bluuebunny/crossref_metadata_2025 huggingface dataset:
ENURESIS: AN ANALYSIS OF VARIOUS THERAPEUTIC APPROACHES
Authors: Marshall Sumner , Marshall Hermine H. , Lyon Richards P.
Published: December 2021

Three hundred enuretic patients from 3 to 14 years of age were treated by various techniques and the effectiveness of these techniques was evaluated. Boys outnumbered girls in the overall group; however, there was no appreciable sex difference in the responses. When the child took an active responsibility for seeking to change his behavior pattern and was supported by reinforcement from his family and physician, the results appeared to be more successful than when the child was a passive participant in the therapy, as with instrumentation-surgery, medications, or conditioning devices. Improvement in these latter groups was frequently more rapid, but the relapse rate higher than in the "responsibility-reinforcement" approach.

Although the results from our study could not be considered statistically significant, there is a trend showing that the "responsibility-reinforcement" technique produces more successful longterm results than the therapies employing instrumentation-surgery, medications, or conditioning devices. Of greater import is the fact that the "responsibility-reinforcement" technique is less disruptive than other therapeutic modalities from the physiological as well as the psychological standpoint. For these reasons, when organic causes can be ruled out, we believe that the "responsibility-reinforcement" technique is the optimal initial approach for the treatment of enuresis.
GROUP DISCUSSIONS WITH THE PARENTS OF LEUKEMIC CHILDREN
Authors: Heffron Warren A. , Bommelaere Karen , Masters Ruth
Published: December 2021

Group meetings are being used in increasing numbers in many divergent areas of patient care. A group for parents of children with acute leukemia was established in conjunction with a leukemia treatment program. The group met weekly and served as a means of problem identification and solution. Areas discussed were problems concerning patients, parents, siblings, friends, and the medical team. It also served as a forum for information dissemination.

It was found that in the management of leukemia in children, the group served as a strengthening of the family during crisis episodes. Discussions of death and dying were difficult, and the death of another parent's child was traumatic to all. However, the benefits of shared experiences outweighed these difficulties. Parents developed a better understanding of leukemia and its treatment and felt that their ability to cope with associated problems was enhanced. Both the families and staff felt the group was a valuable adjunct to the management of acute leukemia in children.

As far as the authors are able to determine this use of a group has not been reported in this form in leukemia management. The evaluation of the success of this group is largely subjective. It is hoped that others will employ the use of such a group and in larger numbers perhaps some degree of objectivity might be able to be developed to adequately evaluate the role of groups in leukemia clinics as well as other areas of medical practice.
Neck Vein Catheters and Pericardial Tamponade
Authors: Fischer Gerald W. , Scherz Robert G.
Published: December 2021

Complications of intravenous catheters are well known in children as well as adults.1 Recent reports of pericardial tamponade secondary to central venous pressure (CVP) catheters have been emphasized in medical literature directed toward physicians who provide medical and surgical care to adults.2,5 The risk of pericardial tamponade from placement of external jugular catheters in children is not well appreciated by pediatricians and surgeons who provide surgical care for pediatric patients.

Case Report

The patient was a 12-month-old Negro boy admitted with second and third degree scald burns over 35% of his body. A two-inch number 18 catheter (Angiocath) was placed in the right external jugular vein for CVP monitoring.
Severe Tetany in an Azotemic Child Related to a Sodium Phosphate Enema
Authors: Oxnard Sarah C. , O'Bell John , Grupe Warren E.
Published: December 2021

The potential toxicity of neutral sodium phosphate medications to infants and azotemic children is rarely taken into consideration. Since the sole route of excretion of absorbed phosphate is renal, diminished renal function secondary to chronic renal disease or renal immaturity will limit the ability to excrete a sudden phosphate load. Previous reports document toxicity of phosphate laxatives to normal infants and hypertonic phosphate enemas to patients with Hirschprung's disease. This report presents a 4½-year-old azotemic boy who was admitted with carpopedal spasm and acidosis in the presence of profound hyperphosphatemia, following administration of a sodium phosphate enema for chronic constipation.
NEONATAL COLD INJURY: EVIDENCE OF DEFECTIVE THERMOGENESIS DUE TO IMPAIRED NOREPINEPHRINE RELEASE
Authors: Anagnostakis D. , Economou-Mavrou C. , Agathopoulos A. , Matsaniotis N.
Published: December 2021

Urinary catecholamine excretion was studied in six preterm newborn babies and one full-term newborn baby suffering from neonatal cold injury during the acute phase of the illness and 4 to 6 days after recovery. In all preterm infants the urinary excretion of norepinephrine (NE) during the acute phase (0.062 ± 0.047 ng/kg/min) was considerably lower than after recovery (0.684 ± 0.139).

The only full-term baby studied had a milder form of cold injury; his urinary excretion of NE was efficient during the cold stress. The urinary excretion of epinephrine (E) was unaffected by cold stress; the values during the acute phase of hypothermia were almost identical to those found after recovery.

It is speculated that prolonged exposure of the newborn to cold max exhaust NE stores leading to inability to stimulate and utilize chemical thermogenesis.
THERAPY OF STAPHYLOCOCCUS EPIDERMIDIS: INFECTIONS ASSOCIATED WITH CEREBROSPINAL FLUID SHUNTS
Authors: Shurtleff David B. , Foltz Eldon L. , Weeks Robert D. , Loeser John
Published: December 2021

This study describes cure rates for 93 different courses of treatment for 28 hydrocephalic patients with V-A shunts and 31 separate infections due to Staphylococcus epidermidis. Systemic treatment alone was effective two out of 39 times (9%). The addition of antibiotics via the intraventricular route (with or without partial shunt revision) cured three with nine trials (33%). All 19 patients, 18 with positive cerebrospinal fluid (CSF) cultures, were cured by complete removal of all shunt elements with replacement in another anatomic site (CSR) combined with high does, specific systemic antibiotic therapy. One of 35 (3%) of those with positive shunt CSF cultures and one of 21 (5%) of those with positive shunt and ventricular CSF cultures responded to systemic treatment without CSR. When infection is widespread, the treatment of choice is appropriate systemic and intraventricular antibiotics and complete replacement of the shunt in a new site.
RICKETS ASSOCIATED WITH ANTICONVULSANT MEDICATION
Authors: Medlinsky H-Lester
Published: December 2021

An example of rickets associated with anticonvulsant medication is described with onset at the age of 5 years 9 months. This patient had received anticonvulsant therapy since the age of 5 months. X-rays and serum values were normal up to age 3 years 2 months. Diagnosis of rickets at age 5 years 9 months was made by decreased serum calcium and phosphorus and elevated alkaline phosphatase plus characteristic x-ray findings. Other causes of rickets were excluded. Healing occurred with oral vitamin D: 10,000 units daily for two weeks, then 2,500 units daily for four weeks. Return of calcium and phosphorus to normal and early x-ray healing had occurred in six weeks. In six months complete healing by x-ray had occurred. Alkaline phosphatase level was persistently elevated, with both bone and liver fractions increased, but finally returned to normal when 50,000 units of oral vitamin D were given daily for 30 days. A plausible mechanism appears to be increased catabolism of vitamin D due to induction of hepatic microsomal enzymes when anticonvulsant medication is given.
Further Comments
Authors: Rosen John F. , Lamm Steven H.
Published: December 2021

We are grateful for this opportunity to clarify some of the issues raised by Dr. Sarett's comments.

As previously reported, the high levels of lead (Pb) in "processed infant formulas," recorded by Lamm et al. in 1971 to 1972, were confirmed by federal (FDA and CDC) and industrial laboratories. Moreover, comparable findings were reflected in careful review of the world literature, including several of Dr. Sarett's references. For the sake of argument, however, even if one agrees with Dr. Sarett's opinion that the measurements of Pb in "processed infant formulas" erred in being on the high side, these formulas nevertheless contained a highly significant amount of Pb.
Neonatal Trichomonas Vaginalis
Authors: Al-Salihi Farouk L. , Curran John P. , Wang Jung-Shung
Published: December 2021

The presence of Trichomonas vaginalis organisms was surveyed in 984 newborns by direct examination of wet smears from the vestibulum vaginae and by both direct examination and culture method in 333. The incidence of T. vaginalis was 0.1% by the direct examination alone and 0.6% by direct and culture method. Case reports of three neonates with T. vaginalis are presented. The present survey and previously reported series suggest that neonatal infection with T. vaginalis can exist in three forms: latent, mild, and virulent. Patients in two of the three cases reported in this article had concomitant monilial infection which resisted therapy until the trichomonads were eliminated.
Kinetics of Salicylate Elimination by Newborn Infants of Mothers Who Ingested Aspirin Before Delivery
Authors: Levy Gerhard , Garrettson Lorne K.
Published: December 2021

The metabolic fate and elimination kinetics of salicylate have been investigated in four newborn infants of mothers who ingested aspirin within 20 hours before delivery. Up to 2.3% of the dose taken by the mother was recovered from urine of the neonates. Salicylate was eliminated mainly by conversion to the glycine and glucuronic acid conjugates. The capacity of these pathways was very low and elimination of salicylate by the newborn infants was, therefore, much slower than in adults.
The Effect of Dilute Corrosives on the Esophagus
Authors: Ashcraft Keith W. , Padula Richard T.
Published: December 2021

Cats were used in this study to demonstrate the effect of dilute corrosive drain cleaners upon the esophagus. Sulfuric acid, potassium hydroxide, and sodium hydroxide in less than 10% strength all produced gross and microscopic evidence of severe damage after 30-second exposure.

We suggest that presently allowable concentrations of these agents for household use should be banned and cite clinical data on accidental injury in childhood to suggest that "child-proof" packages will not afford much protection.
Letter to the Editor
Authors: Cherry James D. , Powell Keith R. , Gardner H. Garry , Roden Vernon J.
Published: December 2021

We are most happy to see the informative letter of Ellis and associates. Their point is well taken. Their discussion leads us to one further comment. They state that, "The basis of the use of racemic epinephrine in croup is its topical vasoconstructive effect when applied to mucous membranes resulting in decreased mucosal edema." Whereas there can be little doubt that the vasoconstrictive effect of epinephrine reduces mucosal edema in allergic disease, there is no evidence to our knowledge which demonstrates that vasoconstriction will appreciably reduce tracheal narrowing resulting from infection.
Dietary Management of Neonatal Chylothorax
Authors: Gershanik Juan J. , Jonsson Haldor T. , Riopel Donald A. , Packer Robert M.
Published: December 2021

A neonate with transposition of the great arteries developed chylothorax following ligation of the patent ductus arteriosus. At first, multiple thoracenteses and chest drainage were employed without significant diminution of pleural fluid production. Administration of a formula containing medium chain triglycerides (MCT) was associated with a marked decrease of pleural fluid accumulation within a few days. Total lipid concentration of pleural fluid prior to the diet was 890 mg/100 ml and diminished to 40 mg/100 ml after eight days of administration of the diet. Cholesterol and cholesterol esters decreased from 101 mg/100 ml to 24 mg/100 ml and from 83 mg/100 ml to 9 mg/100 ml, respectively. Total triglyceride concentration fell from 111 mg/100 ml to 2 mg/100 ml. Only negligible amounts of fatty acids with a chain length lower than capric (C10:0) were recovered from the analyses of the samples.

Thereafter, x-ray films revealed no pleural effusion and at the third-month follow-up visit the chest remained clear. The marked diminution in Volume of the pleural effusion in this case is thought to be associated with MCT feedings. MCT passes directly into the portal system, bypassing the lymphatic pathways and still provides adequate caloric intake. Thus, it seems ideal for the treatment of conditions which have a compromised lymphatic drainage. Both clinical data and biochemical findings in this case strongly suggest the use of MCT diet as an important adjunct of the management of neonatal chylothorax.
Visceral Neurofibromatosis and Hypertension in Childhood
Authors: Klecker R. L. , Roth J. B.
Published: December 2021

Neurofibromatosis is a rare cause of hypertension, particularly in children. Our hypertensive patient was shown to have gross alteration in both renal arteries and a complete block of the superior mesenteric artery. By-pass arterial graft of the right renal artery restored his blood pressure to normal levels.
The Impact of Television Commercials on Health-Related Beliefs and Behaviors of Children
Authors: Lewis Charles E. , Lewis Mary Ann
Published: December 2021

Fifth and sixth grade students in two elementary schools were requested to watch television and describe several commercial "messages" related to health. Children were asked for their conclusions (inferences), if they believed the message, and if either they or their parents used the product advertised. Two hundred and eight students believed 70% of 781 commercials viewed. Forty-five percent of the children had used the product advertised, and 55% of their parents were said to be users. Of the children, 47% were "true believers" (accepting all messages as true). Personal experience and parental modeling behavior (use) increased the credibility of messages. The frequency of use of advertised products and acceptance of the messages as true was higher among children from lower socioeconomic backgrounds.
Neonatal Gonococcal Arthritis: Three Cases and Review of the Literature
Authors: Kohen Daniel P.
Published: December 2021

It is well known that gonorrhea is presently out of control, in fact pandemic, in many areas including many in the United States. On the Navajo Indian Reservation in Arizona and Western New Mexico, the incidence of gonorrhea is statistically higher than it is elsewhere in this country. For a population of 101,200 in 1970, the incidence of gonorrhea on the Reservation for fiscal 1970 was 2,480 per 100,000.1 In 1971 there were 2,564 new cases reported and on a revised population of 188,123, this is an incidence of 1,363 per 100,000 for fiscal 1971.2°

The Fort Defiance, Arizona Indian Hospital provides health services for an estimated 25,000 Navajos. In calendar year 1971 there were 363 new cases of gonorrhea reported there, an incidence of 1,452 per 100,000. With the resurgence of gonorrhea there has been increased reporting of pediatric gonococcal infections.37 In the year August 1971 to August 1972 three proven cases and one presumptive case of neonatal disseminated gonococcal infection were treated at the U.S. Public Health Service Indian Hospital in Fort Defiance. The three proven cases presented as neonatal gonococcal arthritis. A fourth case with a positive blood culture (cord blood) for Neisseria gonorrhoeae was also treated. The paucity of information on this disease, and its apparent rarity, stimulated this report.

CASE REPORTS

Case 1

V. K., a healthy, Apgar 10, 3,827-gm (8 lb, 7 oz) male infant was born on August 16, 1971, to a 20-year-old G2P1 Navajo woman after 40 weeks' gestation. Labor and delivery were complicated by PROM of 36 hours.
Clinical Features of Neonatal Osteomyelitis
Authors: Weissberg Eleanor D. , Smith Arnold L. , Smith David H.
Published: December 2021

The records of 17 infants (1 to 28 days of age) with osteomyelitis who were admitted over a seven-year period were reviewed. There was a predominance of females (ten of 17). Neither shortened gestational age nor low birth weight seemed to be a predisposing factor. Complications of pregnancy occurred in 41% (seven of 17) of the mothers and the deliveries were complicated in 47% (eight of 17). The majority (15 of 17) of the newborns had antecedent illnesses, or were subjected to potentially infective procedures in the perinatal period. Fifty-nine percent (ten of 17) had known exposure to illness in family members or other close contacts. In 14 of 17 infants the illness was not accompanied by systemic signs or symptoms with only focal manifestations of disease. The most frequent local findings were swelling, tenderness and decreased motion. Deep soft-tissue swelling was the most frequently noted early radiographic change. Penicillin-resistant Staphylococcus aureus (the predominant organism) was isolated in seven of 14 patients in which an organism was identified. Seven of the 17 neonates had multiple bone involvement. Joint involvement was present in 12 of 17 neonates and half of these had a significant functional deficit. Deformity was present in 10 patients four months to seven years after onset of disease; six of these had impaired function. There was one death due to aspiration pneumonia.
Diagnosis and Treatment of Epilepsy: Overview and General Principles
Authors: Sibley William A.
Published: December 2021

The management of a patient with epilepsy requires the physician to address himself to two basic tasks: (1) an accurate diagnosis must be made with special attention to the possibility of progressive intracranial disease; and (2) an effective regimen for control of the seizures must be devised.

DIAGNOSTIC CONSIDERATIONS ASSOCIATED WITH AGE

Seizures beginning in infancy are accompanied, in about half of cases, by other evidence of cerebral damage, especially mental subnormality. The precise pathology often cannot be determined during life, although a cerebral developmental defect or birth injury is usually responsible. In a small proportion of cases a metabolic error, subdural hematoma, neuronal degenerative disease, or some other progressive process will be revealed by a history of deterioration in skills previously acquired. The diagnosis can then be established by other characteristic signs of the condition under consideration and appropriate laboratory studies. Grand mal, focal seizures and minor motor seizures are the types usually encountered in infancy.

The same factors which commonly cause seizures in infancy continue to initiate seizures in childhood and early adolescence, but to a steadily decreasing extent. Thus, seizures due to a birth injury, like most post-traumatic seizures, usually begin within 24 months after the traumatic incident1; however, they may be delayed until late childhood or adolescence. Seizures appearing as a sequela of meningitis or other infections are sometimes similarly delayed.

After the second year of life, seizures of unknown cause rapidly increase in incidence, including cases of so-called genetic epilepsy. In the latter, centrencephalic seizure bursts (3/sec wave and spike discharges) appear diffusely in the EEG, not only in patients, but in 45% of their asymptomatic siblings (aged 4 to 16 years), as well.
A Manual of Newborn Medicine, by Gerard Van Leeuwen, M.D. Chicago: Year Book Medical Publishers, Inc., 1973, 287 pp., $9.95
Authors: Adler Saul , Avery Mary Ellen
Published: December 2021

The preface to this paperback manual states it is a "think and do" book, emphasizing the "do." It meets the challenge admirably by its emphasis on common conditions, an excellent chapter called "Procedures," routine orders for medical and nursing care, and highly specific recommendations on management of well and sick infants. The writing is lucid, and at times appropriately light-hearted. The test of any manual is to see if it meets the need for which it was intended.
Helping the Handicapped Teenager Mature, by Evelyn West Ayrault, B.A., M.A. New York: Association Press, 1971, 224 pp., $6.95
Authors: Cossairt Jolan
Published: December 2021

Helping the Handicapped Teenager Mature will find its way to the shelves of the local public library. Parents and others will read it in search of hope and guidance. For this reason, health professionals should be familiar with this volume.

The first seven chapters, and a later one entitled Sex, outline adolescent development as hampered by disability. Special railings to increase mobility and pulleys to allow hanging up one's own clothes, as well as other suggestions to facilitate independence at home, are discussed in three subsequent chapters.
Letter to the Editor
Authors: Livingston Samuel , Berman Wulfred , Pauli Lydia L.
Published: December 2021

We were stunned to read in the reply (Pediatrics, 52:754, 1973) by the Committee on Drugs of the American Academy of Pediatrics to our letter, Amphetamines in Epilepsy, that their "thorough" search of the medical literature failed to elicit any documentation of the value of amphetamines in epilepsy. A cursory glance at the literature would at least reveal publications by more than 30 eminent physicians, including Carter, Eisenberg, Gastaut, Glaser, Goldensohn, Lennox, Schmidt and Yahr, in addition to our 28 articles, relative to the use of amphetamines in the management of epilepsy (efficacy and/or alleviation of anticonvulsant-induced drowsiness [references will be supplied upon request]).
The Competent Infant: Research and Commentary, edited by L. Joseph Stone, Henrietta T. Smith and Lois Barclay Murphy. New York: Basic Books, Inc., 1973, 1,193 pp., $30.00
Authors: Becker R. D.
Published: December 2021

In recent years there has been a bewildering and indeed a staggering proliferation of newly published books, scholarly monographs, research anthologies, and compendia as well as an exponential increase in newly organized professional journals within the areas of developmental and psychological medicine, child neurology, experimental psychopathology and the neurobiology of growth and development as well as new volumes in the area of advances in syndrome identification. These have dealt broadly with subjects ranging from prenatal influences of maternal and fetal undernutrition on the integrity of subsequent brain function to studies dealing with patterns of neurocognitive, affective and communicative development in infancy, to neurological and behavioral sequelae of prenatal and paranatal complications, low birth weight, small-for-dates and preterm babies, fetal heroin or methadone addiction and withdrawal, problems of dysmaturity and the multiple outcomes related to the isolated and restrictive early cognitive and physical environments of the "critically ill" newborn and infant in "intensive special care" in isolettes.
Febrile Convulsions: A Reappraisal, by Margaret A. Lennox-Buchtal, M.D. (Supplement No. 32 to Electroencephalography and Clinical Neurophysiology). Amsterdam/London/New York: Elsevier Publishing Company, 1973, 138 pp., $17.25
Authors: Bray Patrick F.
Published: December 2021

Carrying on in the exemplary Lennox tradition, Dr. Margaret Lennox-Buchtal has written a very carefully researched and annotated review of our current knowledge regarding febrile convulsions. She has meticulously assessed both the clinical and animal studies that cover data pertaining to this common pediatric emergency. This reviewer strongly recommends to the readers of Pediatrics that, if time allows nothing more, they read the succinct summary on pages 113 to 115 to get the authors' key practical points.
Brain Abscess in an Infant With Cyanotic Congenital Heart Disease
Authors: Tingelstad J. B. , Young H. F. , David R. B.
Published: December 2021

An infant with a cyanotic congenital cardiac malformation and brain abscess is described. The rarity of this combination before age 2 years and the need for intensive treatment once it is recognized are stressed.
Dental Implications of Thumb-Sucking
Authors: Curzon M. E. J.
Published: December 2021

Controversy continues to exist over the problem of thumb-sucking, not only as to its cause and implications, but as to the best method and time of treatment. Pediatricians to whom concerned parents bring their children with this problem may find it difficult to decide what are the implications and just what he should advise the parents from both the medical and dental point of view.

HABIT AND PSYCHOLOGIC DISTURBANCE

Although originally considered to be a symptom of deeper psychologic import, the idea that undesirable sequelae will result from punitive restrictions on thumb-sucking derives from Freudian concepts of psychopathology. However, this theory has not been supported by recent research, and nonnutritive sucking is now considered to be simply learned behavior.1-3 There is no evidence to substantiate the theory that prolonged sucking habits result from emotional disturbances.4 No relationship has been found between prolonged sucking habits and the child's place in line of siblings.5

The habit is to be expected to occur in a large percentage of infants but can only be considered pathological, associated as it is with deformity of teeth and related structures, when prolonged beyond infancy.

INCIDENCE

Age is a very important determinant in assessing the incidence of the habit. Thumb-sucking, including various types of finger sucking, is frequent in infants. Traisman and Traisman2 found that 45.6% of American children under the age of 4 years thumb-sucked with no significant differences between the sexes. Baalack and Frisk6 in a retrospective study of Swedish children found that 30.7% had been, or still were, thumb-sucking at the time of the study.
"Brittle" Hair With Short Stature, Intellectual Impairment and Decreased Fertility: An Autosomal Recessive Syndrome in an Amish Kindred
Authors: Jackson Charles E. , Weiss Lester , Watson John H. L.
Published: December 2021

During a study of an Amish population of Northern Indiana, 25 individuals with a syndrome of brittle hair, short stature, and intellectual impairment were found in one large kindred. Observations in 20 of these affected individuals have shown that the short stature and intellectual impairment are relatively mild except in the propositus who also has a deletion of a portion of the long arm of chromosome 14. The hair in each affected individual has an abnormal appearance by light and scanning electron microscopy with an irregular grooved surface lacking in scales. Polarization microscopy of the hair revealed an alternating birefringent pattern. Neutron activation analysis of the hair of 11 affected individuals showed the sulfur content to average 2.51% by weight (approximately one half that of controls and nine obligate heterozygotes). This condition can be differentiated from Menkes' kinky-hair syndrome by the microscopic appearance of the hair, the normal copper and ceruloplasmin levels and the mode of inheritance. The syndrome being reported has similarities to and may be identical with a condition previously reported in two siblings by Pollitt et al. in 1968 and that reported in a 4-year-old girl by Brown et al. in 1970. The number of affected individuals and their distribution in this large kindred have provided evidence for the autosomal recessive inheritance of the condition and for its decreased fertility.
Sacral Agenesis
Authors: Thompson Ian M. , Kirk R. Mark , Dale Marjorie
Published: December 2021

Partial or complete absence of the sacrum is an anomaly that is usually associated with neurogenic bladder dysfunction. Eleven cases of complete sacral agenesis of the sacrum seen at the University of Missouri Medical Center emphasize the serious urological problems which so frequently derive from this anomaly and are so often overlooked to the detriment of the patient's renal and conduit function.
Is Farber's Test Useful?
Authors: Vos L. J. M.
Published: December 2021

Farber's test, as an aid in the diagnosis of congenital atresia, based on demonstration of cornified epithelial cells in the meconium,1 is not widely used since the reliability of the test was dubious due to technical difficulties and the test results have no therapeutic implications.

A theoretical argument to doubt the value of Farber's test has never been given. I think now there is. In 19702 Huisjes of the University of Groningen, Holland, demonstrated in a study of human amniotic fluid during pregnancy, that this fluid contains no cornified epithelial cells prior to the 38th week of pregnancy.
The Wearing of Long Hair by Men as Viewed by Some New England Magistrates in 1649
Authors: C. T. E.
Published: December 2021

Professor Richard Drinnon of Bucknell University in his introduction to his recently published edited edition of John Dunn Hunter's Memoirs of a Captivity among the Indians of North America (1823) writes as follows about the wearing of long hair in the Bay Colony.

In 1649 there was even a campaign to Clean up the Bay Colony or, as Thomas Hutchinson called it, "an association against long hair." Among the documents later collected by the governor, one bears that date and the signatures of the doughty John Endicott, Richard Saltonstall, and other magistrates. It reads:

"For as much as the wearing of long hair, after the manner of ruffians and barbarous Indians, has begun to invade New England, contrary to the rule of God's word, which says it is a shamne for a man to wear long hair, as also the commendable custom generally of all the Godly of our nation until within these few years, we, the Magistrates who have subscribed to this paper (for the showing of our own innocency in this behalf), do declare and manifest our dislike and detestation against the wearing of such long hair, as a thing uncivil and unmanly, whereby men do deform themselves and offend sober and modest men."

The elders were instructed to manifest their zeal in insuring that members of their "respective Churches be not defiled therewith." Hard on themselves, to be sure, these sober and modest men were merciless when it came to native long hairs.1
A Double-Blind Trial of Corticosteroid Therapy in Status Asthmaticus
Authors: Pierson William E. , Bierman C. Warren , Kelley V. C.
Published: December 2021

Initial treatment of status asthmaticus with corticosteroids caused significant improvement in arterial hypoxemia that did not occur in the control group. This improvement was not dependent upon changes in ventilatory function (FVC, FEV1). Betamethasone, hydrocortisone, and dexamethasone all appeared to have this beneficial effect. Both betamethasone and dexamethasone appeared to have the added advantage of higher unbound (pharmacologically active) corticosteroid levels. No toxic or adverse reactions were noted in this 24-hour study. Thus, corticosteroid therapy is indicated early in treatment of status asthmaticus, as withholding it needlessly exposes the patient to the risks of prolonged hypoxemia.
The Effect of a Methadone Treatment Program Upon Pregnant Heroin Addicts and Their Newborn Infants
Authors: Harper Rita G. , Solish George I. , Purow Henry M. , Sang Edward , Panepinto William C.
Published: December 2021

A Family and Maternity Care Program (FMCP) for pregnant addicts, their spouses and the newborn infants was organized at the State University of New York Downstate Medical Center. Twenty-five percent of the women were treated for syphilis; 18% had a recurrent or recent past history of hepatitis. Obstetrical complications were reduced or eliminated by careful obstetrical surveillance. None of the mothers signed out against medical advice postpartum. Of the 51 living infants delivered within the study period, there were 17 infants weighing less than 2,500 gm. The Apgar score at one minute was 7 or higher in 84% of the infants. An excessive incidence of congenital malformation was not seen. Ninety-four percent of the infants developed withdrawal symptoms, 6% of whom convulsed repetitively. Infant withdrawal, however, was unassociated with an increase in mortality or known prolonged morbidity. This low-dose methadone program coupled with intense psychosocial support appeared to alleviate many of the common problems associated with addiction in pregnancy, but failed to prevent withdrawal in the newborn.
THE MANAGEMENT OF ACCIDENTAL CHILDHOOD POISONING
Authors: Scherz Robert G.
Published: December 2021

Accidental childhood poisoning is still a common problem for the physician who provides primary care. At least 2,000,000 childhood ingestions per year come to the attention of the health professions in the United States in the wake of billions of containers of toxic substances, with thousands of variations in names and contents. Imperfect prevention programs fail to protect all young children, particularly those between the ages of 1 and 4 years who tend to include oral sampling of these products in their developmental experiences.

Fortunately, although the samplings are frequent, the amounts ingested are usually of low toxicity, and the actual numbers of deaths and permanent injuries are relatively small. In addition, the patterns of ingestions tend to be repetitious and are useful in devising specific programs for management.

The following series of articles deals with general approaches to the problem of accidental childhood poisoning and focuses on specific problems that require more precise attention.

1. The unknown poison can create a dilemma for parent, child, and the physician. However, by paying close attention to clues provided by a careful history combined with a physical examination and simple laboratory and clinical tests, the physician can both correctly diagnose and treat most ingestions in a rational and effective manner.

2. The management of acute poisoning with activated charcoal is a valuable technique that continues to be ignored by many physicians—yet it is a very effective method for reducing the absorption of many poisons.

3. Aspirin is still the No. 1 substance involved accidental childhood poisoning, although during the period from 1966 to 1973 the percentage of aspirin ingestions by children under 5 years of age reported to the National Clearinghouse for Poison Control Centers decreased from 25.8% to 6.5% of the total reported accidental poisonings—a 75% decrease in the past nine years, principally from ingestions of baby aspirin.
Management of Acute Poisoning With Activated Charcoal
Authors: Corby Donald G. , Decker Walter J.
Published: December 2021

Activated charcoal has been shown to be an effective complexing agent for many drugs. The quantitative in vivo evidence accumulated thus far indicates that this agent can be a very valuable adjunct in the initial phases of treating acute ingestions not only in the emergency room but also as a first aid measure in the home. It is well tolerated in extremely high single doses, and there is no known contraindication to its use in treatment of acute drug ingestion. It is immediately effective upon ingestion and can be given safely by nonprofessionals; hence, its inclusion in household first-aid supplies is warranted. In the emergency room, activated charcoal can be administered by lavage tube to an unconscious patient in large and repeated doses and can be continued throughout the acute phase of the clinical illness. The effectiveness of activated charcoal can be enhanced by emesis induced by apomorphine before or after charcoal administration. Since charcoal effectively adsorbs ipecac, syrup of ipecac should be given before the activated charcoal. Although it is not uniformly efficacious for all drugs, activated charcoal appears to be a generally useful adjunct for gastrointestinal decontamination.
Movement Disorder as a Manifestation of Diphenylhydantoin Toxicity
Authors: Rosenblum Edwin , Rodichok Lawrence , Hanson Peggy A.
Published: December 2021

A patient with a long-standing seizure disorder developed a choreic movement disorder, clinically indistinguishable from Sydenham's chorea when his blood diphenylhydantoin level was clearly in the toxic range. His movement disorder cleared promptly as the diphenylhydantoin level dropped, all other medications being continued. Thus, DPH intoxication should be considered as a rare cause of chorea in childhood.
Effect of MPA on Male Precocious Puberty
Authors: Powell James N. , Schoen Edgar J.
Published: December 2021

Medroxyprogesterone acetate (MPA) has been used by some in the hope of averting dwarfism in male idiopathic isosexual precocious puberty (MIIPP). MPA is known to suppress sexual development; whether it slows bone maturation is unproved. Its use is controversial.1-5 One cannot determine what height the patient with this uncommon disease might have reached without treatment; spontaneous remission occasionally occurs in MIIPP; reported adverse effects of MPA therapy include suppression of adrenocortical function, and disordered testicular function and histology,2-4,6,7 which some have feared would be permanent.
Textbook of Pediatric Nursing, ed. 4, by Dorothy R. Marlow, R.N., Ed.D. Philadelphia/London/Toronto: W. B. Saunders Co., 1973, 776 pp., $10.75
Authors: Marsh Helene I.
Published: December 2021

The organization of this book into units according to specific characteristics of growth and development of the human being, and the care of children of various age groups, is of solid assistance to the nursing student in her concern and endeavor to understand the healthy child and the consequences of common illnesses in children in each of those age groups.

The puissance of this edition lies in the greater emphasis on the scientific explanations for conditions affecting the child at different ages and the enhancement of information presented regarding the care essential for the child in the home.
Lead Neuropathy and Sickle Cell Disease
Authors: Erenberg Gerald , Rinsler Steven S. , Fish Bernard G.
Published: December 2021

Four cases of lead neuropathy in children with hemoglobin S-S or S-C disease are reported. Neuropathy is a rare manifestation of lead poisoning in children, and only ten other cases have been well documented in the pediatric literature. The last previous case report of lead neuropathy was also in a child with hemoglobin S-S disease. The neuropathy seen in the children with sickle cell disease was clinically similar to that seen in the previously reported cases in nonsicklers, but differed in both groups from that usually seen in adult cases. It is, therefore, postulated that children with sickle cell disease have an increased risk of developing neuropathy with exposure to lead. The exact mechanism for this association remains unknown, but in children with sickle cell disease presenting with symptoms or signs of peripheral weakness, the possibility of lead poisoning must be considered.
Radiographic Abnormalities in Acute Asthma in Children
Authors: Eggleston Peyton A. , Ward Byron H. , Pierson William E. , Bierman C. Warren
Published: December 2021

To determine the incidence of radiographic abnormalities in acute asthma of children and adolescents, and to examine the contribution of the chest x-ray to their care, 515 asthma admissions were reviewed. Of these, 479 had admission chest films, 22.3% of which were abnormal. Significant perihilar infiltrates were the most frequent abnormality seen; atelectasis, especially of the right middle lobe, was the next most frequent. Pneumomediastinum was also a common finding. Both pneumomediastinum and infiltrates were strikingly age-dependent: 15.5% over 10 years old had pneumomediastinum; none under 2 years old had this complication; infiltrates occurred in nearly 25% of younger children but in only 8.3% over 10 years old. Since pulmonary complications substantially alter therapeutic management, a chest x-ray should be part of the initial evaluation of any child hospitalized with acute asthma.
Introduction of Newer Modalities in Pediatric Radiology
Authors: Grossman Herman , Felman Alvin , Kirkpatrick John A. , Shopfner Charles E. , Swischuk Leonard E. , Taber Paddy , Tefft Melvin , McSweeney William J.
Published: December 2021

Many new and exciting diagnostic modalities are being introduced into radiology, and some of them are beginning to have an impact on pediatric practice. Most of these modalities are noninvasive techniques which can be performed with ease and safety in the pediatric patient. For example, the application of axial tomography with computer integration of the radiologic image (EMI Scanner, ACTA Scanner) may revolutionize the practice of neuroradiology as we now know it. Nuclear medicine is only beginning to blossom in its many physiologic and morphologic applications, particularly with the introduction of Gamma Cameras and short half-lived scanning agents associated with minimal radiation dose. The use of ultrasonography is becoming particularly important in the evaluation of acquired and congenital heart disease and in the evaluation of abdominal masses. Thermography and xeroradiography have yet to find a significant use in pediatric practice. Fine tuning and modification of diagnostic radiologic procedures used routinely in adult medicine have made the application of such modalities as angiography relatively safe in skilled hands when they are used for children.

These newer diagnostic modalities must be subjected to the same critical analyses regarding efficacy, cost, and safety that currently are demanded and accepted for the introduction of new drugs and other forms of therapy. They will have to be evaluated to establish whether or not they are simply duplications of more conventional methods of diagnosis and fail to improve patient care. Publication of their availability and use, and even advertisements, should be considered carefully before they are accepted for application in pediatrics.
PEDIATRICS AND MENTAL RETARDATION—A CONTINUING CHALLENGE
Authors: Gordon Harry H.
Published: December 2021

It is high privilege to participate in a ceremony in which the American Academy of Pediatrics honors the memory of one of its founders and most illustrious Fellows. The C. Anderson Aldrich Award for 1973 is presented to Dr. Gunnar Dybwad, Professor of Human Development at the Florence Heller Graduate School of Advanced Studies in Social Welfare, Brandeis University. The Award is made for Dr. Dybwad's contributions to the development of children, particularly those with mental retardation. Inherent in his choice as awardee by the Section on Child Development of the Academy is recognition of mental retardation as a disability in development, one that is subject to change with time, either amelioration or deterioration, depending in a major way on the child's social surroundings. It is to these latter that Dr. Gunnar Dybwad has particularly addressed himself.

For the benefit of younger members and guests of the Academy, a few biographical notes seem in order about Dr. Aldrich who died 25 years ago. Born in Plymouth, Massachusetts, in 1888, Dr. Aldrich received his early education in Boston and New York; his college and medical school degrees at Northwestern University. After general practice in Winnetka, Illinois, for five years, he limited his practice to pediatrics. While in practice, he worked at the Children's Memorial Hospital of Chicago rising to a full Professorship at Northwestern University, and succeeding Dr. Joseph Brenneman in 1941 as Chief of Staff at the Children's Memorial Hospital. In 1944 he moved to Rochester, Minnesota, and founded the Rochester Child Health Institute, interested in research on the development of normal infants and children and in a program of delivery of child care to an entire community.
Hyperglycemia and Sickness
Authors: Klein Michael , Kopelman Arthur , Lawrence Ruth
Published: December 2021

Dweck and Cassady1 have done an excellent job of bringing to our attention the frequent occurrence of hyperglycemia in very small premature infants. They implicate as the major cause of this phenomenon glucose infusion rates of >0.4 gm/kg/hr. Based on the association between the highest glucose and osmolality values in their series and intraventricular hemorrhage, they imply causality. The authors suggest further that oral glucose feeding confers a protective effect against hyperglycemia.

The premature infants in the authors group 3, those with serum glucose levels of 300 mg/100 ml, have the lowest birth weights.
Comment by the American Board of Pediatrics, Inc., on Evaluation of Candidates
Authors: Burg Fredric D. , Wright F. Howell , Brownlee Robert C.
Published: December 2021

Continuous self-criticism of its methods has led the American Board of Pediatrics to the realization that a more comprehensive evaluation of its candidates will have to include greater participation by those involved in the training of pediatric residents. Improvements have been made through the use of the pre-test,1 by back-reporting to program directors of the success of their candidates on the oral examination,2 and by the introduction of a more standardized and comprehensive form for letters of recommendation to the Board.
Diagnosis of Gonorrhea and the 1974 Red Book
Authors: Ris Hania W.
Published: December 2021

At Last The Long-Awaited Seventh Edition Of The Red Book,1 The Bible Of The Pediatrician, Has Appeared. The Section On Gonorrhea Was Updated. I Fear, However, That The Paragraph On Diagnostic Tests (Pp. 60-61) May Be Misinterpreted As Meaning That The Gram-Stained Smear Has A High Degree Of Reliability In Diagnosis Of Exudates, As There Is Great Emphasis On The Smear Rather Than The Culture.

It Is Well Established That Grain-Stained Cervical And Vaginal Smears In The Female Are Unreliable For Diagnosis Of Gonorrhea.
Another Method for Changing U. A. Catheters
Authors: Chopra Devinder R. , Flanagan James , Obak Joshua , Sinnhuber John , Kieffer James , Seay Alan
Published: December 2021

In regard to the article by Michael Heymann in the Januany issue1 we have the following comments:

We have had the opportunity of changing arterial catheters in our intensive care unit over the last 1½ years in well over two dozen cases and we did this by the following procedure:

The change is done by two persons—one withdrawing the catheter and the other ready with the new catheter to be inverted. Usually the umbilical cord and artery will be molded around the catheter.
Complication of Ritual Circumcision in Israel
Authors: Frand M. , Berant N. , Brand N. , Rotem Y.
Published: December 2021

We have recently had the opportunity to see 3 cases of a very unusual complication of circumcision. Performers of ritual circumcision in Israel wrap the circumcised penis with a firm, circular bandage for hemostasis.

The three newborn infants we saw were brought to the emergency room about a day after the procedure because of restlessness, refusal to eat and occasional vomiting. One of the mothers noticed blue discoloration of her child's legs.

On examination, cyanosis of both lower extremities and a huge bladder were found in all three infants.
Otitis Media in Eskimos
Authors: Schaefer O.
Published: December 2021

The Commentary in your February 1974 issue entitled "Purulent Otitis Media: Differences Between Populations in Different Environments"1 discusses the otitis media problem which has reached "nearly epidemic proportions" first described in Alaskan and in more recent years also in Canadian Eskimo children. The authors draw, rightly, attention to the possible association of otitis with a changing life style, and base this on differences of otitis prevalence found in larger and smaller settlements, where traditional forms of nutrition in infancy and later in life were preserved to varying degrees.