COMMUNITIES IN ACTION

COMMUNITIES

IN

ACTION

A

Report

on

Project

Head

Start*

Julius

B. Richmond,

M.D.

From the Program Director, Office of Economic Opportunity; and the Department of Pediatrics, State University of New York, Upstate Medical Center

#{176}Special Report to the Annual Meeting of the American Academy of Pediatrics, Sunday, October 24,

1965, Chicago, Illinois.

ADDRESS: 766 Irving Avenue, Syracuse, New York 13210.

905

PnIAmJcs, Vol. 37, No. 6, June 1966

Pthutrics

VOLUME

37

JUNE

1966

NUMBER 6

COMMENTARY

Editorial Note: With the

beginning

of the first year of the

program

seems therefore

summer comes the second year of Project well suited to appear as Commentary for Head Start. Dr. Richmond’s report on the this issue.

I

T is with a deep sense of humility that I

appear before my colleagues in the Acad-emy to report on Project Head Start, for I feel that many members of this Academy are

more qualified to have directed this pro-gram. It does provide me with an

oppor-tunity to express Mr. Shriver’s appreciation

-along with my own-for the efforts of the

officers of the Academy and pediatricians

generally for their contributions, which

went far beyond the call of duty this past summer.

I have

viewed

my

appointment

as

di-rector of this national program for young

children,

not

as a matter

of personal

recog-nition, but rather as a recognition of the

leadership role assigned to pediatrics. It is

not modesty which causes me to note this,

but

rather

my

awareness

of the

traditional

role of pediatricians in serving as advocates

for the child and his family. As Mr. Shriver challenged me

with

the potential

responsi-bility

for

directing

Project

Head

Start,

and

I momentarily wondered whether a pedia-trician should become so involved in a

broad

program

of

child

care, my mind kept

going back to the

fellowship

certificate of the Academy and the wisdom of the found-ing fathers recorded upon it as follows:

“Founded to foster and stimulate interest in pediatrics and in all aspects of the work for the welfare of children.”

I also could not help but be aware

of our

transition in pediatrics, as a past president of the Academy, Dr. George Wheatley,1

put

it, from a “disease-oriented specialty to a child-rearing specialty.” Another

distin-guished member of this Academy, Dr.

Grover Powers,2

formulated

this

as follows:

“There are many aspects of pediatric exper-ience which attract graduates in medicine,

teen-agers, or adolescents-just children.” And note, Dr. Powers didn’t

specify

rich

or poor

children-just children.

So

much

for

the

justification-if

we

needed any-for

a pediatric

involvement

in

Project

Head

Start.

Since

so many

members

of

the

Academy

have

been

involved

in

various ways in

the

program,

some

of my

comments may not be new. But perhaps the most effective way of reporting is

an

his-torical

approach

(lest

anyone

become

con-cerned about the

long

time

perspective

of

most historical presentations, let me reas-sure them by indicating that this program

is less than one year

old).

In

October,

1964,

Congress

passed

the

Economic

Opportunity

Act,

which

was

de-signed

to

minimize

the

impact

of poverty

and

to attempt

to eliminate

it.

This

Act

has

within

it

a

very

signfficant

section

con-cerned

with

the

development

of community

action programs. The provisions under this section encourage communities to

under-take new approaches to the problems asso-ciated with poverty; the significant feature

of this program is that proposals for action

must

come

from

the

community

and

the

implementation

is a community

responsibil-ity.

The

Director

of the

Office

of Economic

Opportunity

has

the

responsibility

for

in-suring

that

the

programs

are

adequate

qualitatively and that they provide a “maxi-mum feasible participation of the poor.”

I dwell on this provision of the Act largely because there is considerable

mis-understanding by various professional groups concerning the responsibility for

the

conduct of programs.

We

continually

receive communications asking us why we don’t take this, that, or another action in

a given community; I, therefore, again

em-phasize

that

the

central

office

staff

charged

with

the

responsibility for community action programs doesn’t run any local program.

When

Mr.

Shriver

was

appointed

to the

position

of

Director

of

the

Office

of

Eco-nomic

Opportunity,

one

of

his

first

con-cems

was

with

efforts

to

interrupt

the

“transmission”

of poverty

from

one

genera-tion

to another.

Perhaps

because

of

his

long-standing interest in mental retardation and child development it is understandable that his thoughts would turn

toward

a

develop-mental

approach

to

the problem.

In

the

late

fall

of

1964

Mr.

Shriver

ap-pointed a Planning Committee to conduct a study of the problems of young children

growing up in poverty and to make recom-mendations which would foster

the

devel-opment of these children. The Planning Committee is composed of 15 members

representing the fields of pediatrics, public health, nursing, education, child psychiatry, child development, and psychology, under

the Chairmanship of Dr. Robert E. Cooke,

the Chairman of the Department of

Pedi-atrics

at the

Johns

Hopkins

School

of

Medi-cine.

The

Committee

met

at frequent

inter-vals and presented its report3 to Mr.

Shriver

and

to

the

President

in

February,

1965.

I believe it is worth quoting from the

introduction to the report, for I feel that it

will become an important historical

docu-ment in the field of child development and

child

care. The Report states:

There is considerable evidence that the early

years of childhood are the most critical point in

the poverty cycle. During these years the creation

of learning patterns, emotional development and the formation of individual expectations and aspira-tions take place at a very rapid pace. For the child

of poverty there are clearly observable deficiencies in the processes which lay the foundation for a pat-tern of failure-and thus a pattern of poverty-throughout the child’s entire life.

Within recent years there has been experimenta-tion and research designed to improve opportunities for the child of poverty. While much of this work is not yet complete there is adequate evidence to

support the view that special programs can be devised for these four and five year olds which will

improve both the child’s opportunities and achieve-ments.

It is clear that successful programs of this type must be comprehensive, involving activities gen-erally associated with the fields of health, social

services, and education. Similarly it is clear that the program must focus on the problems of child and parent and that these activities need to be carefully integrated with programs for the school

years. . . . The Office of Economic Opportunity

COMMENTARY

907

ofactivities from each of the three fields of effort. The need for an urgency of these programs is such that they should be initiated immediately. Many programs could begin in the summer of 1965.

These would help provide a more complete picture

of national needs for use in future planning.

The

question

may

appropriately

be asked

concerning the timing of these recommen-dations. It is significant to note that this is

not the first time that recommendations for early childhood programs have been made.

The

recent

volume

by

Mayer

and

Kahn4

reviews the history of such programs; the

White

House Conferences on Children and

Youth

of 1940

and

1950

suggested

that

sim-ilar

programs

be undertaken.

The

programs

under the WPA in the 1930’s and the

Lan-ham Act during World War II have come

and gone and may suggest some lessons for us today. It would seem, however, that the following factors have combined to in-dicate the need for early childhood pro-grams for children of poor families:

1. The growing awareness of the problem of poverty in an affluent society.

This

con-cern has been translated into action through

the

Economic

Opportunity

Act

and

other

programs.

2. The intensive remedial work of the last

two

decades

with

children

experiencing

school

failure,

drop-out,

or delinquency

has

emphasized the potential significance of

prevention. This, in turn, has focused

atten-tion

on

early

childhood

programs.

3. The

increasing

attention

to mental

re-tardation and the development of the young

child has focused attention on the deficits

of young children growing up in poverty. 4. Recent research in child development has concentrated on the study of the learn-ing process in young children, especially

those

growing

up in disadvantaged

environ-ments.

A number

of volumes

have

recently

appeared which reflect this interest.57

Lest there be any question concerning the timeliness of the recommendations, let us take a look at the record. The planning com-mittee initially considered an estimate of

100,000

children to be a rather optimistic

one

(it is estimated that there are

1,000,000

out of the

4,000,000

children

entering

school

each

fall

classified

as

coming

from

poor

families).

Following

the

announcement

of

the

program

late

in

February,

these

esti-mates had to be revised rather quickly. Ultimately 561,000 children were enrolled in the program in approximately

2,400

corn-munities which operated

13,000

individual

centers. Approximately 41,000 teachers were employed in this effort and each teacher

had

two assistants. There is little doubt,

therefore,

that

this

program

tapped

the

latent interest in American communities in

their

young

children-particularly

since

the

local

communities

had

only

a 6-week

period

in which to draft their applications.

But numbers alone do not properly tell

the

story.

Of

greater

significance

has

been

the

quality

of

programs.

Incidentally,

the

smallest

program

operated

in

an

Eskimo

village

with

10

children;

the

largest

pro-gram

had

26,000

children

enrolled

in New

York

City.

The

auspices

varied

considerably

from one community to another ranging

from

sororities

to

community

centers

to

school

systems.

The Planning Committee, you may recall,

made

the

firm

recommendation that these

programs

be

comprehensive

in

nature-re-gardless

of

the

auspices

or

their

location.

The

applications,

therefore,

were

reviewed

to note

whether

the

following

components

were

included

in the

program.

HEALTh: The matter of examining a large

number of children and identifying treat-ment resources for

them

threw

considerable

strain on the health resources of the com-munities. Although there was considerable

variation

in

the

quality

with

which

health

services were provided, the reports

gen-erally

have

been

quite

favorable.

One

of the

great

difficulties

in the

devel-opment

of

the

health

programs

was

the

matter

of integrating

the

various

community

health

facilities

for the delivery of health

services.

Thus,

the

complexity

of trying

to

utilize

the

Aid

of

Families

of

Dependent

Children’s

Program,

health

departments’

in-fant

and child health

clinics,

school health

im-munization clinics, etc., all on behalf of the

child

and

his

family,

necessitated

consider-able effort and new approaches. Where public health nurses were available to work

in the

health

program,

generally

these

ob-jectives were reasonably well accomplished.

Because of the almost universal presence of dental caries, the delivery of dental

serv-ices over a short period of time proved to

be

difficult.

New

approaches

must

be

ex-plored in order to render these services

more

readily

available.

The nutrition programs served not alone

to

improve

the

nutritional

status

of

the

child, but also as important socializing

ex-periences.

Follow-through

efforts to provide ade-quate medical care for the children who

were in

Head

Start

during

the

summer

are

in

process

currently.

Much

remains

to

be

done

and

some

communities

are

approach-ing

this

with considerable energy and

novelty.

Perhaps one of the greatest difficulties in

the

health

programs

centered

about

the

in-adequate

consultation

which

planning

com-mittees

in local

communities

had

with

the

physicians.

We

have

received

a number

of

letters

from

physicians

emphasizing

the late-ness

with

which

they

were

consulted.

It

should be noted, however, that some phy-sicians’ complaints would suggest that they

regarded

the

program

predominantly

as

a medical one.

I could

not

help,

as I

read some of these letters, but be reminded of the statement of one of the recent past pres-idents of

this

Academy when he said,

“When

pediatricians

talk

only

about

what

is good for pediatricians, no one will listen;

when they talk about what is

good

for

children, everyone will listen.”

THE EA.11Iy CHILDHOOD EDUCATION

COM-PONENT: Since most of the day of the

8-week

program

was

spent

with

teachers

and

since

the

educational

component

was

in-tended to minimize the deficits which these children so frequently manifested, this component represented a very significant aspect of the program. Since it was not

possible

to

recruit

sufficient

numbers

of

teachers fully qualified in the field of early childhood education, we relied on teachers

in the

elementary

grades

to a very

consider-able extent. Through the National Univer-sity Extension Association it was possible to provide an intensive 5-day training pro-gram for almost all teachers between the end of the school year in June and the

start of the Head Start programs in July.

Many teachers reported that this was a very

helpful experience for them.

Perhaps the most significant feature of

the educational program was a relatively favorable teacher-child ratio of 1 to 15.

Since each teacher had

two

assistants, the adult-child ratio was at least 1 to 5. Where volunteers were utilized in the classroom

situation,

the

ratio

was

considerably

more

favorable.

The

comments

from

teachers

were

almost

uniformly favorable concerning the

im-provement

in the

performance

and

achieve-ment of children

in

the

program.

This

re-lated

not

alone

to their

increasing

cognitive

capacities, but also to their personal and

social

growth.

For

example:

I have been trying to bring to these pre-schoolers some experiences which will assure them of success in the first grade and in life. Perhaps I can best describe my experiences by telling you about some

of these children. Lee Andrew is shy, but he thinks a lot. When the other children chatter during “shar-ing time,” he sits quietly, wrapped up in his own thoughts. We have not changed his shyness; but more and more often now, Lee Andrew has a little story to tell the others. He is learning to participate. And his little arms, which at first sought the warmth and security of a teacher’s neck very fre-quently, now are more inclined to seek out puzzles to work, games to play, or books to “read.”

Mary is a lively intelligent girl; but she ducks

her head when talking with adults. And she seems

always to be reaching for something we have in

our hands. We have not taught Mary to look at us directly or to stop grabbing. But we have tried

by gently lifting her face as we lower our own, to show here there is no rejection in our eyes. She is learning now to ask before she takes something

from our hands, and to say “may I” and “please.”

She is learning, slowly and painlessly, to consider

other people as well as herself and to be a helper

instead of a “grabber.”

COMMENTARY

909

came to school he could communicate with others only by pushing or hitting. Now his beautiful smile lights up his face whenever we talk to him;

and he knows we will listen patiently while he stammers out the words he wants to say. He is

learning to keep his hands to himself and to play less roughly. A psychologist secured through Proj-ect Head Start, is now investigating his stammer.

The littlest of all my children is Shirley; she

talks at a phenomenal rate of speed in her efforts to share with the other children and us all the many exciting things which have happened to her

in her lifetime. Shirley is the picture of confidence as she leads a long line of children down the hail

to the lunchroom; and she is all innocence as she

sleeps on her little rug during rest period. Shirley is a happy child; she smiles brightly as she draws,

paints, colors, sings, runs, listens to stories, and

eats good lunches. She expects happiness, and she has not yet been disappointed.

Through Project Head Start all of my children have acquired a surer grasp on their sometimes shaky heritage which promises them the right to the “pursuit of happiness.” They are poor; their

families are large; their mothers may not be mar-ried; their skin is dark. They were born into this situation; but their future will not have to suffer because of it. Poverty is still part of America; but

poverty-stricken children are no longer destined

to remain poor. Their opportunities are as limitless as those of middle and upperciass children.

Project Head Start is making it possible for every American child to face the future with unlimited confidence. It will take time and work to make this possibility a reality. But through Project Head Start and other parts of the Anti-Poverty Program, the reality will come. I am proud to have had a role in such a worthwhile program.

Another teacher wrote:

I cannot help but wonder why no one ever thought of this plan before. What will be the ira-pact on the principal characters of this wonderful play, namely; The Children?

- I see growth in social adjustment, the ability to work with others, both with children and adult friends. I see children becoming less fearful, less tearful, and more secure in the school environment. I see children learning that someone really likes them and accepts them.

I see more smiles, more relaxed children, more verbal expression from most of the non-verbal children. . . . I see the painful process of

adjust-ing to a new environment lessened greatly because of the many adults on hand who are ever willing and ready to reassure, and help the disturbed or emotional child find his way.

I see children becoming more aware of their

environment and the world about them.

Without

minimizing

the

significance

of

training

in

the

field

of

early

childhood

education, it may be a fair generalization

to indicate

that

the

interaction

of

the

child

with

a helpful

adult

may

be

the

most

im-portant

factor

in

the

gains

which

were

attained.

SocIAL

Si.iwics:

The

social

services

were

recommended as a component of the pro-gram because of the many social problems

which

this

population

group

present.

The

programs did not attempt to duplicate

existing agencies,

but

rather

concentrated

on utilizing

appropriate

services

in the

com-munity

on

behalf

of

the

families.

As was

true with health services, we found that because of the variety of social agencies

and

services

in various

communities,

there

was

considerable

difficulty

in

developing

cohesive plans for this aspect of the pro-gram. Much exploration is warranted to

develop

more

effective

social

service

pro-grams.

PARENT INVOLVEMENT: The Economic

Opportunity Act specifies that Community

Action programs should provide for

“maxi-mum

feasible

participation

of

the

poor.” We, therefore, specified that each program make serious efforts to bring parents into a

meaningful

relationship.

We

purposely

did

not

specify

that this

be parent

education,

since

we

were

striving

for

the

increased

understanding

that

comes

from

involvement

and

participation.

Par-ents

were

to be

encouraged

to define

their

areas

of

interest

and

activities.

There

was

no

prohibition

against

employment

of

par-ents;

in

many

communities

they

were

brought

in on a salaried

or volunteer

basis.

The parents-in a simple questionnaire

survey-were overwhelmingly in favor of

the program. In

our

future

efforts

we

hope

to extend their participation to representa-tion on the planning and policy-making

committees. For it

is the

intent

of

the

legis-lation to encourage

the

poor to assume

positions of responsibility in

dealing

with

their problems.

Although many communities were quite

with parents, it is clear that we need to

learn much more about this. We need answers to the problems of method of

ap-proach

and

the

most

effective

people

to do

this (social workers, teachers, aides from the neighborhoods, etc.)

VOLUNTEERS: Perhaps one of the most in-novative features of the program was the extensive use of volunteers in a program in which professionalization is the rule. Of course, professionals, along with many

others-in many instances doctors, dentists,

nurses, teachers, etc.-volunteered their pro-fessional skills.

The

volunteers

were

of all ages

and

back-grounds.

Approximately

55,744 full-time

volunteers came from the neighborhoods and 40,796 from outside the immediate areas of

the

centers.

If we include

part-time

volunteers, about 500,000 people served in

some capacity in jobs ranging from the

renovation of facilities, food preparation,

recreation, and transportation to teaching, medical, and social work aides. The exten-sive involvement of volunteers is borne out by the personal observation in travels about the country indicating that few families

seemed

to have

been

untouched

by the

pro-gram. It has been estimated that the value

of the contributed effort was more than the federal money expended for it.

Although some communities have had experience with the use of volunteers in the schools, in most instances, the Head Start

Program blazed a trail in showing

communi-ties that there are large reservoirs of tal-ented people ready and able to contribute their efforts. In future programs we cer-tainly intend to continue our efforts for

the

fuller utilization of volunteers.

EVALUATION

In any service program the problem of

evaluation is a difficult one; in a public program, the urgency for evaluation is

greater, since there are, quite properly,

pressures to justify the expenditure of pub-lic funds.

We, therefore, set about to gather data,

even though

we

had

little

time

to design

our approaches. Several strategies were

utilized.

THE COLLECTION OF DATA ON A

NATION-WIDE BASIS : This was done for the health,

educational, and psychological components

of the program. Time was not in our favor and there were many mechanical failures in the delivery of materials and their

ad-ministration.

With

more

time,

our

design

could

have been better also.

We did learn-as we already knew-that professional people of all disciplines are

highly

allergic

to forms

and

that

each

has

a design of his own. Many have written us very thoughtful-and occasionally

irate-letters.

We

have

found

that

many

are

not

yet oriented toward forms designed for computer processing.

In spite of our difficulties, there seems to

be valuable data emerging. Reports will

become available summarizing

this

data

before long. In the future, more sophisti-cated sampling techniques could be utilized to good advantage.

STUDIES

Dim:

In addition to larger

scale sampling, we encouraged a number

of university groups with competence in research in child development to study

some programs autonomously. Thus we will have more detailed data on various aspects of the program.

VIsITs BY CONSULTANTS: Perhaps the most

important source of evaluative data in a pro-gram of this complexity may be obtained from the judgement of sophisticated profes-sionals. We had excellent responses to our invitations to consultants, and

approxi-mately

400 people, including many

mem-bers

of

the

Academy,

gave

up

valuable

summer

time

to

visit

programs.

We

had

evaluations on 2,200 of the 2,400 programs. The general reaction among the early childhood education consultants is reflected

in comments

they

wrote:

I was greatly impressed with the ingenuity and imagination and dedication of the staff in taking barren public school first-grade classrooms and converting them into well equipped rooms for young children, using scrap materials, home-made materials, contributed materials.

COMMENTARY

cxcellnt orientation program here at the University. They brought together a top-notch staff, set up

good demonstration groups and really got under people’s skin. Fifteen makes it possible for teachers and nurses and others to use their skills and seems to say the skills must be used-this is a “special program.”

In health, the responses were not so

uni-formly positive.

For

example:

First, I would like to say that I think the program has real potential, but that this summer’s project

should be considered as a pilot project for

informa-tion, rather than a prototype. It seems apparent to me that it should be planned, at least in areas such as ours, around existing services, rather than on the assumption that there is a significant number of children for whom no services are available. Our

experience in our state also suggests that, from the

standpoint of the health program, which is my focus in writing you, little if any attempt was made to get the best qualified people to do the examina-tions, and in a significant number of instances well qualified people were never even asked in their own local areas. On the other hand, we had one general practitioner in a rural area who did a surprisingly good job, although his performance from the standpoint of developmental examination was not up to that we would like to think of as the pediatrician’s standard.

But, there were many enthusiastic

re-sponses, like the following one from one of

the

officers

of the

Academy:

We’re proud of this record in our city, not merely because of how this program is helping children become better prepared for school, but

also because it exemplifies our community’s ability

to mobilize its forces to work harmoniously to achieve a goal.

From the pediatric viewpoint, our city and the

County Health Department deserves the greatest

credit for the large task of getting 7,000 children

examined. A representative of the Public Health Department and I had an initial conference and then maintained telephone communication until we mobilized pediatric and other residents to add to

the group of physicians already able to participate in the examinations. The examinations were done with dispatch and without fanfare.

I know you have had many a large-sized head-ache getting this vast project under way. I admire the effective organization, albeit on short notice and sometimes against opposition at the grass roots. Perhaps the happy outcome of Project Head Start in our city will brighten the overall picture.

The social services were about as difficult to develop in these programs as were the

medical.

Guidelines

are

difficult

to

write

for

communities,

since

each

is idiosyncratic

in the nature and scope of its services. Also,

social

workers

are not as available in the

summer as are teachers. The employment of the full range of social services will

un-doubtedly require the

training

of

social

work assistants or aides. Future programs

will

need

to explore

alternatives

as yet

not

dreamed of.

As the summer drew to a close, the query was heard with increasing frequency : what

of

the

future?

There

seemed

to

be

a

na-tional

consensus

that

an

8-week

program

should not be the beginning of the end, but

rather the end of the beginning.

On August

31, the

President

announced-even though the O.E.O. Appropriation Bill had not yet passed-that there would be a

continuation of the program. He indicated

that

there

would

be three

components:

1. A follow-through

program

for the

chil-dren

in

the

summer

program.

This

could

provide

additional

health

or social

services,

or augmentation

of the

school

program,

as

indicated.

2. A year-round program for those

com-munities

which

have

the

physical

facilities

and

personnel.

3. A repeat

summer

program

in 1966.

SUMMARY

As a result

of the

summer

experience

cer-tain

inferences

may

be

drawn:

1. There is great interest-latent until

now-in

our

communities

in

the

health,

education,

and

welfare

of

our

young

chil-dren.

2. Communities have shown remarkable

resourcefulness and energy in developing

comprehensive programs for young children.

3.

Communities

have

demonstrated

a

re-markable

capacity to mobilize in a short

period of

time.

4. Professionals

of

various

disciplines

have

a deep

commitment

to applying

what

they

know

about

the

needs

of

children

when

offered

the

necessary

support.

5. Alternate administrative patterns make

PAUL

C.

HUCENHOLTZ,

M.D.

options which are highly desirable at this stage of our knowledge.

6. There

remains

much

to

be

learned

about

attracting

the

very

low

income

popu-lation

to programs

of this

nature.

7. Much exploration of means by which

to involve the poor in planning and policy

roles is required.

8. Although

certain

assurances

of quality

can

be enhanced

by administrative

policies,

such as a favorable teacher-pupil ratio,

con-stant

attention

to maintaining

quality

in the

programs

is essential.

9. Vigorous efforts must be undertaken to develop adequate manpower resources to

anticipate

the

expanding

nature

of

these

programs.

Professional

and

non-professional

training

requires

scrutiny

if we

are

to meet

the challenges being put before us.

As we face the future in meeting the needs of young children and their families, it

is apparent

that

ever

so

much

remains

to be done. This

may

be what

Robert

Frost

had in

mind

when he wrote:

The woods are lovely; dark and deep, But I have promises to keep,

And miles to go before I sleep, And miles to go before I sleep.

REFERENCES

1. Wheatley, C.: Pediatrics in Transition. J.A.M.A., 168:856, 1958.

2. Powers, C. F.: American Pediatrics: Coming

Years. PEDIATRICS, 16:688, 1955.

3. Improving the Opportunities and Achievements of Children of the Poor. Report of Planning Committee, Project Head Start, Office of

Economic Opportunity, February 1965. 4. Mayer, A. B., and Kahn, A.

J.:

Day Care as a

Social Instrument. Columbia University School of Social Work, January 1965.

5. Deutsch, M., Ed.: Selected Papers from the Institute for Developmental Studies.

Facilitat-ing Development in the Pre-School Child:

Social and Psychological Perspectives. Mer-rill-Palmer Quarterly, 10:249-263, 1964. 6. Bloom, B. S., Davis, A., and Hess, R.:

Compen-satory Education for Cultural Deprivation.

New York: Holt, Rinehart, and Winston,

1965.

7. Pringle, M. L. K.: Deprivation and Education. London: Longmans Ltd., 1965.

Pimwrmc

EIcrriiocA IOCRA.PHY, Normal

and Abnormal Patterns, Incorporating the Vector Approach, by Warren G. Guntheroth, M.D. Philadelphia: W. B. Saunders Company,

1965,

150 pp.,

$7.00.

This book is well written, well organized,

concise and clear. One finds little fault with its

concepts or the way they are presented. They

are

better

summarized than in most textbooks in the field. The illustrations in particular are

excellent

and

complement

the

text

admirably.

They

bring

out

one

of the

strongest

compo-nents

of the

book,

namely,

the

correlation

be-tween the vectorial and scalar approach. A

particularly

useful

device

is

in the inclusion in the book of looseleaf tables containing selected

criteria

and

ranges

of normal

values

for

elec-trocardiograms

in

the pediatric

patient.

However,

as

with

most

small

books

which

emphasize brevity and accentuate “the intro-duction” as their approach, the intellectual

ap-petite

is stimulated

rather

than

satisfied.

In the

entire

field

of electrocardiography,

but

particu-larly in congenital heart disease, the time has come to quantitate disorders and to free the field from the restrictions imposed by the de-scriptive terminology from older textbooks. The author would appear eminently qualified to undertake such a task and one can only hope that this

book

is a first installment. The

need

to correlate

the

electrocardiogram

with

hemodynamic events is

growing

rapidly and it is from laboratories such as that of Doctor Guntheroth that one expects an answer.

As a consequence, I can recommend this

book

heartily but only to the medical student and to the physician not familiar with the field. For those wishing more detailed informa-tion the need for a more comprehensive cover-age of electrocardiography in congenital heart

1966;37;905

Pediatrics

Julius B. Richmond

COMMUNITIES IN ACTION: A Report on Project Head Start

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1966;37;905

Pediatrics

Julius B. Richmond

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