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Families in whom cot deaths occur are a particularly neglected group. They are subjected to unnecessary psychological trauma as part of the process of the exclusion of unnatural death. Paediatricians should make the welfare of the family units part of their own concern and take steps to help both parents and siblings. It is suggested that possibly the coroner or the general practitioner could make an appointment for the family to see a paediatrician interested in cot deaths. This would do much to alleviate suffering associated with them.

From the case notes of a medium sized psychiatric hospital, 134 women were found to have been admitted with puerperal psychoses between the years 1927 and 1961 inclusive. Over this period there has been no change in the average age of onset of illness. In the prepared 1942 period 14 per cent. were unmarried compared with only 2.25 per cent. between 1942 and 1961. This change in incidence of psychoses associated with illegitimate births bears out the findings of earlier authors (Partridge, 1911; Armstrong-Jones, 1923) who claimed a high incidence, and more recent workers (Vislie, 1956; Sim, 1963) who have claimed it to be very low in spite of the increasing illegitimacy rate. Sixty-six per cent. of the whole group had a first puerperal illness following first pregnancies. The clinical syndromes consisted of 91 affective reactions, 37 schizophrenic, and 6 organic. This marked preponderance of affective states supports the views of Hemphill (1952) rather than those of some authors of more recent years who claim schizophrenic states to be more common. The symptoms and signs were very similar to those seen in the usual functional psychoses of acute onset, clouding of consciousness being commonly present. Twenty-eight per cent. of the whole group had some kind of complication in pregnancy or labour, but in few, other than the six organic states, were these at all outstanding. Evidence of particular psychological trauma was absent in most. Two only of the 52 women admitted before 1942 received treatment other than general care. Twenty-five per cent. of those women died in hospital, mainly from diseases attributable to general conditions existing in mental hospitals at that time. The last death occurred in a patient admitted in 1943. The introduction of physical treatments has generally lessened the period of in-patient stay for patients with affective states (from 8 months to 2.4 months average) and even more so for schizophrenics (4 years to 3.8 months). Of 114 women traced, one had remained in hospital since admission in 1941. Of the remaining 113, 104 women were traced. Of these, 49 had at least one further psychotic illness, 14 had further puerperal illnesses, 40 had non-puerperal psychoses and 5 had both. If the previous illnesses of the whole group are considered, recurrence of psychotic illness in association or not with the puerperium is much greater. The likelihood of a puerperal illness occurring in a further pregnancy in individual manic-depressive and schizophrenic probands is much greater than that of the pregnant woman who has not suffered a previous puerperal psychosis. Of the 95 probands traced whose indexed psychosis was the first puerperal illness, 53 had a total of 121 further pregnancies and 14 had a further 18 puerperal psychoses between them. Recovery from further manic-depressive states [See Table XIV in source PDF] was excellent, but a number of the schizophrenic probands passed into chronic residual states. At the time of follow-up, 61 probands were known to have had 149 further pregnancies. All but 6 of the 104 probands discharged were living, or had lived up to the time of death, in satisfactory marital harmony and reasonably well-kept homes. The mental state of those admitted with manic-depressive illnesses was superior to that of schizophrenic probands. Two-thirds of the schizophrenics originally admitted had a poor outcome, particularly due to deaths in the pre-1942 era. Fifty per cent. of those ultimately discharged and traced were well and symptom free, whereas of the manic-depressive group 86 per cent. were symptom free. Satisfactory family histories were obtained of 79 probands and 19 probands suffering from puerperal affective psychoses and puerperal schizophrenic psychoses respectively. Weinberg's (1925) shorter method for calculation of the risk lifetimes was used. The risk period for manic-depressive psychosis was accepted as 20 to 60 years, for schizophrenia 20 to 50 years. The morbidity risks amongst parents and siblings of probands for non-puerperal psychoses were similar to those described for relatives of patients with non-puerperal manic-depressive illness and schizophrenia. No specific genetic predisposition to puerperal psychoses, as such, could be demonstrated.

The truc sex of an individual is not necessarily that which agrees with his or her chromosomes, gonads, hormone production, morphology of the external genitals or that of the internal genitals. After the age of 2½ years, it is definitely the sex of assignment and rearing, fortified by gender role and psychosexual orientation. Eight clinical types of ambiguities of sexing are classified and synopsized with their chromosomal, morphological, and endocrinological characteristies. These types are reconciled with Jost's theory of the role of the fetal testis in sex differentiation. Sex chromatin data are of ancillary but not primary valuc in the differentiation of these types. A practical plan for prompt sex assignment at birth is outlined. This is advisable to avoid psychological trauma to parents and to circumvent gossiping of relatives and acquaintances. Surgery and/or endocrine therapy usually are necessary to implement the assigned sex. Parents should understand this plan to complete the sexual development of their “unfinished” baby. Medical, religious, and medicolegal aspects of the implementation of assigned sex are discussed. The assignment and implementation of a practical sex, before gender role complicates matters, should assure individuals with sexual ambiguities of becoming well-oriented, coitally adequate, if not fertile, adults. If sex reassignment becomes necessary, it should be done before gender role is established, a new birth certificate should be filed and all pertinent documents, as wills and insurance policies, altered. When sex is reassigned after gender role is established, psychosexual problems arise and rarely, if ever, is a pervasive, convincing, and unequivocal adaptation to the new sex developed.

T HE government and peoples of the United States have frequently demonstrated congern for underprivileged peoples by their efforts to improve the situations of such groups. Whether the misfortunes of these groups have resulted from flood, earthquake, famine, or war the agencies, personnel, and supplies for relief have often been provided by this country. World War II, affecting people of all races in scattered countries, has created perhaps the greatest problem of relief and rehabilitation in history. In this conflict governments of ~he United States and other United Nations have had a special interest in the health and welfare of civil populations. This interest is not prompted merely by humanitarian instincts, but also by the fact that conditions of poor sanitation and high disease incidence among civilians are detrimental to the health of Allied troops stationed in the areas and, consequently, prejudicial to the war effort. Prolonged dietary restriction, destruction of homes and sanitary facilities, lack of adequate medical care, and the psychological trauma of modern warfare have made definite and often permanent imprint upon the health of individuals in civil populations. I t is unlikely ttiat any age groups have been more adversely affected than infants, children, and adolescents. To anticipate the nature and probable extent of problems of health trod welfare of the children in various countries, a kno~vledge of composition of populations as to age groups, birth and infant mortality rates, and adequacy and standards of prewar medical care is helpful. Such data, though modified by several years of war, provide an index to the type and extent of problems which may be anticipated. Moreover, knowledge of this type facilitates proper plans for relief and rehabititat;~on of these unfortunate younger groups.

duit may be children with congenital sacrospinal cord lesions such as meningocele, myelomeningocele or spina bifida, or they may be adults in the most productive period of life with neurogenic bladders and incontinence due to cord injury or neurological disease, or victims of vesical carcinoma with or without exenteration surgery(1). When the patient with a neurogenic bladder is a child, incontinence is often a cause of severe psychological trauma which affects his personality development adversely. Ridicule and merciless teasing by playmates because of his urinous odor

Shortly after an attempted rape and life threat a four-year-old girl developed a loss of speech followed by a clinical picture of Heller's dementia. She had mainly nocturnal fits of terror, but no evidence of an epileptic nature was established until four years after the onset of these fits when she developed a status epilepticus authenticated by a deeply disturbed electroencephalogram. The literature on Heller's dementia, the meaning of the various symptoms, and the possible impact of the psychological trauma were discussed.

This study has two central themes, both relevant to application of the behavioral sciences in "real-life situations." First, considerable psychological trauma can be generated by events such as the demotions reported here. Second, substantial evidence suggests that a learning design based on the laboratory approach can significantly moderate such trauma. Methodological problems prevent our assigning all observed effects to the learning design, but there is strong presumptive evidence that this action design is one way to apply in organizations the forces often observed in the development of the miniature societies that are T Groups.

WHAT IS IT THAT NURSES do for emotionally disturbed chlidren? We know nursing is vital in their treatment. Yet we must determine what our role is and why. Also, our concepts must be acceptable to members of other disciplines-psychiatrists, psychologists, social workersif we are to be truly effective. Psychiatric nursing is concerned with the emotional, as well as the physical, needs of patients. Of course, concepts important in psychiatric nursing are part of all nursing. The pediatric nurse, for example, helps a child to accept an intravenous infusion which she knows is threaten.ing to him. She recognizes that children need love and attention and she knows how extremely dependent ill children are. She is aware of the psychological trauma associated with tube feedings and physical examinations and the worries that accompany a fractured arm or leg. Most of all, realizing the desolation a child feels when he is separated from his parents, she helps the child accept the temporary separation and reassures the parents. In psychiatric nursing per se, the nurse may have little contact with physically ill patients, but her role is just as vital in the patients' recovery of sound mental health. However, if she is to live up to her potential it is essential that she receive supervision and emotional support from other members of the professional staff, especially from the psychiatrist. At the University of Iowa's Psychopathic Hospital, this support is achieved on both a formal and informal level. The formal structure is such that each nurse is assigned an adviser, who is either a senior social worker, psychologist, or a psychiatrist. She meets with her adviser once a week for an hour to discuss problems she is encountering in her work with the children. The formal structure also calls for a weekly nursing conference under the direction of the psychiatrist. This, too, is a problem-centered discussion about the children. On the informal level, the nurses confer almost daily with individual therapists to report a child's progress, discuss his daily difficulties, and plan experiences for him.

TREATMENT of patients with head and neck cancer should not terminate with the elimination of the disease. Current surgical treatment for cancer often produces large defects which are accompanied by dysfunctions and distortions of the affected parts. Rehabilitation of patients with such defects is an essential phase of treatment. It is the purpose of this article to present certain problems resulting from cancer surgery and their possible prosthetic management. Specific techniques of prosthetic rehabilitation of orofacial defects have been detailed in other articles. 1-6 The head and neck areas contain major concentrations of complex neuromuscular systems. Speech, deglutition, and mastication are significantly affected by surgery in the oral cavity. These functional impairments make readjustment to family life and employment virtually impossible. Massive, or in some instances, moderate defects of the face can produce severe psychological trauma which are as debilitating as a biological injury. 7 Rehabilitation of oral and facial defects can

Bilateral differences in the diameter of the two pupils, anisocoria, has been associated with everything from beri beri to psychological trauma. The one common finding in most studies dealing with anisocoria is the increased psychophysiological variability of this population. A neurological model is proposed explaining both the anisocoric condition and increase in autonomic variability. The model suggests that deficiencies in the ascending bulbar inhibitory system reduce tonic control of the medial reticular activating system and may be implicated in the etiology of anisocoria. The portions of the nervous system implicated are those reported by Lacey (1967) to be involved in “directional fractionation.” It is suggested that the anisocoric individual may provide a ready made “lesioned” sample with which to compare normal subjects. At the very least anisocoria represents another example of bilateral autonomic asymmetry. Possible research in this area is discussed.

A patient recovering from a cerebrovascular accident needs all of the support and encouragement that can be provided in view of the organic and psychological trauma he has suffered. The existing aphasia should be considered as a disturbance having four aspects or involving four functions: understanding, talking, reading, and writing. Careful diagnostic tests identify the nature of the impairment and form the basis for establishing a program of therapy. The goals are thought of in terms of basic communication, home adequacy, social acceptability, and vocational adequacy. In a large rehabilitation center an aphasia therapist should assume leadership in helping other members of the rehabilitation team to understand the patient and to coordinate the program. Group therapy is applicable in many forms, and it helps to provide multistimuli situations. The families of aphasic patients also need support and guidance. A family group session sometimes helps to bridge the gaps from the rehabilitation center to the sheltered family home and thence to the world outside.

TRAUMATIC events have long been felt to be of importance as etiologic factors in disease. Physical trauma is one cause of physical illness, and psychological trauma is a cause of psychopathology. But what is psychological trauma? For the purpose of this and related studies we define psychological trauma as those events that require a readjustment on the part of the individual, a change in his life, so to speak; and we quantify this readjustment in terms of Life Change Units (L.C.U.s). This concept and terminology was introduced by HOLMES and RAHE [l] in 1967 and applied to the field of Child Psychiatry by the author [2] in 1970. The reader will note that the definition is very broad and includes events with a positive as well as a negative connotation. For example, a move to a new school district may be good or bad for a given child, but in either case requires some readjustment. By means of a survey [2] of 243 professionals (131 teachers, 25 pediatricians, and 87 mental health workers) we gathered the data necessary to assign a weight in L.C.U.s to each of the events noted in Table 2. The current study is aimed at establishing normal values for children of different ages and investigating the influence of the variables of sex, race socio-economic class, and religion on these normal values. How much psychological readjustment can the average child be expected to undergo in the course of a year? With this information a normal “growth” curve can then be constructed on which an individual child’s experience can be plotted and compared. METHOD Research was conducted by a bi-racial team of male and female students during a six week period in the summer of 1971. Attempting a valid cross-section of the population, surveying was done around the Columbus, Ohio, area at suburban and city swimming pools, community recreation centers, day care centres, county fairs, and by door-to-door canvassing. Parents were asked to complete the preschool and elementary school age forms, while junior high and senior high forms were filled out by the subjects themselves. To prevent repetition of family events, researchers polled only one member of a family and instructed him to indicate those events listed that have occurred in the past year. Information was obtained from 3620 individuals. Surveyors chose a sample population with a racial proportion approximating the state of Ohio (Table 1). Also considered was a balance of age and social class as determined by Hollingshead Index of social position score and Hollingshead Social class. Due to ambiguity of the printed forms, responses to the religious item were discounted. form through typographical error. “Death of a parent” was omitted from the elementary Further scrutiny of Table 1 reveals that 94 subjects indicated that they had had a serious illness requiring hospitalization in the past year. Since this was an attempt to study the effect of life events on the etiology of illness, these children were excluded from our calculations, hence our total N becomes 3526.

HE persistence of behavior with no obvious reinforcement poses special problems for theories of learning. But numerous experimental studies confirm the clinical observation that traumatically acquired habits maintain a marked resistance to extinction despite the lack of renewed primary reinforcement (3, 4, 6, 8). The generality of the problem has been indicated by Mowrer(9), who formulates as the central problem of neurosis the paradoxical perpetuation of nonadaptive behavior. The present research deals with the extinction of a habit acquired under the conditions of traumatic avoidance learning. The habit proved to be markedly resistant to the ordinary extinction procedure. However, extinction could be brought about through the use of special techniques. The obtained data suggested theoretical explanations of high resistance to extinction as well as explanations of the relative efficacy of the special techniques. We presume that die findings have a wide generality for theories of therapy and the nature of psychological trauma. The findings to be reported in this paper were obtained under the following conditions. Using a modification of the Mowrer-Miller shuttlebox, learned avoidance responses were established in normal mongrel dogs. Under the impetus of very intense (just subtetanizing) electric shock, the dogs were trained to jump over a barrier from one compartment to the other in order to avoid the shock. The details of the training procedure are given in another paper (13). Ten trials comprised each day's session. After the animals had met an acquisition criterion of 10 successive responses on a given day, different dogs were

The psychodynamic approach to immediate denture prosthesis is predicated on the need to treat the dental patient as a total personality with an understanding of his emotional requirements and with respect for his uniqueness. The dental situation produces apprehension and dread in all persons, normal as well as neurotic. The kind of fear experienced by the neurotic patient can be understood only in the light of the psychogenicity of anxiety. Neurotic anxiety is not directly related to the real threat in the environment (that is, the pain of the operation and the loss of teeth), but originates in unconscious ideation in which extraction of teeth takes on symbolic meaning. Such anxiety also may be the product of traumatic experiences of the patient or of parents or siblings which are related to dental situations. It is recommended that the dentist obtain a full anamnesis covering medical, psychological, and dental background of his patient. Basic to psychological understanding and good management is the establishment of a doctor-patient relationship built on an empathic, permissive, and accepting attitude of the dentist toward his patient. The alert practitioner, in recognizing certain symptoms, can obtain an over-all picture of the personality structure of his patient with a view to helping him handle his anxiety and adjnst to the traumatizing situation. The use of the hospital for surgical prosthesis is a most important aid in allaying anxiety in the patient, reducing both his physical and psychological trauma, and hastening the recuperative process. In addition, the hospital lends status to a surgical procedure which too often is regarded as routine office practice, and gives professional dignity to the dentist by removing him from the “everyday concept” of the title, dentist .

A SEVERE burn in a child is an extremely stressful experience for both the child and his family. Not only is the physical recovery slow and painful, but the psychological trauma has long-lasting effects. Follow-up studies 1,2 of the children who have recovered physically from severe burns have revealed that emotional disturbances exist in approximately 80% of the children and 60% of their mothers. The majority of these mothers thought the disturbances in their children were the result of the burn experience, pain, and the separation from home during the hospitalization. However, Long and Cope 3 report a high incidence of psychopathology in the family unit antedating the burn incident, and Vigliano et al 4 further suggest that chronic relationship problems may become overtly manifest only at the time of the children's burns. Previous work by the present authors also emphasizes the importance of considering the "battered child syndrome" in

We have outlined, for the sake of simplicity, 3 groups of psychosomatic theorists. One assumes that the psychological make-up of the individual and the character of the psychological trauma determine the nature of organic illness. Another group believes that the structure of the patient's personality and the nature of his conflicts and psychological trauma have no direct bearing on the type of organic pathology he will develop. They assume that any kind of psychological stress may be associated with a pathogenic physiological concomitant leading to organic disease, the nature of which depends probably more on the physical than on the psychological make-up of the individual. The third group is not really worthy as yet of being characterized as a theoretical group. It consists of those who object to the lack of validation of the intellectually attractive specificity theories and yet are dissatisfied with the overgeneralized nonspecific theories. These theorists are using the "shotgun," or multidisciplinary,...

It is the purpose of this article to introduce a check list which we have found useful in the University Hospital Audiology and Speech Service for the informal differential diagnosis of functional hearing losses and for instruction of medical students. Previous articles 5,9,10 have noted the increase in the incidence of functional hearing losses being seen clinically. This increase may be attributed to the following: Greater awareness of the problem. Increase in acoustic, physical, and psychological trauma. Liberalization of compensatory interpretation of the law. Liberalization of the private point of view in obtaining compensation. The "Psycho-Tell" is the product of the realization that a goodly number of the cases referred to the Audiology and Speech Service for simple and routine hearing tests were neither simple nor routine. In addition, it was noted that a number of outside referrals had been unsuccessfully tested before being passed on

One hundred male infants were studied at the Kingston General Hospital, Kingston, Ontario, to determine the incidence and complications of routine circumcision. The parents were also interviewed concerning the reason for operation.In these 100 infants, complications, usually minor, were very common, and included hemorrhage (35), meatal ulcers (31), infection (eight), phimosis (one) and meatal stenosis.The reasons given for operation were prophylactic-to avoid the psychological trauma of later operations for infection, phimosis and "troubles" (40), cleanliness (11) and phimosis (four). The remaining cases were for social and other non-medical reasons. Attitudes of parents and physicians regarding circumcision varied from firm belief in its value to a casual approach. One-half of the babies had partial circumcisions, confirming previous suspicions that non-Jewish males frequently had partial operations. Partial operations do not always guarantee cleanliness and probably do not eliminate the risk of penile carcinoma in all cases, if smegma is carcinogenic. Routine circumcisions spare a few children psychologically traumatic operations at a later date and relieve parents of anxiety about the future of the uncircumcised child. This should be balanced against the complications which, although usually minor, may occasionally be serious.Between 1961 and 1962, at the Kingston General Hospital, 349 (48%) of 727 male newborn babies were routinely circumcised.

Introduction Vitiligo is a disorder of pigmentation which has baffled the medical world for centuries. It should be differentiated from the more inclusive descriptive term leukoderma, which may also include depigmentations due to obvious local causes, such as burns or wounds, chronic eczematous conditions, psoriasis, leprosy, or syphilitic leukomelanoderma. Although there is no restriction of physical endurance, work capacity, or life expectancy, vitiligo patients frequently suffer from severe psychological trauma because of the disfiguration of unsightly white patches, especially if these occur on exposed areas of the face or extremities. From my observations on 410 cases of vitiligo seen over a period of three years in the Dermatology Clinic, Christian Medical College Hospital, Vellore, South India, I have been impressed by the variability in distribution of lesions, type of lesions, course of the disease, and particularly in response to treatment. Although the pso

Anxiety, either manifest or in the form of non-specific emotional disturbance, has been widely accepted as an operative factor in the personality structure of delinquent subjects (Aichhorn, 1; Burt, 5; Friedlander, 17; Stott, 53), and at present it appears that cognitive factors have little or no bearing upon the problem (Marcus, 43; Woodward, 61). By regarding anxiety or activated stress as a stimulus producing response (Hull, 24, 25; Miller, 45), delinquent behaviour has been postulated as learned responsiveness to anxiety or stress, which also functions as a learnable drive (Tong, 55). Previous investigations using Rorschach, persistence and galvanic skin response indices of anxiety or emotional disturbance have shown that there are significant variations according to both the nature of the conduct disorder (sex, violence, larceny, etc.), and ratings of stability (Tong, 54, 55). Different forms of conduct disorder are also known to carry different relapse potentialities, so that sex offenders, for example, are less likely to relapse than are larceny offenders (Mannheim and Wilkins, 42; Tong and Mackay, 60), although it is possible that different methods of treatment or disposal influence the likelihood of relapse for different sex offenders (Radzinowicz, 48). Prediction tables have been constructed for the purpose of more accurately assessing the most unstable offenders (42), and although such systems carry an encouraging degree of reliability it is apparent that greater reliability in prediction will only follow more accurate personality assessment than is possible by the use of impressionistic methods alone (58). Only knowledge of the relevant personality variables will lead to accurate assessment of change in subjects for whom the significant historical factors necessarily remain fixed. Furthermore, assessment techniques must be relatively unaffected by intelligence, education and rapport factors.

seminars, books, lectures and demonstrations have inundated physicians. Among the conditions that some of its advocates have claimed to be materially helped or “cured” by acupuncture are headache, diarrhea, bedwetting, swelling, amenorrhea, dysmenorrhea, high blood pressure, gall bladder trouble, cardiac arrhythmia, impotence, menopause, hemorrhoids, constipation, liver trouble, kidney trouble, colds, low blood pressure and “many more.” When this melange of claims is accompanied by the clutching of the Red Book and the mouthing of the current political quotations-in favor, it approaches travesty and yields the unacceptable mixture of politics and medicine. However, despite an almost automatic rejection by physiologically trained and oriented Western cardiologists of methods that have dim rationales and are promoted by hyperbole, one cannot deny that acupuncture has been used successfully as an anesthetic adjuvant during cardiac surgery, as succinctly and objectively described by Katz. It therefore behooves us to give the technique recognition and to try to explain or at least evaluate it. My colleague, Dr. David C. C. Stark (clinical professor of anesthesiology, Mount Sinai School of Medicine) has studied the Katz report and has come to the conclusion that the technique does not appear to provide a wholly satisfactory form of anesthesia. The instability of the pulse rate in response to auditory stimuli and apprehension suggest that afferent stimuli are not blocked. The psychological trauma associated with the procedure in a conscious or semiconscious patient needs to be considered. The depression of the respiratory rate to 8 to lO/min suggests the use of either more meperidine (Demerole) than indicated in the description or perhaps a fair degree of hypothermia (body temperature not provided) with attendant analgesia and some cortical depression.

TWENTY-FIVE to thirty per cent of diabetic patients require insulin to remain alive and well. In the main these patients have the juvenile-onset type of diabetes mellitus and treatment for many years is normal. So far, the insulin they require can only be administered parenterally, despite many attempts in the past 40 years to circumvent the injections needed and the physical risks and psychological trauma involved1.

The hospitalization of young children is an important and difficult experience for the child and the family, especially the mother. To those responsible for the health of the child there is the challenge of helping the child and mother to master this difficult experience.* Often it appears that the hospital provides for the physical needs of the child and opposes or deals harshly with his psychological needs. When hospitalization is planned as a therapeutic measure, one avoids the limited view that it is suitable for young children if psychological trauma is avoided. Indeed, the personnel of the modern hospital often is able to create an environment in which certain children for a short time can deal with their physical and emotional needs better than at home. It is the purpose of this paper to demonstrate that in the elective hospitalization of young children, both psychological and physical needs can be

A HOLISTIC theory of psychopathology interprets the individual as the unique product of complex interactions between biological, psychological, and sociocultural determinants. It makes little sense to ask how much of a given characteristic in a single individual is determined by heredity and how much by environment, since both are essential to the survival of the organism. However, it is still pertinent to ask what proportion of a given characteristic in a total population is determined by specific hereditary or environmental influences. Stated another way, the heritability of a trait is the proportion of the population variance that is determined by genetic endowment. Much of the population variance with respect to many forms of psychopathology is believed to be acquired or learned as a consequence of adverse postnatal environmental experiences, often referred to as psychological trauma, stress, or deprivation. Freud considered that in adults with

Assessing the relative importance of environment and heredity on facets of group behavior can be extremely difficult. With respect to the possibility of racial differences in performance being partly of genetic origin, an authoritative statement recently contended: "In the absence of some now unforseen way of equalizing all aspects of the environment, answers to this question can hardly be more than reasonable guesses" (Council, 1968). The implication is that ethnic and racial differences on various tests cannot be assigned to genetic causes until every subtle environmental factor has been identified and equalized. This position effectively removes the problem from active investigation. An attempt to bypass this objection was made by comparing two minorities larking the intangible benefits of membership in the majority culture. Using data from a national survey (Coleman, et al., 1966), it was shown that American Indian children outperformed Negro children on several scholastic tests (Kuttner, 1968a, 1968b). Accompanying socioeconomic indiccs and available census statistics rank Indian srudents substantially below the Negro for the ordinary amenities of life. Either the Indian has superior capacity on these tests or the socioeconomic factors are less decisive than many believe (Jensen, 1969). Geneticists have disputed this conclusion (Crow, 1969; Lewontin, 1970). It is argued that if lndians score better than Negroes, then the Indian must rank higher on some crucial environmental variable that was missed when the family and home inventories were compiled, or the Negro is more damaged than his superior material status indicates. However, this postulate of hidden psychological trauma does not seem plausible. As originally emphasized (Kuttner, 1968a, 1968b), Indian ambition, motivation, and self-concept were rated inferior to those of the Negro (Coleman, et al., 1966). It is therefore reaffirmed that evidence of genetic components in group performance can be obtained without the necessity of equating all known and suspected environmental factors. The greater the socioeconomic disparity, the greater the importance of genetic influences on any aspect of behavior on which a more deprived group exceeds a more favored group. This view avoids the need for perfectly matching subsamples before comparisons are carried out.

Unfortunately, since communication tends to break down, nurses on a transfer unit may lack baseline information for the patient with which to compare their nursing observations. The postoperative patient has been subjected to multiple physiological and psychological trauma. His recovery depends largely on competent, knowledgeable nursing care. His condition cannot be assessed accurately without knowing his preoperative parameters. Isolated measurements may be meaningless, but serial measurements are usually valuable. Since we knew of no practical communication tool to provide the