Incest
Sir.\p=m-\Thearticle
on
incest
by
Weitzel
et al (132:127-130) and the editorial comment by Weiner (132:123) in the
February
1978 issue of the Journal welcome additions to the scanty and perplexing literature on child sexual abuse. I agree that "knee jerk responses" may be detrimental, ie, immediate removal of the child. The symptom of incest warrants careful evaluation and planning. The authors clearly pointed out that the studies used to support allegations that sexual abuse of children is damaging are biased and select for children already identified as disturbed. However, the data used to support the contention that sexual abuse may not be harmful are equally misleading1,2; both studies deal with an inpatient psychiatric population. Those authors' perceptions of the severity of damage seem are
open to question. At this point, we honestly don't know what the acute and long-term effects of child sexual abuse are, and until long-term follow-up studies are funded, we won't. In the meantime, however, it would seem unwise to assume that there are no effects, and one must plan an individualized inter¬ vention that will assure that the child will no longer be victimized by the adult. As Weiner et al and Weitzel pointed out, this intervention may
take
variety of forms. ORR, MD Department of Pediatrics University of California, Irvine California College of Medicine Irvine, CA 92717
a
DONALD P.
daughter incest in a family regularly triggers a strong and negative reaction among medical practitioners and social agency employees. The danger of overreaction and acquiescence to the impulse to "do something" is often great. Dr Orr is correct in highlighting again that the long-term, controlled, conclusive studies still need to be done to confirm the conclusion that episodes of father-daughter incest inevitably reflect family relationships that are so disturbed and of such a danger to the daughter's present and future mental health that so extreme a social intervention as removal of the child from the home can be justified. Incest behavior in a family deserves our professional concern and help. Case examples of daughters who are clearly being victimized by their fathers in such a relationship do deserve carefully conceived and executed plans for intervention. We do not advocate that since so little is definitively known about long-term consequences, nothing should be done. We do take issue with intrusive social policy actions based primarily on the strong feelings and firmly held im¬ pressions of some health care provid¬ ers camouflaged behind the assertion that father-daughter incest behavior always leads to some form of mental illness in the daughter. BARBARA J. POWELL, PHD ELIZABETH C. PENICK, PHD WILLIAM D. WEITZEL, MD Department of Psychiatry University of Kentucky Medical Center Lexington, KY 40506
Grugett AE Jr: A follow-up report children who had atypical sexual experience. Am J Orthopsychiatry 22:825-837, 1952. 2. Yurokoglu A, Kemph JP: Children not severely damaged by incest with a parent. J Am Acad Child Psychiatry 5:111-124, 1966. In
Reply.\p=m-\Thediscovery
of father-
gitis; one each, Staphylococcus aureus sepsis and osteomyelitis, Salmonella typhimurium sepsis and osteomyelitis, Klebsiella sp sepsis and pyelonephritis, Escherichia coli pyelonephritis, and Diplococcus sepsis and otitis media; two, purulent otitis media; three, S aureus pyoderma and abscess; four, group A \g=b\-hemolytic Streptococcus pharyngitis; one, D pneumoniae sepsis and pneumonia; 16 were considered clinically to have bacterial pneumonia. During the steady state, the mean WBC count was 12,000 \m=+-\3,100 (SD)/ mm, with
Leukocyte Counts in Children With Sickle Cell Disease Sir.\p=m-\Arecent article by Buchanan and Glader in the Journal (132:396\x=req-\ 398, 1978) prompted us to review the records of 73 children under our care
Downloaded From: http://archpedi.jamanetwork.com/ by a New York University User on 06/03/2015
range of
5,800 to segmented polymorphonuclear neutrophilic leu¬ kocyte (PMN) count was 6,000 ± 2,600/cu mm, with a range of 2,100 to 13,700/cu mm; mean nonsegmented cu
19,500/cu
mm.
a
The
mean
PMN count, 90 ± 100/cu mm, with a range of 0 to 800/cu mm. Mild eosinophilia (635 to 3,400/cu mm) was pres¬ ent in 22 children. During the vaso-occlusive crisis, the mean WBC count was 17,500 ± 5,800/ cu mm, with a range of 8,000 to 35,500/cu mm. The mean segmented PMN count was 10,800 ± 5,100/cu mm, with a range of 3,200 to 28,000/cu mm; mean nonsegmented PMN count, 330 ± 400/cu mm, with a range of 0 to
1,400/cu
1. Bender L,
on
with homozygous sickle cell disease. The children ranged in age from 2 to 18 years, with a mean age of 9.2 years. Leukocyte counts were recorded in all 73 children during the steady state, in 47 during vaso-occlusive crises (88 episodes), and in 26 with bacterial infections (34 episodes). Of the 26 with bacterial infection, three had Diplococcus pneumoniae sepsis and menin-
mm.
In the presence of bacterial infec¬ tion, the mean WBC count was 25,200 ± 9,000/cu mm, with a range of 15,300 to 48,900/cu mm. The mean segmented PMN count was 15,300 ± 6,800/cu mm, with a range of 8,800 to
38,100/cu mm; mean nonsegmented
Sir.\p=m-\Thearticle
on
incest
by
Weitzel
et al (132:127-130) and the editorial comment by Weiner (132:123) in the
February
1978 issue of the Journal welcome additions to the scanty and perplexing literature on child sexual abuse. I agree that "knee jerk responses" may be detrimental, ie, immediate removal of the child. The symptom of incest warrants careful evaluation and planning. The authors clearly pointed out that the studies used to support allegations that sexual abuse of children is damaging are biased and select for children already identified as disturbed. However, the data used to support the contention that sexual abuse may not be harmful are equally misleading1,2; both studies deal with an inpatient psychiatric population. Those authors' perceptions of the severity of damage seem are
open to question. At this point, we honestly don't know what the acute and long-term effects of child sexual abuse are, and until long-term follow-up studies are funded, we won't. In the meantime, however, it would seem unwise to assume that there are no effects, and one must plan an individualized inter¬ vention that will assure that the child will no longer be victimized by the adult. As Weiner et al and Weitzel pointed out, this intervention may
take
variety of forms. ORR, MD Department of Pediatrics University of California, Irvine California College of Medicine Irvine, CA 92717
a
DONALD P.
daughter incest in a family regularly triggers a strong and negative reaction among medical practitioners and social agency employees. The danger of overreaction and acquiescence to the impulse to "do something" is often great. Dr Orr is correct in highlighting again that the long-term, controlled, conclusive studies still need to be done to confirm the conclusion that episodes of father-daughter incest inevitably reflect family relationships that are so disturbed and of such a danger to the daughter's present and future mental health that so extreme a social intervention as removal of the child from the home can be justified. Incest behavior in a family deserves our professional concern and help. Case examples of daughters who are clearly being victimized by their fathers in such a relationship do deserve carefully conceived and executed plans for intervention. We do not advocate that since so little is definitively known about long-term consequences, nothing should be done. We do take issue with intrusive social policy actions based primarily on the strong feelings and firmly held im¬ pressions of some health care provid¬ ers camouflaged behind the assertion that father-daughter incest behavior always leads to some form of mental illness in the daughter. BARBARA J. POWELL, PHD ELIZABETH C. PENICK, PHD WILLIAM D. WEITZEL, MD Department of Psychiatry University of Kentucky Medical Center Lexington, KY 40506
Grugett AE Jr: A follow-up report children who had atypical sexual experience. Am J Orthopsychiatry 22:825-837, 1952. 2. Yurokoglu A, Kemph JP: Children not severely damaged by incest with a parent. J Am Acad Child Psychiatry 5:111-124, 1966. In
Reply.\p=m-\Thediscovery
of father-
gitis; one each, Staphylococcus aureus sepsis and osteomyelitis, Salmonella typhimurium sepsis and osteomyelitis, Klebsiella sp sepsis and pyelonephritis, Escherichia coli pyelonephritis, and Diplococcus sepsis and otitis media; two, purulent otitis media; three, S aureus pyoderma and abscess; four, group A \g=b\-hemolytic Streptococcus pharyngitis; one, D pneumoniae sepsis and pneumonia; 16 were considered clinically to have bacterial pneumonia. During the steady state, the mean WBC count was 12,000 \m=+-\3,100 (SD)/ mm, with
Leukocyte Counts in Children With Sickle Cell Disease Sir.\p=m-\Arecent article by Buchanan and Glader in the Journal (132:396\x=req-\ 398, 1978) prompted us to review the records of 73 children under our care
Downloaded From: http://archpedi.jamanetwork.com/ by a New York University User on 06/03/2015
range of
5,800 to segmented polymorphonuclear neutrophilic leu¬ kocyte (PMN) count was 6,000 ± 2,600/cu mm, with a range of 2,100 to 13,700/cu mm; mean nonsegmented cu
19,500/cu
mm.
a
The
mean
PMN count, 90 ± 100/cu mm, with a range of 0 to 800/cu mm. Mild eosinophilia (635 to 3,400/cu mm) was pres¬ ent in 22 children. During the vaso-occlusive crisis, the mean WBC count was 17,500 ± 5,800/ cu mm, with a range of 8,000 to 35,500/cu mm. The mean segmented PMN count was 10,800 ± 5,100/cu mm, with a range of 3,200 to 28,000/cu mm; mean nonsegmented PMN count, 330 ± 400/cu mm, with a range of 0 to
1,400/cu
1. Bender L,
on
with homozygous sickle cell disease. The children ranged in age from 2 to 18 years, with a mean age of 9.2 years. Leukocyte counts were recorded in all 73 children during the steady state, in 47 during vaso-occlusive crises (88 episodes), and in 26 with bacterial infections (34 episodes). Of the 26 with bacterial infection, three had Diplococcus pneumoniae sepsis and menin-
mm.
In the presence of bacterial infec¬ tion, the mean WBC count was 25,200 ± 9,000/cu mm, with a range of 15,300 to 48,900/cu mm. The mean segmented PMN count was 15,300 ± 6,800/cu mm, with a range of 8,800 to
38,100/cu mm; mean nonsegmented
