We have just finished a 3 day symposium on "the injured child"
As S.G. I stand at the narrow point of the hour glass between the govt. and the public
Appropriate that I should say a few words about the P.H. implications of past 3 days
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Year 1981, the latest complete ones we have, we can see that the motor vehicle is still one of the leading causes of injury
to children. In 1981, over a quarter of a million children were admitted to emergency rooms for treatment of injuries incurred
from some kind of accident with a car or truck. Two thirds of those children were between the ages of 5 and 14 and a third
-- close to 90,000 -- were under the age of 4.
But, according to the government's national electronic injury surveillance system, the leading cause of injury to Americans
in 1981 was not the motor vehicle at all. It is something much humbler. The leading cause was stairs -- those little architectural
aids that are supposed to help us get safely from one level in space to another.
Generally they do. But in 1981 there were 784,000 emergency room admissions for injuries incurred by people primarily going
-- or being carried -- up or down steps. Of the three quarters of a million injuries associated with stairs, one fourth of
them -- or about 200,000 -- involved children under the age of 14.
The next largest category of injuries involved the use of bicycles. There were an estimated half million such injuries in
1981, of which about the great majority -- 378,000 -- involved children under the age of 14.
I won't go any further with such a litany. It happens to be my opinion that our conference this week may well be one
of the few conferences this year in any area of medicine that will be focusing on so large population of vulnerable, virtually
defenseless people who suffer such a variety of life-threatening insults.
And that is why I believe this conference on "the injured child" cannot be only our opportunity to assemble the best
observations on this subject. And it cannot be remembered primarily as a "summation of summations." Rather, this
conference, as I mentioned a moment ago, should be a great personal and professional challenge to each of us.
And first challenge, by the way, is right there in the title. I want to spend just a moment to take a closer look at that
word "injured." Usually means that there has been some blow to the head, the chest, or to the extremities . . . or
there are burns, cuts, or other forms of disfigurement . . . or the child has suffered poisoning, starvation, or some other
accidental or deliberate assault. That's the usual cluster of explanations for the word "injured."
But children sustain many kinds of injuries for which medicine can fumble for an adequate response at all. For example, there
are thousands of children on our streets today for whom the word "family" has little or no personal meaning. They've
been denied the kind of family love and care that the rest of us take for granted. The absence of a caring family is a cruel
and profound injury. And I don't believe there is anything -- even in such a fine health science center as this -- that
can repair that kind of hurt. Nothing at all.
Other children have been physically and sexually abused in their homes . . . they've been preyed upon in their own neighborhoods
. . . been exploited by evil people for evil ends. And our schools and community organizations may have failed them just
when help was needed the most. These are not "injuries" as they are understood in traditional physical medicine,
but they are traumatic nevertheless. And they are important, because they determine whether or not a child has the will to
fight the pain of physical injury -- or simply to surrender.
But we have to think of the injured child in the broader context of violence of all sorts.
Violence in all its aspects has grown to become one of the major public health problems in American society today. It is
not new, of course. Violence of some kind -- murder, suicide, assault, armed confrontation of neighbor against neighbor --
these have appeared in our national history since the 17th century. In the past 80 years or so, as we improved our ability
to collect vital statistics, we have been able to identify periods when there were increases in the incidence of morbidity
and morality caused by violence. We are coming through just such a period now.
Violence in this country surged in the late 1960s and into the 1970s. Al the indicators went up. But the toll upon young
people -- pre-schoolers, early adolescents, and young adults -- has been particularly high. The mortality rates have risen
during this period and there seems to be little likelihood that they will return to the levels of the 1950s and early 1960s.
But believe that we are seeing more and more clearly that, within the overall issue of violence, lies the heart of the matter:
violence in the family. The evidence -- since the time that evidence was first collected -- is simply overwhelming:
Violent families tend to produce violent children who commit crimes outside the home as well as inside and tend to do that
when they become adults, too. If we could bring about a marked reduction in family violence, we would, in effect, be reducing
the possibility of crime in general for years to come.
That is not meant to be a summation of the problem. It is the challenge itself. Yes, family violence is central to violence
in the society generally. Now what are we going to do about it?
There is a strategy that is evolving from among individuals and groups concerned about family violence. And the federal government
has a particular role to play and has begun to do it.
Part of the strategy is to open up discussion of family violence, to let some light in and fresh air in, to indicate to those
who may be predisposed to violence that it can no longer remain as their own little secret, and to let potential victims know
that they are not isolated from the rest of society: their plight is our plight.
"Going public" on this issue means, interesting the media in giving this subject better coverage that just surface
sensationalism. I think they will. To be perfectly candid, I think part of the fault of the media's poor record so far
must lie with those of us who know better but have not been able to convey that knowledge to the media in terms they can accept
and use. I think we have to deal with that part of the problem, too -- our part.
But that still ought not to let the media off the hook, especially television. I don't know how many times the government
has to come out with yet another study of television violence to make the point that it is harmful to children. There has
been an interminable amount of bean-counting to quantify the obvious:
Children spend at least 2 hours and a half in front of a T.V. set each day . . .
Many of today's high school graduates will have spent more of their lives in front of a T.V. set than in the classroom
. . .
By the age of 18 a young person could have witnessed over 18,000 murders on television. This does not count the documentation
of violence that seems to be in every T.V. news report . . .
Adults spend about 40 percent of their leisure time watching television, which ranks third -- behind sleep and work -- as
an occupier of an adult's average day.
Not only are the specific details of a fictional crime re-enacted by viewers -- often young children or adolescents -- but
there is a strong suspicion that the aggressive behaviors by the "heavies" on television are mimicked by viewers also,
whether consciously or unconsciously, in a variety of relationships and settings.
Children tend to speak for all of us, too, when adults are still stumbling for the right words.
I would like to repeat that oft-quoted section from The Diary of Anne Frank. You'll recognize it, I'm sure. I think
it sums up the extraordinary treasure that is embodied in our children and remains an inspiration to every civilized person
who is determined to confront violence -- and stop it.
You may recall that Anne Frank wrote these words just two weeks before her hiding-place was discovered and she was sent to
Then she closed her entry for that Saturday in July 1944 by writing . . .
"If I look up into the heavens, I think that it will all come right and this cruelty too will end and peace and tranquility
will return again . . . "
How sad for Anne for many people like here -- people of all ages -- that the ideal vision she had is still so far from being
I'd like to say a few words to the young people here tonight
is time in human history. I think people -- especially young people -- are taking a second look at values and are trying
to build their lives around the values that hold meaning for them. I think you are really beginning to care about each other,
openly and freely and even joyfully.
Your caring is going to be tested by the nature of some changes taking place in our society. In the few minutes left I want
to focus on two in order to suggest the challenges ahead for each of you, -- not only at whatever you will become as far as
your occupation is concerned but also as a human being. These two are the growth of an aging population and the new concern
for disabled persons.
During the last quarter of this century the median age of the American population will gradually creep upward. In 1975 the
median age of the American population was 28.8 years. In the year 2000 the median age will be 35.5 years, according to the
latest median estimate by the census bureau.
During this decade of the 1980s, the age cohort of 35 to 44, the so-called "baby boom generation," will expand by
about 40 percent. Shortly after the turn of the century, about 1 in 5 Americans will be a senior citizen -- about 50 million
compared to today's 25 million. Equally important is the fact that nearly half those senior citizens will be age 75 or
A man who reaches the age of 65 now has a life expectancy of another 12 years. A woman of the same age, 15 years. Will we
provide them only with as much curative and reparative care as we can, or will we practice preventive medicine as well? What
about the 65-year-old person who has smoked two packs of cigarettes a day -- and then stops. That person will se his or her
lung functions return toward normal of course' if there is already the beginning of a cancer, -- quitting cigarettes will
not resolve the situation. Will we be sensitive enough to advise that 65-year-old to stop smoking?
And need I add that, as this country begins to show more gray on the heads of its citizens, more gray will be appearing on
your heads as well, and on the heads of your colleagues.
And now I would turn your attention to the disabled, a group of Americans that is also growing in numbers -- a group that
presents its own special challenges.
Today about 1 of every 7 Americans is disabled or limited in some way from living a life that is normal for his or her age
group. That's something like 35 million Americans . . . about one-third increase over the number of Americans who were
disabled or had limitations on their activities in 1969. It is an increase far larger than our overall population increase
during the same 12 years. The numbers include . . .
The nearly 5 million persons who suffer from impairments of the back, the spine, the shoulders, and the upper and lower extremities.
Many of these impairments are from injuries sustained in preventable highway accidents. And many of those preventable accidents
came from the killing combination of drinking and driving.
There are also the 3 to 4 million people who live with disabling and chronic bronchitis, asthma, emphysema, and other respiratory
conditions that may be traced to smoking or to preventable high-risk conditions in the workplace.
The total also includes about 6 million people who suffer from arthritis, rheumatism, and other musculoskeletal disorders
about which we need to learn much more in order to control and prevent them.
And there are the 5 million or so people who have not died of heart disease, who were saved but are nevertheless limited in
what they can do for the rest of their lives. In a sense, many of them survive as casualties of poor nutrition, smoking,
lack of exercise, or an inability to handle the stresses of modern life. Those are also preventable causes.
In the single year 1980, the department of labor reported a total of 5.5 million occupation-related illness and traumatic
injuries. These produced a total nearly 42 million lost work days. And the total earnings lost came to $2 Billion.
Some person . . . some agency . . . some one has to make up that loss. It may be replaced by worker's compensation or
insurance, by a relative or a friend, a charitable organization, or a social service agency. The earnings may be replaced,
but never replaced will be the lost days and lost years of full, active living.
At this point, I am asking you to break through those cultural barriers you may have acquired so far. If we have trouble
coping with the aged person -- and I think we do -- then how much more difficult will it be. To cope with the aged person
who is also disabled. Thanks to modern medicine, both have a better chance of surviving.
This is a challenge to you personally
It might be appropriate, to close with this observation by T.H. Huxley, written nearly a century ago. He said . . .
"Perhaps the most valuable result of all education is the ability to make yourself do the things you have to do, when
it ought to be done, and whether you like it or not."
To an extraordinary, recent history of vaccine development and mass child immunizations, we are seeing record low numbers
of many of the most common childhood diseases. Polio has virtually disappeared and we are on the brink of announcing the
end of indigenous measles in the United States.
These great accomplishments in child health are the result of the collective professional and public will. And we may well
need the same kind of totally national commitment to trauma, if we hope to see any real decline in the mortality and morbidity
figures associated with the injuries of children.
Certainly the example of Dr. Robert E. Gross and the attention being shown by everyone at this conference can only help to
capture the nation's interest. I, for one, am honored to have been asked to take part and I thank you again for your