A short time ago I attended an allday scientific conference in honor of Dr. Henry Barnett. Most of us consider him to be the father of pédiatrie nephrology.
Among the list of subjects on the program was one on "von Neumann's Disease," described as the greatest threat to American youth. The speaker was Dr. Phillip Morrison, Professor of Physics at the Massachusetts Institute of Technology. I had never heard of von Neumann's Disease.
Dr. Morrison told us, at the outset of his talk, that the disease was named after John von Neumann, a famous Austrian mathematician. Shortly before his death in 1957, von Neumann wrote that the great problem of our times is the fact that the weapons the world is producing grow greater and more powerful, while the earth and the atmosphere remain unchanged. It was Dr. Morrison who named the condition.
And then, after this introduction, he presented his paper.
He first showed a photograph of the nuclear bomb that destroyed Hiroshima. A picture of the mushroom cloud followed, and then a photo of a modern nuclear bomb which he described as 1,000 times more powerful than the HiroshimaNagasaki explosives.
Next he placed a map of the United States on the screen. There were about 500 dots on the map. An atomic attack is aimed at these dots - and the entire map is erased.
The United States has 9,000-9,500 long-range nuclear warheads, the Soviet Union about 8,000. These are the missiles that are carried by planes, submarines or stored in silos. There are also thousands of shortrange missiles.
Dr. Morrison estimated that only several hundred of our larger missiles would destroy the Soviet society.
Following the meeting, I spoke to this physicist. He told me that millions of Canadians would also die in an attack on the United States.
Just who is Dr. Morrison who speaks with such depth of feeling and conviction about atomic warfare as a threat to us and future generations? He was at Los Alamos and at the desert site for the first test of atomic bombs. He then went to the Marianas to take part in preparing the bomb used on Nagasaki. "I assembled the nuclear cores of the Nagasaki bomb with my own hands, aided by a colleague or two," said Dr. Morrison. And so, at the close of his talk I was very much shaken. I learned about von Neumann's Disease - and I shall never forget it.
We should be able to conquer this most disastrous iatrogenic threat to our children - indeed to every human being, and American civilization as well, but only by abolishing all nuclear weapons on an international scale.
This ever-present threat of sudden annihilation is the latest of an unending series of periods of apprehension and tension that has clouded both our lives and the lives of our children.
I remember a period in my childhood when there was no war or fear of involvement in other nations* wars. These were the years from 1907 to 1913. As children we were brought up with complete confidence that we were living in a nation of peace, righteousness and security. We were isolated from problems of Europe and Asia, so many thousands of miles away.
We worshipped and cheered our national heroes - the veterans of the American Civil War - who were still parading in their blue uniforms every Memorial Day.
Woodrow Wilson was elected President in 1912. It was still a world without war. And then came 1914 and the European conflagration.
We thought that as Americans, we were safe and secure. Woodrow Wilson won the election again in 1916 with the slogan "He kept us out of war." But in April 1917 we declared war on Germany - and our world was never again the same.
Since that time we and all of our children have been exposed over and over again, almost continuously, to an atmosphere of depressing insecurity.
We have lived with the crash of the stock market in 1929; the rise and threat of Hitlerism; our entrance and experience in World War II; our continuous tension with Soviet Russia; our bitter event in Vietnam; and now the threat of total annihilation by the nuclear bomb.
In addition, drug use and abuse among our teenagers has become an increasing problem during the past 30 years. Numerous studies have been made in an effort to determine the basic causes that draw so many young people to the use of illicit drugs. The conclusions were not unexpected. Among the major reasons reported by the students were peer group influence, curiosity, easing depression, and overcoming boredom.
Almost all adolescents are subject to peer influence, and adolescents normally are curious and prone to experimentation. Most teenagers graduating from high school have already tried alcohol and marijuana. This can be understood although not necessarily condoned.
The adolescents who take drugs and alcohol are frequently our problems - and the majority of these have been found to be depressed, anxious or unable to cope. There are many reasons for their emotional difficulties - but one cannot help feeling that the underlying insecurity and fear related to world turmoil influences and fosters much of this depression. Ten to IS years ago, pediatricians were disturbed by a good many of our patients who were taking LSD, barbiturates, and amphetamines. Today the use of LSD has been almost eliminated due to fear of dangerous side effects. Sedatives and stimulants are less frequently used than previously.
Now our problems seem to be largely with alcohol and marijuana, although we still occasionally are faced with the problems of heroin addiction, cocaine and various tranquilizers.
The pediatrician is still called upon to detect the use of drugs among his patients. He must know all the signs and symptoms as well as the means of definite detection, whether through serum or urine examination.
To organize the symposium on "Alcohol and Drug Abuse" we have called upon Dr. Richard G. MacKenzie, Director of Adolescent Medicine at the Children's Hospital of Los Angeles. He has chosen for discussion three papers on alcohol and drug abuse and one on the prevention of teenage cigarette smoking.
The first paper, entitled the "Evaluation and Management of Drug Problems in Adolescents," is contributed by Dr. S. M. Coupey, Assistant Professor of Pediatrics and Dr. S. Kenneth Schonberg, Associate Professor of Pediatrics at the Albert Einstein College of Medicine. Both are in the Division of Adolescent Medicine of which Dr. Schonberg is the Director.
This paper deals broadly with teenage usage of drugs - the reasons leading to their active experience as well as the risks involved. The authors emphasize that certain adolescents who are problem drinkers and marijuana smokers are boys and girls with underlying psychosocial deviation. They suggest that there is an adolescent syndrome of "proneness to problem behavior" and they present an approach for the identification of such teenagers.
The final portion of the article deals with the goals of intervention and the difficult problem of intervention strategies.
This is an excellent summary of the drug problem, and the pediatrician's part when called on by parents to handle patients who are known or suspected of taking drugs or alcohol.
The second contribution - "The Adolescent as a Drug Abuser - A Paradigm for Intervention" - logically follows the first article. It has been written by Dr. Richard G. MacKenzie, previously mentioned as Director of the Division of Adolescent Medicine at the Children's Hospital, Los Angeles, and Assistant Professor of Pediatrics at the University of Southern California School of Medicine.
This paper concentrates on the needs of teenagers and the emotional urges that direct them to drug usage. Dr. MacKenzie notes that adolescents, with their numerous changes (emotional as well as physical), are more vulnerable to drugs for euphoria, reality avoiding, mind expanding, or experience enhancing.
He presents the latest statistics (1980) showing changes in trends of drug usage in American high school seniors. Of those studied, nearly twothirds had used illicit drugs. Dr. MacKenzie then carefully studies the contributing factors responsible for initiating and continuing drug usage, and presents several interesting case histories as illustrations.
The third article, "Use of the Clinical Laboratory in the Diagnosis and Treatment of Substance Abuse," is presented by Dr. Deborah C. Stewart, Medical Director of the Comprehensive Adolescent Program at the Charles Drew Post-Graduate Medical School in Los Angeles.
This is an important and valuable paper on the emergency care of a person suspected of substance abuse.
It gives specific directions for the analysis of urine, blood, gastric contents and saliva both qualitative and quantitative.
The author clearly demonstrates how invaluable the findings of a good clinical laboratory can be, not only in the diagnosis of substance abuse, but in treatment as well.
The final contribution deals with "Preventing Regular Teenage Cigarette Smoking." It is co-authored by William J. Wong-McCarthy, Assistant Research Psychologist, Department of Psychology, and Ellen R. Gritz, Associate Research Psychologist, Department of Psychiatry and Director of Macomber-Murphy Cancer Prevention Program, Jonsson Comprehensive Cancer Center. Both authors are from UCLA.
Alter noting the sizable number of teenagers who take to the habit of smoking, the authors state that the prevention of regular smoking appears to be the most effective way to reduce the incidence. Peer influence and the desire for social status are the strongest influences in the decision of teenagers to smoke. Once the habit has become established it becomes a dependence disorder.
There is so much pressure from the media to smoke that the adolescent is almost impelled to do so to assure social acceptance and well being.
However, the prevention programs may be effective and are detailed in this article. They include the cooperation of parents, schools, physicians, athletic directors and youth groups in helping teenagers to resist the pressures of advertising and peer groups.