Benjamin Pasamanick

The association of maternal and fetal factors with the development of cerebral palsy and epilepsy

Abstract A study of the birth certificates of 561 cerebral palsied children born in Upper New York State between 1940 and 1947 showed that their mothers had significantly more complications of pregnancy and labor, prematurity, and previous infant loss than the population of births from which they were derived. The pattern of the association of these factors with cerebral palsy was similar to that found with regard to stillbirths and neonatal deaths. This led to postulating the existence of a continuum of reproductive casualty composed of a lethal component consisting of abortions, stillbirths, and neonatal deaths and a sublethal component consisting of cerebral palsy and perhaps other related conditions. Using this concept of a continuum as a working hypothesis, similar studies have been carried out in Baltimore with regard to epilepsy, mental deficiency, and behavior disorders of childhood. The results of the study of epileptic children are presented in detail while the results of the other studies are briefly summarized. The prenatal and paranatal records of mothers of 564 epileptic children born in Baltimore between 1935 and 1952 showed significantly more complications of pregnancy and delivery, prematurity and abnormal neonatal conditions than a similar number of matched controls. In addition, more mothers of the epileptic children had a history of previous reproductive casualties than the mothers of the controls. The fact that the pattern of association of these maternal and fetal factors with epilepsy, mental deficiency, and behavior disorders of childhood was similar to that found with regard to cerebral palsy indicates that these conditions should be included in the postulated continuum . The importance of the concept of the continuum as providing a conceptual framework for obstetrical research and practice is discussed.

Seasonal Variation in the Births of the Mentally Deficient

IT IS well known that the time at which injury to the developing fetus occurs results in a differential effect on the production of congenital anomalies. The embryonic stage, rather than the specific nature of the prenatal stress, appears to determine the type of malformation that will appear. Defects will manifest themselves in those organ systems that are undergoing the greatest amount of differentiation or organization at the time of the injury.1 In the central nervous system2 damage which occurs prior to the eighth week of fetal life usually results in gross anomalies, many of which are inoompatible with life. During the eighth to 12th week the cerebral cortex is undergoing its organization into the various molecular layers, and this period would be the critical time during which maternal stress would be apt to lead to those neuropsychiatric disabilities which result from cortical disorganization. Infectious diseases play prominent roles in the production of central nervous system damage. Congenital lues in the past was one of the major conditions which acted during fetal life to produce remote as well as immediate damage to the brain. In the more recent past reports have appeared about the effect of rubella in the first trimester of pregnancy in the production of several central nervous system defects. Viral infections operate in the postnatal period to damage the brain and their effects are easily observed. The influence of similar infections in the mother during pregnancy is not as easily subjected to investigation, but it may be equally if not more important. As a starting point, one of a series of neuropsychiatric disabilities-mental deficiency-was selected and a study designed to test the hypothesis that, because of the variation in the prevalence of viral infection, differences in the incidence of mental deficiency would occur which would be dependent on the season of birth. Infants conceived in the winter months it was postulated would have an increased incidence of mental deficiency when compared to infants conceived in the summer months, because of the increase in the prevalence of these infections during the colder seasons.

Schizophrenics in the community : an experimental study in the prevention of hospitalization

This highly successful book gives students a brood understanding of the nature, origins, development, and problems of a modern industrial society. Material from anthropology, psychology, sociology, economics, and political science is used where appropriate. The book has been thoroughly updated with much of the material rewritten to reflect new areas of interest such as economic growth, race relations, and international relations. Recent events such as the 1964 tax revision and the war on poverty are discussed in some detail. Two-thirds of the illustrations are new; a bibliography is included at the end.

Geographic and Seasonal Variations in Births

IN previous investigations we have attempte,d to demonstrate the relationship of climatic variations during the first trimester of pregnancy to the b,irth of mentally deficient children. In the most recent study we tested the hypothesis that above-average summer temperatures during the third month of pregnancy, the critical period of fetal central nervous system development, are associated with an increased risk of being born mentally defective. This hypothesis was substantiated for the period of 1913-48 based on the date of birth, and therefore of conception, of mentally defective children admitted to the Columbus State

Immigration and insanity

I NFOR1AMATTION on mental illness among the foreign-born is sparse and vefry little is, current. Indeed, in a recently publisihed booik the data in the section on nativity pertained to the period 1917-34 (1). Also, aside from gross na,tional data derived from the decennial ceins.us of institutions, most of the detailed available information on this subject concerns admissions to mental hospitals in but three States,: Minnesota (2), Massachusetts (3), and New York (4-6). This paper reviews these early data and presents the rateis at whiclh native and foreignborn were admitted to Ohio, public mental hiospitals during tihe period 1948 to June 30, 1952.

The Contribution of Some Organic Factors to School Retardation in Negro Children

The stereotype of the Negro school child as being duller, having a lower capacity to learn, possessing many specific learning disabilities, and presenting numerous problems of behavior and discipline is widespread. It served and is still serving the opponents of racial equality as a potent weapon in their efforts to maintain segregation. Because stereotypes have unfortunate and frequently vicious origins and effects, we have tended to brand them as completely false in toto. On the other hand, whenever any of the components of a stereotype have any validity, there is a tendency to accept both the stereotype and the action advocated by the stereotypers. As Dr. Campbell has stated in a Symposium on “Research and Race Differences in the Current Social Climate”, both attitudes are unfortunate.*

Social Class, Expectations, and Performance of Mental Patients

The influence of social class and expectations on the posthospital performance of sixty-two married female mental patients is examined here. Both class and expectations were posited as interrelated determinants of performance. The results indicate that this thesis is highly questionable. Social class did not correlate significantly with performance; patient expectations, on the other hand, were related to such performance in the working class but not in the middle class. These finding suggest that for these cases, disease manifestations are more significant than class and expectations as criteria of posthospital adjustment.

Mental Diseases of the Senium at Mid-Century: First Admissions to Ohio State Public Mental Hospitals

THE DISPROPORTIONATELY large number of first admissions to public mental hospitals arising from the population 65 years of age and over is a matter of much concern to public health, mental hospital, and welfare officials throughout the nation. The reasons for this concern are several. First, the population in the age group 65 and over has been increasing rapidly; and it is anticipated that by 1980 the population in this age group will be 50 per cent more than it is now.1 Therefore, even if admission rates stay at current levels, there will be a considerable increase in the number of persons in this age group admitted to mental hospitals. Second, patients in this age group constitute a special problem for hospital staffs, since they require a great deal of physical and medical care and account to a large extent for the high mortality rate in the mental hospitals. To assist in the solution of this problem considerably more knowledge is needed on the aging process; the etiology of mental illness in the older population; the social, economic, and cultural factors that lead to various patterns of care for those who become ill; and, in particular, the factors that lead to the admissions of these people to the mental hospital as opposed to other community facilities. Although data are available to show the trend of first admission rates for the nation and for the various states,2 there is a paucity of current data on the variations of these rates by such factors as race, marital status, education, urbanrural residence, occupation, etc. The most extensive studies of these rates by such factors were those done by Dayton for first admissions to mental hospitals in the years 1917-1933 in the State of Massachusetts3 and by Malzberg for first admissions to the New York State Civil Hospital for the years 1929-1931 and 1939.1941.4,5,6 Recently, an extensive analysis has been carried out, on first admissions to the state public mental hospitals in Ohio, which yielded certain data on the variations and the rates of admissions to these hospitals for patients with mental

The Dutchess County Project

In January 1960 we set up a relatively small, geographically decentralized 550-bed Unit within a 5,000-bed state hospital to serve all degrees and types of mental illnesses in the county. The countys population was approximately 175,000 and is now approximately 200,000. We automatically accepted mentally ill persons into the Unit, with the exception of children under 16 and individuals with open pulmonary tuberculosis. We had to maintain an acute service and an emergency service because this is part and parcel of the New York State system. We hoped to demonstrate the value of a small community-oriented, malleable, clinically autonomous Unit in accomplishing the following-

Some comments on research in a state department of mental hygiene

Now that money flows less freely from most sources, and not at all from some, Dr. Pasamanicks cogent balancing of the ideal with the pragmatic is very much to the point.His useful suggestions come out of hard experience, and he follows them up with a convincing plea for a larger sense of responsibility among scientists to educate both themselves and the general public and their representatives to a greater social responsibility.