd Journeys International escort throughout the itinerary; cocktails as specified in the itinerary; all taxes.

Anyone iiitcrested should contact Mrs. Ioaii V. Beckham, Jour- neys International, 2 West 46th Street, New York 36, New York, giving your name and address and asking for a copy of the APHA itinerary arid reservation form.