bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitamin K Deficiency After the Newborn Period
Authors: Speck William T.
Published: December 2021

"Another lesson" not mentioned by Drs. Goldman and Amadio,1 yet confirmed in their report, is that the routine use of antibiotics for diarrheal disease in most pediatric populations in our country, without prior bacteriological confirmation, may be fraught with profound consequences and should be discouraged.
Letter To The Editor
Authors: Christopherson E. H. , Yankauer Alfred
Published: December 2021

For the Committee, and its subcommittee most closely involved, Dr. Christopherson and Dr. Yankauer replied to this letter as follows:

At one stage in the development of the Committee's Statement on Child Health and Community Health Centers in the Americas, it included almost all the points which Dr. Elbualy has raised in his letter. These were eventually reduced to a few words in the eighth and ninth paragraphs of the published statement which refer to the "overwhelming social, economic, and cultural inequities and inadequacies" which lead to high mortality among the children of the poor.
ADVICE ABOUT EDUCATING THE SLOW CHILD IN 1812
Authors: C. T. E.
Published: December 2021

Maria Anne Campbell1 in 1812 wrote a delightful book about female education including her ideas on the special needs of the slow child. Many of her suggestions cited below concerning the teaching of such a child are surprisingly modern:

There are many slow children, who are frequently confounded with those who are naturally dull, by preceptors who are not capable of discerning the different capacities of children committed to their care, or who perhaps, form their opinions too hastily on the subject; and from the mode of treatment, generally adopted . . . arises many errors. . . . They (slow children) are frequently told by their teachers, that they are incorrigible dunces. . . .This treatment so depresses their spirit, and suspends the free exercise of their faculties, that they begin to think it quite unnecessary to make any further exertion, imagining that they lie under an insurmountable natural defect. And thus it happens that more children are made dunces than born so.

When a child is known to possess a slow perception, care should be taken to impress habits of the strictest perseverance on her, and let not her dullness be treated as an irreparable misfortune. On the contrary, she should be told that by strict application to her studies, she may at length equal, if not surpass those of the most brilliant parts. Historical examples may be quoted to shew (sic) her the advantages that are to be derived from perseverance; amongst others, that celebrated one of Demosthenes' having overcome a great natural defect by perseverance. . .
RESEARCH ISSUES IN CHILD HEALTH
Authors: Birch Herbert G.
Published: December 2021

The discussion of research issues in child health and nutrition at this symposium has centered around what are really two different types of questions. One type of question is in regard to political imperatives: imperatives for social and economic change, imperatives for change in the circumstances of whole segments of population, and imperatives for the expression of dignity and for the expression of self-determination on the part of these segments of the population. The second type of question, which has been confused with rather than integrated with the first, concerns research issues and research problems that may be confronted in the area of health, education, and development, particularly as it affects certain segments of the population which are called "socially disadvantaged."

This "disadvantaged" population has not merely been culturally deprived. Its members have been exploited. They have been segregated in the community. They have been subjected to excessive and unbearable patterns of insult for centuries. They have been deprived of housing, of health, of educational and economic opportunities, and of a variety of other things. Our discussion takes place in an atmosphere in which a significant segment of this part of the American population is expressing itself in various and heterogeneous ways and in many different voices, but with a common message, namely, "We wish to be heard. We wish to be determiners of our own destinies. We wish to define the kinds of problems we have and the ways in which the problems we have are to be approached. problems we have are to be approached.
Antenatal Infection and Unruptured Membranes
Authors: Driscoll Shirley G.
Published: December 2021

The report, "Congenital Bacterial Pneumonia with Intact Fetal Membranes," by Dr. Monif1, draws attention to the widespread, but unwarranted view among clinicians that an intact amnion is insurance against transamniotic fetal infection. The twin assumptions that manifest physical integrity of the membranes protects the contained fetus from infection and that membranes discovered to be infected after rupture were not inflamed while intact, are fallacious. Both chorioamnionitis (inflammation, though not necessarily infection, of the membranes) and microbial contamination of the liquor amnii have been repeatedly observed without such high risk antecedents as prolonged rupture, prolonged labor, instrumentation, or vaginal examinations.
Vitamin K Deficiency and So-called Nodular Purpura in Infancy
Authors: Burgio G. R. , Vaccaro R.
Published: December 2021

Goldman and Amadio (Pediatrics, 44:745, 1969) recently reviewed 15 cases (including 3 not previously published) of "vitamin K deficiency bleeding after the newborn period" and attributed the cause of this deficiency to a low dietary intake of vitamin K and low intestinal supply.

We would like to point out that the same factors have been considered for a clinical condition of vitamin K deficiency after the newborn period, indicated as "nodular purpura in infancy." This definition was suggested by the presence of hemorrhagic infiltrations on the skin.
Child Abuse Control Centers: A Project for the Academy?
Authors: Brem Jacob
Published: December 2021

A good deal of literature on child abuse has accumulated since Kempe and his group first described the "Battered Child Syndrome."1 Enlightened laws have been passed in the various states and management transferred from the police into the hands of social agencies. Furthermore, the reporting physician was protected from libel. However, at the grass root level, conditions are far from ideal. Physicians are unfamiliar with the various laws and are reluctant to report for fear of getting involved in unpleasant situations.
Clinical Disorders of Hemoglobin Structure and Synthesis, by Thomas F. Necheles, M.D., Ph.D., Donald M. Allen, M.D., and Harvey E. Finkel, M.D., F.A.C.P., with a foreword by Sydney S. Gellis, M.D. New York: Appleton-Century-Crofts, Education Division, Meredith Corporation (440 Park Avenue South, New York, New York 10016), 1969, 220 pp., $10.00
Authors: Pearson Howard A.
Published: December 2021

During recent years a number of monographs have been published. describing the biochemical, genetic, and clinical aspects of normal and abnormal hemoglobin synthesis. Although this book covers the same ground, its tone and emphasis reflect the authors' clinical base. It is primarily directed to clinicians, and so it is particularly readable and useful.

After a brief survey of normal structure and synthesis, the authors concentrate on clinical and genetic aspects of abnormal hemoglobin syndromes. Most attention is devoted to sickle cell and Cooley's anemias.
WHAT AILED SAM STONE'S INFANT SON?
Authors: C. T. E.
Published: December 2021

No physician of eminence came to this country during the seventeenth century. Medicine was practiced either by clergymen, or the Colonial Governors; both, at best, were only partly trained as physicians.1

The pathetic letter below, exactly as written by the child's father, was sent to John Winthrop, the Younger (1606-1676). This letter is typical of those Winthrop often received from desperate parents who had no other source of medical advice for their children.

Worthie Sir

I am bold to write a few lines about our child. he is 23 weeks old, hath been somewhat ill 3 or 4 weeks, unquiet, his eyes looking yellow, having a cough, especially when he takes his vistuals. wee thought he might have been breeding teeth: but about a week past we peceived yt. [that] he had the yellow Jaundise. By Mrs. Hooker her advice we gave him Barbaric barke boyled in beer, wth saffron, twice a day, for two dayes together. & one time saffron alone. Also lice 2 or 3 times [once thought to be of therapeutic value in jaundice] & Tumerick twice. we hoped yt. the Jaundise had been cured: because he was sometimes more cheareful & had a better appetite, but the last Saterdaie at night he was very unquiet heavie & could not sleep & upon the Sabbath seemed to looke somewhat swart [flushed] in the face. In the afternoone we gave him about 3 quarters of a grain of your purging powder, which we had of Mrs. haynes which caused him to vomit twice or thrice, & to purge downwards thrice he slept well the night after & in the morning was somewhat unquiet again as before, wringing & winding back.
THE CRITICALLY ILL CHILD: RESPIRATORY ARREST AND ITS SEQUELAE
Authors: Smith Robert M.
Published: December 2021

The term respiratory arrest is at once an admission of inaccuracy and confusion, since it can only stand for the chaos of a bad accident or, worse, the unhappy occasion where a patient has been allowed to slip through the measurable stages of respiratory failure due to neglect, poor judgment, or inadequate therapy.

Unfortunately, we do find ourselves confronted by children in respiratory arrest all too frequently. Regardless of the cause, salvage of many of them depends not only upon management of the emergency itself, about which there has been considerable discussion, but also upon management of the sequelae, an area which deserves more attention. Actually, the two phases are markedly different: the emergency period demands instant action, rapid thinking, and efficient organization, while the recovery period requires more sophisticated evaluation and grueling observation and sometimes ends in painful decision.

MANAGEMENT OF EMERGENCY PHASE

The two principal factors in emergency care of children in respiratory arrest are: (1) the preparation for such incidents, and (2) an organized response to the emergency when it occurs.

Preparation

Suitable Treatment Areas: Wellequipped hospitals will have apparatus for resuscitation in emergency rooms for accidents and outpatient care, and in intensive care units for long-term respiratory therapy. Also, the hospitals will have portable resuscitation kits on all nursing divisions.

Equipment: In each of the preceding areas, suction apparatus, oxygen, airways, laryngoscopes, endotracheal tubes, self-in-flating breathing bags, masks, syringes, needies, and suitable drugs (Table I) are stocked, easily available, and ready for use. Mechanical ventilators are seldom necessary for emergency use, but they might be available in intensive care units where more extensive monitoring and diagnostic equipment should be maintained.
THE BOOK OF ACCIDENTS: DESIGNED FOR YOUNG CHILDREN
Authors: Cone Thomas E.
Published: December 2021

In 1830 a long-forgotten printer published a small chapbook by an unknown author bearing the title The Book of Accidents; Designed for Young Children. This small paper-covered book, which remains unlisted in any of the standard bibliographies of children's books, contains a number of lessons written for children illustrating in both prose and woodcut some of the pitfalls to which children are liablefalling out of a window, falling out of a coach, playing with firearms, crossing streets, tumbling down stairs, and so forth.

Although written almost a century and a half ago, many of our readers may find these lessons more effective—and I suspect a good deal more engaging—than most of the contemporary accident prevention pamphlets written for children.

The appearance in 1830 of a children's book concerned with accidents may come as a surprise because, to my knowledge, none of the standard pediatric texts contained such information until the turn of the century.
INTERNATIONAL FOOD AND NUTRITION PROGRAMS
Authors: Filer L. J. , Barness Lewis A. , Goldbloom Richard B. , Holliday Malcolm A. , Miller Robert W. , O'Brien Donough , Pearson Howard A. , Scriver Charles R. , Weil William B. , Kline O. L. , Whitten Charles , Cravioto Joaquin
Published: December 2021

Workers in the pediatric field have recognized that undernutrition is of major importance in developing countries around the world and have expressed interest in the extent to which efforts have been made in the United States to deal with this problem. This report attempts to bring together information from a wide variety of sources and to summarize the considerable efforts that have been made in dealing with these problems of undernutrition. It may provide a basis for future planning and involvement on the part of those concerned with solutions for the food problems abroad as well as the application of experience with them to situations in this country.

The vital importance of nutrition was forcefully described by the President's Science Advisory Committee in its 1968 report on the "World Food Problem."

The principal findings and conclusions reached were stated as follows:

1. the scale, severity, and duration of the world food problem are so great that a massive, long-range, innovative effort unprecedented in human history will be required to master it;

2. the solution of the problem that will exist after about 1985 demands that programs of family planning and population control be initiated now. The food supply is critical for the immediate future;

3. food supply is directly related to agricultural development and, in turn, agricultural development and overall economic development are critically interdependent in the hungry countries; and

4. a strategy for attacking the world food problem will, of necessity, encompass the entire foreign economic assistance effort of the United States in concert with other developed countries, voluntary institutions, and international organizations.
Pediatric and Pediatrics
Authors: Riley Harris D.
Published: December 2021

I wish to express my concern with the widespread, incorrect use of the words "pediatric" and "pediatrics." With increasing frequency, medical journals and even more often, people in conversation, use such phrases as "pediatrics resident," "pediatrics service," and "pediatrics department," employing a noun as a modifier of another noun.

Webster's Third New International Dictionary of the English Language states:

pediatric also paediatric/ /adj. (paed- + -iadnic): of or relating to the care and medical treatment of children (an effective ~ service): belonging to or concerned with pediatrics.
Letter To The Editor
Authors: Tobin Jordan D. , Roux Jacques F. , Soeldner J. Stuart
Published: December 2021

Drs. Tobin, Roux, and Soeldner comment as follows:

We have read with interest the letter of Drs. Cordero, Grunt, and Anderson and appreciate their sharing their experiences with us. It is possible that the differences in both the dose (1.0 gm/kg versus 0.5 gm/kg) and the time of the infusion (10 minutes versus 3 minutes) account for some of the differences in our resuits. The prolonged maternal hyperinsulinemia might be responsible for the late rise seen in some of their fetuses and may represent transplacental crossing of insulin as well as fetal insulin production.
Letter To The Editor
Authors: Nejedlá Zdenka
Published: December 2021

Dr. Nejedlá comments as follows:

I agree with Dr. R. H. Rapkin's opinion that it would be necessary to examine a further group of neonates with hyperbilirubinemia without incompatibility to prove completely the influence of bilirubin on the development of immunologic reactivity. At present we have such a group under observation. Only one child of the 12 mentioned in our study, did not show any incompatibility.

However, I cannot agree with the explanation of Dr. Rapkin that maternal placentally transferred antibodies suppress the antibody formation by the infants still at the age of 6 months.
Azathioprine (Imuran) in Treatment of Hepatic Failure
Authors: Deitcher Kenneth A.
Published: December 2021

The article "The Critically Ill Child: Acute Hepatic Failure" (Pediatrics, 45:93, 1970) by Dr. Trey failed to mention one drug that has been recently used as an adjunct to chemotherapy of acute hepatic failure in children. Azathioprine (Imuran) in the dosage of 50 to 100 mg per day has been utilized in this disease to suppress any auto-immune factors that may contribute to the destruction of hepatic tissue or in the prevention of regeneration of hepatic cells.
Decalog for Pediatricians
Authors: Von Hofe Frederick H.
Published: December 2021

The following is in response to your invitation on page 722 in Pediatrics, April, 1970.

I. Have no standing lamps or other pieces of furniture that can be readily thrown over or dislodged in the waiting room. Children should be permitted to learn by exploring. Don't cramp their style.

II. Don't wear white coats in private practice. A child readily associates the white coat with some previous unpleasant experience.

III. If crying makes auscultation and percussion of the lung difficult, have the mother hold the patient over her shoulder.
Pediatric Urology, edited by D. Innes Williams, M.D., M.Chir., F.R.C.S. (Eng.). New York: Appleton-Century-Crofts, Division of Meredith Publishing Company (440 Park Avenue South, New York, New York 10016), 1969, 585 pp., $31.50
Authors: Lattimer John K.
Published: December 2021

Pediatric Urology, edited by Mr. D. Innes Williams, of the Hospital for Sick Children, Great Ormond Street, London, is a well-bal-anced compendium of the current information and thinking of leading British pediatric urologists. These urologists are all thoroughly conversant with the views held in other countries, largely as a result of the ever-increasing number of national and international meetings devoted to this branch of urology during the last decade. Each of the authors writes in the succinct and attractive style so commonly found in English medical writing; practically every facet of pediatric urology is touched upon in the 36 chapters and 4 appendices.
Mental Retardation: Diagnosis and Treatment, by Charles M. Poser, M.D., F.A.A.P., with 17 authors. New York/ Evanston/London: Harper and Row Publishers, 1969, 271 pp., $9.50
Authors: Crocker Allen C.
Published: December 2021

Mental Retardation: Diagnosis and Treatment, is a survey of modest size (271 pages) with a light, very readable style, touching briefly on the main areas of study of the child with cerebral handicap and thus oriented primarily toward the student or the generalist. Whereas two well written and broadly useful chapters are "Education information" (chapter 4) and "Treatment of metabolic and endocrine causes" (chapter 7) , the bulk of the text is distressingly superficial and unsatisfactory, representing a medically pragmatic and rather compromising attitude.
HISTIDINEMIA DISCOVERED BY URINE SCREENING AFTER RENAL TRANSPLANTATION
Authors: Rosenblatt David , Mohyuddin Fazl , Scriver Charles R.
Published: December 2021

Histidinemia has been discovered by urine screening in a 17-year-old French-Canadian female, who has a single, transplanted cadaver kidney. She has normal intelligence and speech. Activity of L-histidine, ammonia-lyase (histidase) was absent in stratum corneum and other organs. The transplanted kidney handled histidine and its metabolites efficiently. The trait was inherited as an autosomal recessive, with both parents exhibiting deficient histidase activity. The patient is ently chimerical for histidase activity. The host cells contain no activity; the implanted kidney presumably contains the normal but ineffective amount of histidase activity. Homozygotes with certain inborn errors of metabolism might benefit in the future from "transplant chimerism" if the appropriate organ containing the missing enzyme were implanted.
HISTIOCYTIC REACTION IN DYSGAMMAGLOBULINEMIA AND CONGENITAL RUBELLA
Authors: Claman Henry N. , Suvatte Vinai , Githens John H. , Hathaway William E.
Published: December 2021

A girl was born of a mother who had rubella during the first trimester of pregnancy. The child showed failure to thrive, hepatosplenomegaly, lymphadenopathy, glaucoma, and nerve deafness. She also developed a dysgammaglobulinemia with low serum γM, low to absent γA, and high (19s) γM. She was treated with methyl prednisolone and vinblastine and appeared to improve; but, after an infection at age 3½, the lymphadenopathy returned and γG became undetectable. Peripheral blood cells were normally stimulated by phytohemagglutinin. A lymph node biopsy showed a marked histiocytic reaction pattern.

The incidence of "histiocytosis" in congenital rubella is reviewed, and the possible relations between congenital rubella, dysgammaglobulinemia, and histiocytic reactions are discussed. The following hypothesis is suggested: histiocytosis may be a tissue reaction to a persistent (viral) infection in the presence of an altered immune mechanism also caused by that infection.
PEDIATRIC GLOBALISM
Authors: Work Henry H.
Published: December 2021

About a year ago in these pages there appeared a group of articles and commentaries which suggested that there continues to be a strong need for the pediatrician to practice "comprehensive care."1, 2 The urging in these commentaries was not different from that which has appeared over the years in pediatric journals. The evidence of such a recurrent phenomenon suggests that there is a group of individuals in the profession who continue to do such urging and others who appear to continue to resist the demand.

Recently, two letters have appeared in Pediatrics taking a position that there is a limit to pediatric activities and possibly that pediatricians are being overly coerced.
THYROID FUNCTION IN THE PRETERM FETUS
Authors: Fisher Delbert A. , Hobel Calvin J. , Garza Romulo , Pierce Claire A.
Published: December 2021

Measurements of serum total thyroxine (T4), free thyroxine (FT4), and/or immunoreactive thyrotropin (TSH) were conducted on 14 pairs of maternal and cord blood specimens obtained at the time of elective therapeutic abortion of 11- to 18-week pregnancies and on 21 paired maternal and fetal cord blood specimens collected at the time of spontaneous, premature delivery of 22- to 34-week pregnancies. T4 concentrations were elevated in all maternal samples to levels characteristic of pregnancy; mean values were similar at 11 to 18 and at 22 to 34 weeks and did not differ from the mean level reported previously at term. Mean maternal TSH concentrations also were similar at 11 to 18 weeks, 22 to 34 weeks, and at term. The mean FT4 concentration in maternal serum between 11 and 18 weeks was significantly higher than the level reported previously at term. Fetal serum T4 and FT4 concentrations were low between 11 and 18 weeks and increased progressively between 22 weeks and term. Fetal serum TSH concentrations were low between 11 and 18 weeks of pregnancy but seemed to increase abruptly between 18 and 22 weeks to levels characteristic of term infants.

These data suggest that the maternal concentration of FT4 is higher early in pregnancy than at term, perhaps because of the higher blood levels of human chorionic thyrotropin in early pregnancy. They also indicate autonomous function of the fetal hypothalamic-pituitary control system as early as 12 weeks' gestation. The abrupt increase in fetal serum TSH between 18 and 22 weeks suggests rapid maturation of the fetal hypothalamic-pituitary unit during this period. The subsequent progressive increase in fetal FT4 concentration indicates an increasing thyroidal response to the TSH stimulus.
PHOSPHOLIPIDS OF RED CELLS AND BLOOD PLASMA IN ADULTS, NEWBORN INFANTS, AND PATIENTS WITH RH ERYTHROBLASTOSIS
Authors: Hürter Peter , Schröter Werner , Schedel Ingolf , Gercken Günther
Published: December 2021

The concentration of total and individual phospholipids was determined in erythrocytes and plasma of adults, neonates, and newborn infants with Rh erythroblastosis. After extraction the phospholipids were separated by one-dimensional, thin layer chromatography into six fractions: phosphatidylethanolamine, phosphatidylserine, phosphatidylcholine, lysophosphatidylcholine, sphingomyelin, and nonidentified phospholipids. In normal neonates the total amount of red cell and plasma phospholipids was significantly decreased (1.32±0.20 µmoles/ml plasma, p<0.001; 3.03±0.65x10-10 µmoles/erythrocyte, p<0.001) when compared with the data of the adults (2.88±0.69µmoles/ml plasma; 4.11± 0.37x10-10 µmoles/erythrocyte). All the individual phospholipids were diminished in the plasma. In erythrocytes only the amount of phosphatidylcholine, phosphatidylethanolamine, and phosphatidylserine was reduced, whereas the sphingomyelin content was unchanged, i.e., it was increased when expressed as percent of total phospholipids (adult blood erythrocytes 24.2±0.8%; cord blood erythrocytes 29.7±2.8%, p<0.001). Thus, the sphingomyehn/phosphatidylcholine ratio was markedly higher in cord blood erythrocytes (1.03) than in adult red cells (0.81). In newborn infants with Rh erythroblastosis, the decrease of total and individual red cell phospholipids was less striking than in normal neonates. In the plasma the phospholipid patterns of the two neonate groups were identical. It is suggested that the total and individual phospholipid alterations in fetal red cells might be due to the low plasma levels of phospholipids in neonates.
Standards of Fetal Growth
Authors: Silverman William A.
Published: December 2021

It is encouraging to read that J. M. Tanner, who has so thoroughly pondered the perplexing problems of constructing postnatal growth standards, has now turned his critical eye to the quandaries which face those who are attempting to establish standards of fetal growth (Pediatrics, 46: 1, 1970) . Tanner's suggestions (especially edit programs for errors, corrections for non-normality, and criteria for exclusions from the "normal" sample) will certainly be taken to heart by the aficionados.
Letter To The Editor
Authors: Mortimer Edward A.
Published: December 2021

We asked Drs. Edward Mortimer and Heinz Eichenwald for their comments. These follow:

I agree with Dr. Franciosi that the most practical guide to therapy of bacterial infections with antibiotics currently is the in vitro sensitivity test. There is, of course, some variability in results that depends on many factors, including techniques, which unfortunately may differ from time to time and between laboratories. However, most laboratories currently find about two thirds of E. coli strains sensitive to ampicillin, as noted by Dr. Franciosi.
Letter To The Editor
Authors: Franciosi Ralph A.
Published: December 2021

Thank you very much for your letter regarding my letter to the editor and for the responses from Drs. Eichenwald and Mortimer. One interesting development that could be added as an addendum to show the artificial atmosphere of in vitro sensitivity is the finding that since we stopped incubating our sensitivity plates in a CO2 atmosphere, we have noted that only 11.5% of E. coli are resistant to kanamycin and only 8% resistant to ampicillin. Our sensitivity media is Mueller-Hinton with a pH of approximately 7.4. Apparently incubatioii in a CO2 atmosphere, which decreases the pH of the media, interferes with the sensitivity of E. coli in particular to kanamycin and ampicillin.
Plasma Resin Activity Coarctation of the Aorta
Authors: Guntheroth Warren G.
Published: December 2021

The report on the peripheral and renal vain renin activity in coarctation of the aorta confirms previous reports by Hickler and co-workers. The data are not in question, but their conclusions are misleading. Consideration of control theory suggests that a direct correlation between elevation of blood pressure and the elevation of plasma renin activity should not be expected. If blood pressure is regulated by a feedback mechanism, and the evidence for this is overwhelming, the relationship between an effector substance and the regulated variable will never be linear, particularly if the effector has slow, as well as rapidly-acting components.
Duodenal Ulcer—in Office Practice and Hospital Clinics
Authors: Prouty Margaret , Oakley Dorothy
Published: December 2021

We have read the article on duodenal ulcer in childhood1 with considerable interest, but would criticize the study as presenting a distorted picture in that it seems to suggest that ulcer is rare in childhood because it is rarely seen in hospitalized patients. It disregards ulcer where it is commonly seen and diagnosed, namely, in the office. It is our observation that few ulcer patients are hospitalized and those only because of complications, such as intractable bleeding, perforation, or pain that cannot be controlled in a home situation where there are large emotional factors.
LIPID STUDIES IN WOLMAN'S DISEASE
Authors: Kyriakides Emilios C. , Filippone Nicholas , Paul Betty , Grattan William , Balint John A.
Published: December 2021

Studies of the tissue lipids of two siblings with Wolman's disease are presented. In both patients massive accumulations of triglycerides, as well as of free and esterified cholesterol in the liver and spleen were found. Linoleic acid was greatly reduced in the tissue lipids of one patient who received a skim milk diet, but was present in normal concentrations in the second, whose diet was based on a soybean formula. Plasma α-lipoproteins were absent by electrophoresis in the first patient at age 6 months, but were present at birth in the second patient, though they disappeared as the disease progressed. Cultured fibroblasts from two patients showed increased content of cholesterol, and increased incorporation of mevalonic acid into cholesterol in one of these.
WITCH DOCTORS
Authors: Williams Cicely
Published: December 2021

As a refreshing departure from our usual articles, we welcome the chance to publish these perceptions of an unusual pediatrician. In presenting Dr. Cicely Williams to her Baltimore audience, Dr. Nicholas J. Fortuin said:

"Today we introduce to you a distinguished British woman of medicine. Though born in Jamaica, Dr. Williams received her early medical education in England, but later left for a tour with the colonial services in Ghana, where she began her life-long interest in tropical pediatrics and first described the disease we know today as kwashiorkor. After spending 7 years in Africa, Dr. Williams went to Singapore in 1936 as pediatrician to the College of Medicine and, after the second world war, became advisor in child health to the Federation of Malaya. Subsequently she became the first head of the World Health Organization's Department of Maternal and Child Health, and after some years of teaching and consulting work in England, Visiting Professor of Maternal and Child Health at the American University in Beirut in 1960. Dr. Williams returned to London to work with the Family Planning Association in recent years, where she has been able to pursue an interest in population control. Dr. Williams:"

I'm sorry if my title is misleading. It's a bit pretentious because it isn't really that I've had spectacular experiences with witch doctors; but, in wandering about the world I've met various unorthodox sorts of medicine and, rather than calling it "unorthodox," it seemed quicker to call it "witch doctors." In every type of medicine we depend largely on confidence, on patient reaction, often on empiricism.
An Evaluation of the Metacarpal Sign (Short Fourth Metacarpal)
Authors: Slater Stanley
Published: December 2021

Short fourth metacarpal bones have been detected clinically in 9.6% of an unselected group of 1,510 patients over the age of 6 years. Ten percent false positives were noted, based on x-ray examination of some of the subjects. The maximum shortening noted was 3 mm clinically and 2.5 mm on x-ray. No endocrine abnormalities were associated with the shortening noted in this group.
BOOK OF ACCIDENTS
Authors: Cone Thomas E.
Published: December 2021

Crossing streets was even hazardous for children 140 years ago, long before the invention of the automobile. The illustrated lesson below, from the first book on accident prevention written especially for children in the United States (1830), vividly describes what might happen to careless children who, in spite of warning, run across the street when carts are near.

The modern reader may well be surprised to find the tone of this lesson more severe than that used by contemporary writers of books for children. But, as Philippe Ariés has recently and convincingly shown, the child as an object to be "coddled" is a development of this century.
SULFONAMIDE COMBINATIONS: RECENT FDA ACTION
Authors: Weiss Charles F. , Yaffe Sumner J. , Cann Howard M. , Gold Arnold P. , Kenny Frederic M. , Riley Harris D. , Schafer Irwin , Stern Leo , Shirkey Harry C.
Published: December 2021

The Committee on Drugs of the American Academy of Pediatrics has transmitted the following letter to the Federal Food and Drug Administration on the recent action by that agency regarding the use of sulfonamide combinations in pediatrics.

Your letter of September 12, 1969, regarding the role of systemic sulfonamides in the treatment of infections, has resulted in many comments being directed to the committee on Drugs of the American Academy of Pediatrics. Consequently, this matter was discussed during the Committee meeting held on October 20 and 21, 1969, in chicago. After careful and extensive review, the Committee wishes to express the following comments.

Sulfonamides have been shown to be of value in the treatment of certain infectious diseases in children, including acute otitis media, and penicillin and sulfonamides are generally recognized in combination as effective therapy in this common disorder. In young children where a high incidence of infection due to H. influenzae has been demonstrated, the usefulness of this combination is confirmed by the widespread clinical experience of Academy members, as well as by certain published controlled clinical studies.

While meningitis due to H. influenzae is included as an approved indication for sulfonamide therapy (reference your letter, Item 9), the Committee on Drugs regards the omission of otitis media as a serious error. As you know, otitis due to H. influenzae is often a precursor of meningitis in small children. Both of these infections are indications for the adjunctive use of sulfonamides, and to restrict its use to one is illogical and contrary to good medical practice.
Letter To The Editor
Authors: Edwards Charles C.
Published: December 2021

This replies to your letter dated December 19, 1969, and addressed to Commissioner Ley. Your letter, which represents the stand of the Committee on Drugs of the American Academy of Pediatrics, emphasizes the usefulness of systemic sulfonamides in combination with penicillin in the treatment of acute otitis media in young children where a high incidence of H. influenzae infection is known to occur. Our letter of September 12, 1969, to physicians did not include such an indication when listing the uses of the short-acting sulfonamides.

We have received several other expnessions like yours, calling attention to this omission in the indications for the systemic short-acting sulfonamides. I am pleased to be able to tell you that we are about to publish, in the Federal Register, a revised list of the indications for the short-acting, systemic sulfonamides, which will include the indication for use in otitis media due to H. influenzae. Concurrent administration of sulfonamides with adequate doses of penicillin is recommended in the treatment of H. influenzae-caused otitis media.

We appreciate very much your letter and your offer of assistance in decisions regarding drug therapy in infants and children. I understand this assistance has been helpful to us in the past, and I believe that the Food and Drug Administration is represented on your Committee. We look forward to still closer cooperation with your Committee and with the Academy.
Letter To The Editor
Authors: Seagle Joseph B.
Published: December 2021

I started asking my associate Dr. Hugh C. Thompson 2 or 3 years ago when the members of the Academy might expect an up-to-date combined index to supplement the one that was put out many years ago for Vol. 1 through 20 of Pediatrics (1948 to 1957).

It would be a tremendous help to those of us in practice if the last 13 years could be added to a combined index so that when we want to look up references for a complicated or difficult case, we could do it without going through every 6-month index over all of these years.
Letter To The Editor
Authors: Murphy Solbritt , Chapman Warren
Published: December 2021

Needling hurts less when it is amusing.

Drs. Murphy and Chapman comment on Dr. Fink's letter as follows:

Is the true measure of success the realization that someone really reads what you write? If so, we must have made it, judging by the thoroughness of Dr. Fink's critique. Not to find sex in an article one reads so carefully is certainly disappointing. There were 6 girls and 21 boys in the enuretic group. Among the girls, two had urethral strictures, grade 1 and 2 respectively, one a meatal stricture, grade 1, one had chronic urinary tract infections, one had a horse shoe kidney, and one had an incomplete work-up.
Letter To The Editor
Authors: Medearis Donald N.
Published: December 2021

Dr. Medearis offered the following brief reply:

The information presented by Drs. Nakao and Chiba is interesting and probably significant. The use of the macroglobulin technique developed by Dr. Hanshow is an important way to further pursue the possible relationship between microcephaly, mental retardation, and cytomegalovirus infection. We can look forward with anticipation to receiving the results of Drs. Nakao's and Chiba's studies of a very much larger number of microcephalic and normal infants using this technique.
Viral Infections of the Human Fetus, by Gilles R. G. Monif, M.D. New York: The Macmillan Company (866 Third Avenue, New York 10022), 1969, 164 pp., $9.95
Authors: Eichenwald Heinz F.
Published: December 2021

Because of a longstanding interest in the subject, I began to read this small book with some enthusiasm which, however, soon turned to disinterest and finally faded into boredom. It is not unreasonable, I believe, to require that a monograph on a specific subject should illuminate it, summarize and analyze available information, and offer perhaps some new insights or interpretation. This volume accomplishes none of these goals. In a rather pedantic manner, it winds its way through the various congenital infections; the information presented is usually less complete than that which can readily be found in any of several recent journal or monograph series reviews.
GENERALIZED LYMPHANGIOMA IN INFANCY WITH CHYLOTHORAX
Authors: Morphis Leonidas G. , Arcinue Edgardo L. , Krause John R.
Published: December 2021

A case of generalized lymphangioma in a 9-month-old boy is described. Radioisotope studies using radioiodinated human albumin and triolein demonstrated a primary disorder in the lymphatic system. Postmortem findings revealed lymphangiomatous involvement of numerous bones, the posterior mediastinum, and the spleen, while dilated lymphatic channels were present in other viscera. The findings support the hypothesis of a generalized lymphatic abnormality.
Brazilian Contribution to Phototherapy
Authors: Senna José Olympio
Published: December 2021

Pediatrics published (44:155, 1969) a Commentary, "Nursery Illumination as a Factor in Neonatal Hyperbilirubinemia," by Jerold F. Lucey, and an article (44: 162, 1969) "Effect of Environmental Illumination in Prevention of Hyperbilirubinemia of Prematurity," by F. Giunta and J. Rath. I confess that, at first, I was glad to notice that phototherapy had managed to draw the approval of American investigators because, although this method originated in England, it was in Brazil that it was first used on a large scale.
Letter To The Editor
Authors: Lucey Jerold F.
Published: December 2021

I have always been impressed by the work done in phototherapy by Brazilians. In our 1968 article1 we actually referred to 9 of the 10 Brazilian authors mentioned by Dr. Senna. Now that there is so much concern and controversy in this country on the use of phototherapy it would be great if once again Brazil led the way by publishing some follow-up studies of infants treated by phototherapy over a decade ago. These studies would be very useful, and I'm sure avidly read by North Americans now that we have "seen the light."
TREATMENT OF CHRONIC UREMIA IN CHILDHOOD. II. HEMODIALYSIS
Authors: Potter Donald , Larsen Duane , Leumann Ernst , Perin David , Simmons James , Piel Carolyn F. , Holliday Malcolm A.
Published: December 2021

Fourteen children, 2 to 16 years of age, were dialyzed three times weekly for periods of 1 to 27 months on the modified Kiil or Dow Hollow Fiber Kidney. There was one death—from recurrence of Wilms' tumor—and seven children received renal transplants. The superficial femoral, brachial, posterior tibial, or radial artery was cannulated and blood flow during dialysis was > 150 ml/minute without a pump. Mean pre-dialysis serum urea nitrogen levels of 70 to 86 mg/100 ml were maintained in children from 10 to 52 kg by varying the efficiency of the dialyzer and the number of dialysis hours with the size of the child. The children were active and symptoms of uremia were uncommon.

Complications found included hemodynamic effects of the shunt, shunt clotting and infection, anemia, hypertension, heart failure, and renal osteodystrophy. Growth was related to calorie intake and was normal in four of eight children. Chronic dialysis was considered successful therapy for uremic children.
Needles for Percutaneous Renal Biopsy in Infants and Children
Authors: Metcoff Jack
Published: December 2021

The thin musculature and relatively small kidneys of infants and young children do not readily accommodate the rather heavy percutaneous renal biopsy needle with its large, projecting, cutting blades, which has been used with relative safety and success in adults. For use in children, the reduction in length of the adult-type needle usually is accomplished by shortening the length of the shaft. This is done by removing a segment at the end opposite to the cutting blades, without diminishing the projection of these blades. The weight of the Franklin-Silverman small version, commercially available, is about 17 gm. The cutting blades project about 22 mm.
Evaluation of Routine Examinations: Is the Private Practice of Pediatrics by the Pediatrician Ineffective?
Authors: Heller George
Published: December 2021

Though it grieves me, a former Yale intern during the days of Doctors Park and Powers, to support the doubts of Harvard Doctors Peebles1 and Yankauer,2 I am unwilling to accept Dr. Anderson's conclusions that the private practice of pediatrics by the pediatrician is ineffective.3

During the course of an office visit a comparatively short time is spent in examining the child. In my own practice and that of my colleagues in "country" as opposed to institutional practice, while the nurse is undressing and weighing the baby my time is spent in interviewing the parent and discussing problems that are disturbing her and then, after examining the baby, in reviewing my findings with her.
In Reply: Head Circumference Growth in North American Negro Children
Authors: Verghese Kannarkat P. , Scott Roland B.
Published: December 2021

The purpose of our publication was to augment the fragmentary data currently available for the growth of North American Negro children beyond infancy. The children in this study were from low income levels with an annual income less than $3,000 for a family of three. We characterized the children as normal and healthy in the sense that they were "free from any chronic and debilitating disease or congenital anomalies." According to Webster's Seventh New Collegiate Dictionary "healthy implies full strength and vigor as well as freedom from signs of disease"–obviously these words may convery different shades of meaning depending upon the context of usage and the interpretation of the reader.
DISADVANTAGED CHILDREN: HEALTH, NUTRITION, AND SCHOOL FAILURE, by Herbert G. Birch, M.D., Ph.D. and Joan Dye Gussow. New York: Grune & Stratton, Inc., 1970, 322 pp., $7.50
Authors: Coles Robert
Published: December 2021

Books like this one, meant to clarify honestly and thoroughly the prospects of poor children, the fate that awaits them, can only be considered a mixed blessing; one welcomes them, applauds them–and then sinks into a sullen mood or an outraged fit, because neither the authors nor their readers are in a position to feel any reasonable optimism that the conditions described in Disadvantaged Children will not persist right through the seventies and into the eighties-until God knows when.
PSYCHIATRY FOR THE PEDIATRICIAN, by Stuart M. Finch, M.D., and John F. McDermott, Jr., M.D. New York: W. W. Norton Company, Inc., 1970, 236 pp., $7.50
Authors: Lewis Melvin
Published: December 2021

This book is an excellent primer for the uninitiated pediatrician. The points of view expressed are sound, and the substantive material is based on a thorough understanding of the subject matter. The book is well organized and is divided into three sections. The first section describes in very general terms an overview of psychological development during childhood from a psychoanalytic standpoint. The second section consists of brief descriptions of seven major types of problem children, including such topics as children who are neurotic, psychotic, psychosomatically ill, mentally retarded, brain damaged, or who have a behavior disorder or a learning disorder.
CONGENITAL DEFICIENCY OF FACTOR XIII: REPORT OF A FAMILY FROM NEWFOUNDLAND WITH ASSOCIATED MILD DEFICIENCY OF FACTOR XII
Authors: Hanna Mary
Published: December 2021

In the article, "Deficiency of Factor XIII: Report of a Family from Newfoundland with Associated Mild Deficiency of Factor XII," by Dr. Mary Hanna (Pediatrics, 46: 611), on page 617, the XII under Effect of Transfusions should have been XIII. The correction has been made in the author's reprints.
THE USE OF GRIST MILLS IN THE TREATMENT OF WHOOPING COUGH ACCORDING TO DR. ROBERT JAMES (1705-1776)
Authors: C. T. E.
Published: December 2021

Folk medicine, both in the United States and Great Britain, contains many references to the use of grist mills in the treatment of whooping cough.1 Most writers advised taking a child with whooping cough into a grist mill and holding it over the hopper so that he might inhale the dust from the mill. An even more curious and inhuman use of a grist mill is described by Dr. Robert James in his three-volume medical dictionary of 1743-1745:

Another empirical method of curing the Chincough when Medicines prove ineffectual is to fright the Child by putting it in the Hopper of a Mill, which makes a terrible Noise, and the Aspect of whose Wheels is dreadful; and by this Method a Chin-cough is sometimes suddenly cured; the Reason son of which undoubtedly confits (sic) in this, not only that the animal Spirits, being, by the Fright, forced into new Distractions, leave their former inordinate Motions, but also, that the matter producing the spasms is, by such Perturbation, either dissipated, or forced into other Nerves, where it proves less troublesome.2
Can the de Lange Syndrome Always Be Diagnosed at Birth?
Authors: Pashayan H. , Levy E. P. , Fraser F. C.
Published: December 2021

The comment "... The children are diagnosable at birth. This resemblance to one another is as striking to us as the resemblance of mongols to each other"1 holds true for most, but not all cases of the de Lange syndrome.2,3

This paper will describe a patient who at the age of 9 months had features suggestive of Turner's syndrome, and at the age of 21 months had the typical appearance of the de Lange syndrome.

Case Report

The patient, a Caucasian female, was the third child of unrelated parents who were 28 and 30 years old respectively when she was born January 29, 1968.