Charles R. Hayman

Sexual assault on women and girls

Abstract Sexual assaults are increasing rapidly, as are other violent crimes. In the District of Columbia, September, 1965–June, 1969, police brought 2,190 alleged female victims to examination, practically all at D. C. General Hospital. Incidents varied from rape to child molestation. Ages ranged from 6 months to 91 years, with peak at 14 to 15. Eighty-five per cent of victims were Negro. Twenty-four patients were hospitalized and 58 given major emergency room treatment. Examination should be done by trained residents away from emergency facilities with attention to emotional component. In a unique follow-up, public health nurses uncovered many emotional disturbances and gave early support. Fifteen hundred referrals were made to clinics and private physicians, of which 60 per cent were kept. The patients with emotional disturbance, pregnancy, gonorrhea, and syphilis related to assault were brought to treatment. Re-examination must evaluate the whole patient.

Rape in the District of Columbia

Abstract From July, 1969, through December, 1970, almost 1,200 female alleged victims of sexual assault were brought for medical examination at D. C. General Hospital. Ninety per cent alleged vaginal penetration. Coercion occurred with the use of threat, weapon, or physical injury, or threat was felt although only implied. Thirty per cent of attacks were by 2 or more males. The number of attacks per hour increased from the daytime, to the “swing shift”, to evening, to night. The alleged victims were 76 per cent Black. Ages of the victims ranged from 15 months to 82 years, with 63 per cent 18 years and over. Practically all assaults were by Black males, and 60 per cent were strangers to the victims. Fifteen women and girls had injuries requiring hospitalization; 58 with severe injuries and 33 with emotional trauma needed emergency room treatment. Follow-up by nurses provided emotional support and opportunity for patients to abreact the event. Patients brought for treatment included 61 with emotional disturbances, 53 with gonorrhea, and 15 for therapeutic abortions. Nine patients were hospitalized for emotional reactions and reactivations. In comparison to periods from September, 1965 through 1969, there were increases in complainants to the Sex Section and brought to initial medical examination, with a shift to older alleged victims; more were White and attacked by strangers, with injuries and emotional trauma. Constant reiteration made interns and residents aware of the latter. Because of a nursing shortage, follow-up was not as extensive, but a larger number and proportion of patients were brought to treatment for emotional disturbances, gonorrhea, and pregnancy.

A Public Health Program for Sexually Assaulted Females

A 21/2 -year-old girl was taken to a local hospital after she was attacked in her home by an unknown man. She suffered deep vaginal tears. She was given a sedative and transferred to the municipal general hospital where she was examined, treated, and discharged. Her parents were instructed to give her sitz baths and to apply a vaginal cream. Four months after the incident, the child had recovered physically.

Sexual Assaults on Women and Girls

Excerpt In 1968 the Federal Bureau of Investigation reported for the calendar year 31,060 forcible and attempted rapes and statutory rapes with force. The increase of 84% since 1960 is part of a ge...

Screening children for heart disease with a portable tape recorder

CREENING of children for heart disease is at this time best done by an auscultatory technique. Previous articles have described the process of recording heart sounds on high fidelity equipment and listening to them on playback equipment (1-3). The main advantage of this process over direct auscultation is that the physician may listen to the tapes in a quiet place at a time of his, choice. A preliminary study to investigate the feasibility of this method for screening childrens heart sounds for heart disease was begun in Chicago in 1954 (1). Satisfactory results led to a mass field trial on more than 33,000 school children in that city during 1959-60 (2,3). About 1,000 children were screened per week, using fixed equipment set up in a mobile trailer. Sixty-four cases of definite organic heart disease, a rate of 2 cases per 1,000 children screened, were found in the study. Half of these cases were previously unknown. In late 1961, the Advisory Committee of the Heart Disease Control Program, Chronic Diseases Division, Public Health Service, recommended that comparative and evaluative studies of this method be initiated using portable equipment assembled by the program from adaptable components available on the commercial market (4). Since the Pennsylvania Department of Health was interested in the method for possible use in school health programs, a preliminary field test using the ne-w equipment was conducted in that State during the 1962-63 school year. Lancaster County was selected as a trial area for several reasons. The Heart Association of Lancaster County, a new organization, was eager to initiate a community service project and the Pennsylvania Department of Health had a well-functioning cardiac clinic which could provide followup for the children found positive in screening. The county, a medium-sized community with 275,000 people, was ideal for a field trial. It had urban, suburban, and rural communities and schools. The studys main objectives were to: (a) test the practicability of using portable equipment by determining its portability and sturdiness and the frequency and cost of repairs and maintenance under field conditions; (b) determine how many children could be screened in an hour and in a school day; (c) ascertain the, number of tapes to which a physician could Dr. Myron M. Rubin, senior physician and associate cardiologist, Lancaster General Hospital, Lancaster, Pa., served for the Lancaster County Heart Association as medical administrator of the screening project described in this paper; Mrs. Bushnell served as project coordinator for the heart association. Dr. Hayman, associate director for preventive services, District of Columbia Department of Health, was at the time of the study medical director of region VI, Pennsylvania Department of Health. Dr. Levy is chief of the Congenital Heart Disease Section, Heart Disease Control Program, Division of Chronic Diseases, Public Health Service. The late Dr. William Kraus, director, division of chronic diseases, and Dr. Clarence A. Tinsman, chief, heart and metabolic diseases section, Pennsylvania Department of Health, were instrumental in obtaining support for this study, which was conducted under a contract from the Pennsylvania Department of Health.

FIELD TRIAL OF A SYSTEM TO OBTAIN DATA ON POPULATION EXPOSURE TO X-RAYS

A system to obtain data on population exposure to x rays included a household interview survey followed by a mail questionnaire to x-ray facilities. Separate report forms were used for medical and dental x-ray examinations. Film packs were designed and used to test the reliability of information on diagnostic radiographic units related to machine output, beam quality, size, and angulation. Results are reported on a field trial of the system in Berks County, Penna. This site had the desired urban-rural and socioeconomic characteristics. It was concluded that the methods, procedures, and forms used are appropriate for deriving estimates of population exposure to this source of radiation and for obtaining data that are compatible with current research in dose model development. (C.H.)

DETERMINING COMMUNITY IMMUNIZATION LEVEL WITH EXAMPLES FOR POLIOMYELITIS.

T HE IMMUNIZATION level of a community may be defined as the percentage of the population protected by natural and artificially induced immunity. The level is ultimately measured by the communitys disease experience as evidenced by cases reported and otherwise discovered. This method of measurement is applicable to all communities, but it may be of little value when cases of disea,se are rare, as with smallpox, or infrequent, as with poliomyelitis. In Pennsylvania there were few cases of poliomyelitis in Berks, Lehigh, and Northampton Counties for 5 years before the mass vaccination programs of 1963, and only one case since (see table). However, there was a considerable potential as shown by sizable 1963 outbreaks in nearby Philadelphia and Cumberland Counties. Case investigations necessary to validate the diagnosis include clinical, serologic, and virological studies on the patients. Such studies in Cincinnati were reported by Sabin (1) and in Czechoslovakia by Skovranek (s), as ruling out the diagnosis of poliomyelitis during 1960 and 1961. Case attack rates will show whether differences exist between vaccinated and unvaccinated groups at one particular time and may show the influence of vaccination over a period of time. An example of a study at one point in time is Fendalls report on the epidemic in Kenya in 1960, with more than twice as many cases in the unvaccinated as in the vaccinated (3). Chin showed the decrease in case rates in Des Moines, Iowa, and Kansas City, Mo., from 1954 to 1959, concurrent with increased Salk vaccination (4). The immunization level may also be measured by detection of antibodies in a reipresentative sample of individuals as reported from South Africa (5). The most recent report describes a survey of children 1 through 4 years of age in Cleveland, Ohio, following an oral vaccination program in 1962. Titers were determined in vaccinated and unvaccinated children. Advances in laboratory methods may bring periodic sero-immunity surveys within the, capabilities of many health departments (6). Intestinal infection occurring naturally or produced by ingestion of vaccine may be demonstrated by identification of virus in patients and in sample surveys. Both were, done in Israel before and during an outbreak of poliomyelitis in 1961 (7). Spread of virus may be shown by its recovery from sewage as was done in Hillsborough County, Fla. (8).