At present there is a vigorous campaign throughout the world against venereal disease. Although the attention of both the medical profession and the laity is being spurred by militant publicity, the problem of gonorrhea in the child remains almost completely neglected. The presence of this disease is rarely suspected, and the ignorance of both the lay public and the medical profession is the greatest obstacle to urgently needed concerted action for the control, study and prosecution of obviously required public health measures. Further, most of the recent articles in the literature are concerned with the treatment of the disease but totally disregard the larger problem of the social aspects, the public health question and the psychologic effects of the disease on the child. The few articles which call attention to these problems appear at irregular intervals and leave no deep or permanent impression on the medical profession, the social service agencies or public health officials. One finds, widespread, a dread of the appearance of the disease and the formulation of methods preventing the entrance of infected children into hospitals, nurseries, orphanages and convalescent homes. The exclusion of these children from schools removes them from restraint and training and leaves them marked among their playmates. Is it unexpected that such children become problem children, juvenile delinquents and maladjusted adults? Is it surprising that they feel themselves to be and are treated as the outcasts, the pariahs, of society ?Add to this the reaction of the relatives of these children, who in the majority of cases belong to the poorer classes. If they place any importance at all on the presence of a vaginal discharge, they associate it with venereal disease and cannot help making the child aware of the stigma attached to it. The irony of the situation lies in the fact that in the great majority of cases this is not a venereal disease in the true meaning of the word but is contracted innocentlv.
Few anatomic, physiologic, bacteriologic or pathologic studies of the normal or the gonorrhea-infected vagina and cervix in the infant and in the child have been reported.1 Lewis,2 the first to give impetus to such studies, reported the use of estrogen in the treatment of gonorrheal vaginitis. Since then his studies as well as those of others have emphasized the histologic variations in the lower part of the genital tract in children as well as the effect of estrogenic therapy on the hydrogen ion concentration and the cellular content of the vaginal secretion. Reichert 3 and his co-workers reported on the bacteriologic conditions of the lower part of the genital tract in infected children. Pathologic studies were directed mainly toward determining the presence or absence of cervicitis or endocervicitis in cases of gonorrheal infection in children. Ronchese 4 in Italy reported observations on 3 cases in which autopsy was done; in these cases the infection was confined to the vagina and a small portion of the cervical canal. Frequent reference is made to the report of Hess,5 although this article does not give detailed information.
SIR,-Dr Terry Kemple has highlighted the reasons for children not receiving measles immunisation (11 May, p 1395). He comments that "confusion with the pertussis immunisation" was one of the common categories for not accepting measles vaccine. We have recently performed a study on the measles and pertussis immunisation status of all age eligible children born in four calendar months of 1983, as recorded on the district immunisation and vaccination record card. One of the subgroups studied was the measles immunisation status of children who had received the recommended three courses of diphtheria, tetanus, and polio, with or without pertussis. Companison of pertussis and measles immunisation status in children who completed the recommended diphtheria, tetanus, and polio schedule Immunisation status Measles No measles Total Pertussis 354 37 391 No pertussis 93 59 152 Total 447 96 543
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