called attention to the changes occurring from one year to another in the clinical manifestations of the rheumatic state. More striking, even, are the modifications through which the clinical concept of the rheumatic state has passed in recent years ; and it has seemed to us of some interest to review the records of our youngest group of rheumatic patients, in the hope of obtaining a picture of the clinical and anatomic manifestations of the disease at an early age. We had the impression that rheumatic fever expresses itself in a subject under 3 years of age in a manner different from that by which one is accustomed to recognize it in older children. At the same time, its infrequency in early life throws a formidable obstacle in the path of the individual observer who attempts to formulate from his own experience a not too one-sided picture of the disease. We have selected from the records of the Babies Hospital, covering a period of about twentyfive years, a group of 24 cases, in all of which the disease appears to have begun before the age of 3 years and in which the evidence warrants, in our judgment, the diagnosis of rheumatic infection.Rheumatic infection is predominantly a disease of childhood. Analy¬ sis of the records of large groups of cases has brought out the fact that the greatest number of first attacks occurs in children between the ages of 5 and 15 years. Poynton2 found the average age of onset to be 7 years ; Coombs,3 10.2 years ;

The pediatrician can be useful to the young person with a drug problem if he: (1) is aware of the different motivations for drug abuse by adolescents and how to approach them, (2) recognizes the need for confidentiality, (3) provides factual information in a non-authoritarian manner and listens and counsels as indicated, and (4) manipulates the environment-to relieve school and family pressures and to help youngsters find better challenges. Drug abuse in children and adolescents is a major source of concern to parents, educators, law enforcement agencies, and physicians. For the pediatrician as well as the others, a challenge exists to find more appropriate ways of help for young people who turn to drug abuse for the answer that is not there.

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