bluuebunny/crossref_metadata_2025 huggingface dataset:
THE AGE AT WHICH A CHILD SHOULD BE ENCOURAGED TO WALK ACCORDING TO DR. HUGH SMITH WRITING IN 1772
Authors: C. T. E.
Published: December 2021

In his delightful Letters to Married Women on Nursing and the Management of Children, first published in London in 1772, eighteenth century mothers read this about the age at which children should be put upon their feet.

I beg leave, my fair friends, to say something concerning their being put upon their feet. With respect to the time, the strength of the child must determine that period. Of this be assured, that all children will shew (sic) an inclination to walk, as soon as their bones have acquired a firmness sufficient to support the body. I am fearful many heavy children are injured by exciting their feeble efforts to walk too soon. Doubtless it is a convenience and ease to nurses to set them upon their feet, as they do not then require exercise in the arms; and consequently are not so great a trouble and fatigue to those who have the care of them. But it is a fault entirely to be condemned, and what I particularly caution you against; because, whoever you may have to attend upon your children, they will certainly encourage them to walk, for reasons above mentioned.

Therefore throw aside your leading-strings, and your back-strings, and every other crafty invention which tends to put children forwarder than Nature designed. Our young plants are to be cultivated without art. The industrious gardener, it is true, can boast of his exotics, and early fruits, by forcing their growth. Yet say, ye sons of Epicurus, are your grapes or pines thus raised equal to the produce of their natural climate?
HOW JOHN QUINCY ADAMS, THE SIXTH PRESIDENT OF THE UNITED STATES, MANAGED HIS GRANDSON'S SCHOOL PHOBIA
Authors: C. T. E.
Published: December 2021

Henry Adams (1838-1918), in his superb autobiography, The Education of Henry Adams, describes his school phobia and what his grandfather, President John Quincy Adams (1767-1848) did about it as follows:

... but he distinctly remembered standing at the house door one summer morning in a passionate outburst of rebellion against going to school. Naturally his mother was the immediate victim of his rage; that is what mothers are for, and boys also; but in this case the boy had his mother at unfair disadvantage, for she was a guest, and had no means of enforcing obedience. Henry showed a certain tactical ability by refusing to start, and he met all efforts at compulsion by successful, though too vehement protest. He was in fair way to win, and was holding his own, with sufficient energy, at the bottom of the long staircase which led up to the door of the President's library, when the door opened, and the old man slowly came down. Putting on his hat, he took the boy's hand without a word, and walked with him, paralyzed by awe, up the road to the town. After the first moments of consternation at this interference in a domestic dispute, the boy reflected that an old gentleman close on eighty would never trouble himself to walk near a mile on a hot summer morning over a shadeless road to take a boy to school, and that it would be strange if a lad imbued with the passion of freedom could not find a corner to dodge around, somewhere before reaching the school door.
Skin Creases on the Sole of the Foot as a Physical Index of Maturity: Comparison Between Caucasian and Negro Infants
Authors: Damoulaki-Sfakianaki Eleni , Robertson Alex , Cordero Leandro
Published: December 2021

It has been known that the development of skin creases on the sole of the foot occurs in late intrauterine life and that after birth this is a helpful clinical sign to determine gestational age. Until 36 weeks of gestation there are only one or two transverse skin creases on the anterior part of the sole. The posterior two-thirds of the sole are smooth. By 37 to 38 weeks of gestation more creases have appeared and in the full-term infant there is a complex series of criss-crossed creases covering the entire sole.

Since no racial differences in the presence or absence of this sign have ever been published a study was designed to compare the development of skin creases on the sole of the foot between Caucasian and Negro newborn infants.
Excerpt III: Waggoner and Hercules
Authors: Cone Thomas E.
Published: December 2021

The fable illustrated be1ow1 shows the manner in which children of the early nineteenth century were taught about right and wrong. There was always the same sharp contrast; laziness suffered prompt and severe punishment, and initiative was as promptly and decisively rewarded. Actual experience may have been sorely disappointing to the child who unequivocally accepted the lesson of this fable.2
Letter to the Editor
Authors: Cook Charles D. , Duff Raymond S.
Published: December 2021

We certainly agree with Dr. Rako that a fulltime Chief of Pediatrics in a Community Hospital should decrease unnecessary hospital admissions. We currently have an opportunity to reexamine the admission practices of one of the community hospitals studied earlier to see if such is the case; our preliminary findings suggest that the full-time chief, without a critical house staff, may have disappointingly little influence on the criteria used for admission.

In regard to the comment of "I. M. Tired": we are having pediatricians from community hospitals review records from the "Ivory Tower" and from the community hospitals; hopefully this will have an educational value for both professional groups.
Letter to the Editor
Authors: Filer L. J.
Published: December 2021

The Committee on Nutrition report on "Childhood Diet and Coronary Heart Disease" may appear "typical and old-fashioned" even though it highlights total calories and intake of saturated fats as recommended by Dr. Stare. The recommendation that unproven preventive measures be tested in a group at high risk of disease is good experimental design. The testing of extremes to evaluate an unproven effect can save considerable research dollars and effort. Based on the findings from genetically defined populations, a more meaningful approach can be made to the population at large.
THYROXINE-BINDING GLOBULIN DEFICIENCY AND ASSOCIATED NEUROLOGICAL DEFICIT
Authors: AvRuskin Theodore W. , Braverman Lewis E. , Crigler John F.
Published: December 2021

Thyroxine-binding globulin deficiency and significant mental deficiency were found to be associated in four males of one family, all of whom had absence of serum thyroxine-binding globulin (TBG). In 18 family members studied, two additional females had a decreased thyroxine (T4) binding capacity of TBG but were not retarded. No other specific cause of the mental retardation could be elicited. The hereditary nature of TBG deficiency and the associated neurological and mental defects could suggest that the gene loci for these disorders are "near" to each other, although no evidence is available to verify this possibility. The spectrum of this disorder should now be widened to include mental retardation as one of its features.
Corticosteroids in the Treatment of Croup
Authors: Yaffe Sumner J.
Published: December 2021

The use of corticosteroids in croup remains controversial as evidenced by the many recent Commentaries in Pediatrics.1

The Committee on Drugs has been concerned about the lack of well-controlled studies on this question. A similar concern was expressed in its recent statement on the use of steroids in bronchiolitis.2 Therefore, at the request of an Academy Fellow, the Committee has prepared a suggested protocol for a multiclinic study of corticosteroid usage in croup. This should prove useful to all who plan well-controlled clinical studies on this controversial question.
When A Child Goes to the Hospital, by Anne Leslie Moore. Medford, Massachusetts: Alumnae Association of the Eliot-Pearson Department of Child Study, Tufts University, 1971, 34 pp., $1.00
Authors: Piazza Eugene U.
Published: December 2021

This book's purpose is to provide parents with a useful discussion of the child's needs as he prepares for admission to the hospital. The admission procedure is fully explored both in regard to what might be expected from the hospital as well as in helpful hints to assuage the child's anxiety about what will happen to him when he becomes a hospital patient. The author correctly stresses the child's need to have something from home to gain comfort during his stay in the hospital.
Cancer Diagnosis in Children, by L. D. Samuels, M.D. Cleveland: The Chemical Rubber Company, 1972, 131 pp., $25.00
Authors: Jaffe Norman
Published: December 2021

Cancer Diagnosis in Children is a review of the diagnostic work-up which the author claims will be of interest to the general physician, paramedical personnel, students, and anyone concerned with child health. The text is presented in readable style, culminating in an extremely useful appendix (Chapter 7) . This provides a concise resume of the information presented in the previous six chapters. It adds to the quality of the book which could have been further enhanced by the inclusion of an index, which I found sadly lacking.
NATURALISTIC OBSERVATIONS IN A PEDIATRIC OUTPATIENT CLINIC
Authors: Green Morris
Published: December 2021

The naturalistic observations on life in the Yale Pediatric Clinic by Duff and his co-workers in this issue carry the potential of an important service to American pediatrics if their publication stimulates constructive change. Because their findings can be widely generalized throughout the nation and this is a time of rapid reinstitutionalization of health services, it would appear likely that this manuscript will stimulate thoughtful reaction from many groups. The paper by Duff et al. presents observations on a medical model of care that is not working adequately not just in New Haven but in other leading medical centers throughout the country. Since it has not worked in the past and it does not now, what is its future?

This paper demonstrates forcefully the need for a statement of objectives to be transmitted to the student, the instructor, the patient, and the hospital administrator. Such stated objectives and a regular evaluation of the extent to which they are being met should be a basic requirement for pediatric outpatient departments not only for educational purposes but also as a highly effective management tool. Another educational principle that needs to be invoked in situations such as described is that the educational challenge should be graduated according to the readiness of the student. The student preformance expected in a clinical situation should exceed, but only to a reasonable extent, his current level of ability to deliver such services. Undergraduate students generally do not have yet all the skills required to encompass simultaneously complex biomedical and psychosocial facets of health and disease, especially when the patients present, in such a high percentage of cases, extremely complex situations.
ANNUAL SUMMARY OF VITAL STATISTICS—1971
Authors: Wegman Myron E.
Published: December 2021

Births in 1971 were lower than in 1970 (Table I); the birth rate turned down again; deaths were about the same; and the natural increase in population, 1,638,000 or 0.8%, was the lowest in several years. Infant mortality continued to drop slowly, marriages were down slightly, and divorces were up slightly.

Data for this article, as in previous reports, are drawn principally from two sources: the Monthly Vital Statistics Report, published by the National Center for Health Statistics, and the Demographic Yearbook and the monthly quarterly, Population and Vital Statistics, published by the Statistical Office of the United Nations. The limitations on the data used are explained in these reports and do not differ from previous years.
Excerpt VI: Fisherman and the Fish
Authors: Cone Thomas E.
Published: December 2021

A FAVORITE moral taught to our schoolchildren a century and a half ago was that a bird in the hand is worth two in the bush.1 This precept was reinforced by also having the children memorize the following quotation from Horace: Snatch the sleeve of today and trust as little as you may to to tomorrow.
Letter to the Editor
Authors: Katz Samuel L.
Published: December 2021

Dr. Barton is an astute and well-informed reader whose comments are absolutely correct. The Committee on Youth report on "Venereal Disease and the Pediatrician" must have been prepared prior to publication of the revised recommendations of the U.S. Public Health Service for treatment of gonococcal infection. The dosages, routes, and alternatives which she has accurately quoted should be substituted for those in the footnote (p. 494) of the journal's September issue.

Thank you, Leslie, for calling this to our readers' attention.
Mortality, Fatality, and Morbidity (Proper Use of Terms)
Authors: Top Franklin H.
Published: December 2021

The interesting article by Alden et al. in the July 1972 issue of Pediatrics is a too common example of the incorrect use of the word mortality where fatality is intended.

Mortality represents the number of deaths per unit of population (100,000 now generally used and indicated) which population consists of the sick and the well, thus:

mortality

= deaths (for a given illness)/unit of population (100,000 sick and well)

Fatality is based on the number of deaths per 100 cases of a given disease:
Diaper Rash: More Truth (We Hope) Than Poetry?
Authors: Hall Caroline B.
Published: December 2021

Diaper rash plagues Mom and doctor, too. Baby's bottom's bathed with salves anew, Or Mother's told no pants must be the cure; And hence, it's endless wash she must endure.

What remedy? A sanitary pad!

'Neath cloth or paper diaper you may add One pad per daytime change or two for night.

This makes less diapers used and bottoms right.

The cost per dime store pad's about three cents, But less prescriptions, wash are recompense!
"urse" Poisons
Authors: Shulman Bernard H. , Reddy Gaddam D.
Published: December 2021

Recently we have become very impressed with a hitherto unpublicized source of poisoning for children, namely the female purse. Medication carried in the purse for personal use is a ready source of poisons for the curious child, who customarily seeks candy, gum, and other treasures within the purse or handbag. Multicolored pills and tablets not intended for the child are often carried, and easily accessible.

The awareness of this additional source of potential and actual poisoning in childhood led us to make a random survey of 300 females accompanying children to our various clinics. These ladies included mothers, grandmothers, and other relatives and friends.
Alert Practitioner Program
Authors: Harrison Stanley L.
Published: December 2021

The best clues to etiology often come from observations made by alert practitioners. Every major human teratogen has, in fact, been revealed in this fashion. Rubella embryopathy was recognized by an Australian ophthalmologist, phocomelia was first linked to thalidomide by an Australian obstetrician and a German human geneticist, and recognition that radiation could induce microcephaly and mental retardation was advanced by Philadelphia obstetricians.

This history has led to the establishment of an "Alert Practitioner Program."
Letters to the Editor
Authors: Kenny Thomas J. , Clemmens Raymond L.
Published: December 2021

Before formally closing this correspondence we add the comments of Drs. Kenny and Clemmens:

Dr. Gregory agrees with the central conclusion of our paper in his opening paragraph. Some misguided school systems had even come to the position of requiring neurological consultations and EEC's on each child prior to admission to appropriate educational programs.

We feel the approach outlined by Dr. Gregory has greater utility. We particularly agree with his next to last paragraph and the point of view that pediatricians must learn about learning difficulties.
Sociology In Medicine, ed.2, by M. W. Susser and W. Watson. New York/Toronto/London: Oxford University Press, 1971, 468 pp., $11.50
Authors: Talbot Nathan B.
Published: December 2021

This book reflects the epidemiologic and sociologic approach of the authors to medicine. Thus, several of the early chapters are concerned with relationships between the economic condition of people, population size, cultural attitudes and practices, social mobility, and disorders of health. While most of this material is set forth in broad, general terms, some of the information, such as that relating to doctor-patient relationship, social support and the sick role is directly relevant to the daily work of health care professionals.
ULTRASONICALLY GUIDED SUPRAPUBIC URINARY BLADDER ASPIRATION
Authors: Goldberg Barry B. , Meyer Harold
Published: December 2021

Ultrasound has been used successfully to evaluate for the presence of urine within the urinary bladder prior to percutaneous suprapubic urinary bladder aspiration in 18 cases. When an echo-free zone indicating fluid was recorded, the skin was prepared using established techniques for suprapubic aspiration. A sterilized, specially modified ultrasonic transducer with a central lumen was then placed on the anterior abdominal wall above the pubis and a needle was directed into the urinary bladder. Continuous ultrasonic monitoring was provided by means of an echo produced at the needle tip. This allowed the exact location of the needle within the urinary bladder to be known at all times. With this technique, it was possible to avoid needling infants who had no urine in the bladder.
NONOPERATIVE DIAGNOSIS OF HIRSCHSPRUNG'S DISEASE IN NEONATES
Authors: Suzuki Hiroshi , White John J. , Shafle Mohamed El , Shaker Issam J. , Haller J. Alex , Schnaufer Louise
Published: December 2021

Twenty-eight neonates who presented with symptoms suggestive of Hirschsprung's disease have been studied by the technique of anorectal manometry using newly developed, miniaturized instrumentation. Eight infants have demonstrated the typical lack of relaxation of the smoothmuscle internal anorectal sphincter characteristic of Hirschsprung's disease. Aganglionosis has been demonstrated histologically in all eight, including two prematures; the remainder have not developed any sign of Hirschsprung's disease. This miniaturized technique of anorectal manometry may provide an accurate, simple, and atraumatic method for identifying Hirschsprung's disease in the newborn infant.
RETROLENTAL FIBROPLASIA IN A CYANOTIC INFANT
Authors: Kalina Robert E. , Hodson W. Alan , Morgan Beverly C.
Published: December 2021

In the Abstract of the article by Drs. Kalina, Hodson, and Morgan: Retrolental Fibroplasia in a Cyanotic Infant, Pediatrics, 50:765 (November), 1972, the word "not" was omitted from the second sentence. This should begin: "Arterial oxygen tensions usually considered to be pathologic were not noted in this infant and would not appear to have been possible..."
FURTHER COMMENTS
Authors: Yankauer Alfred
Published: December 2021

This is Dr. Wilson's wisdom, and–better still–the Wilson touch. It is this touch which is the essence of pediatrics and few could express it as simply and clearly as Dr. Wilson.

From the vantage point of one who has spent most of his career dealing with issues on a community basis, I would like to add a few reactions.

The first is the slightly sad reflection that part of this learning experience was hidden from Dr. Wilson until he had left Academia and research. It is not as if the kind of role which the public health nurse later filled with Dr. Wilson, the practitioner, did not exist 30 years ago. Public health nurses have performed this role for many years. Unfortunately, their contribution to child health care was excluded–perhaps even downgraded and scorned–by many of the hospital-trained and biomedically oriented professors of the times and by the generation of practitioners who were exposed to the models of their preceptors. I can remember the early impression of Dr. Wilson's humane perfectionism upon me very well. He approached children and families with the same innate understanding of the psychosocial aspects of health and disease that graces his words today. But would he have considered delegating responsibility, or working as a "team member," to formulate a joint plan in the past? In fact, I believe he once expressed himself against the whole concept of "team care" as divisory of patient care responsibility.

The other reaction is to reinforce Dr. Wilson's emphasis on the contribution of the nurse to the quality of patient care rather than to increasing the numbers of patients seen.
EFFECTS OF BRIEF POSTNATAL FASTING UPON BRAIN DEVELOPMENT OF RABBITS
Authors: Schain Richard J. , Watanabe Kathy , Harel Shaul
Published: December 2021

Newborn animals were subjected to a two-day postnatal fast immediately after birth. These animals and control littermates matched for birth weight were killed at 60 days of age. The brain was weighed, divided into regional brain areas, and analyzed for DNA, RNA, protein, and cholesterol content. Those fasted animals whose body weight was more than 25% below the control littermate at 12 days of age exhibited a significant reduction of brain weight and constituents at 60 days of age (group II). Cholesterol accumulation was slowed to a greater extent than other constituents (84% of control values) but DNA, RNA, and protein levels were also diminished in a statistically significant manner. Those fasted animals whose body weight nearly caught up to the controls after the fast did not manifest differences of brain size and composition at 60 days of age (group I). When adjusted for life span, the timetable of resumption of weight gain in fasted rabbits is comparable to the time required for regaining birth weight of very low birth weight human infants. These data indicate that the degree of body weight catch-up after a brief postnatal fast will affect subsequent brain development in the rabbit, a species which, like the human, is a perinatal brain developer.
SCREENING FOR LEAD POISONING IN CHILDREN
Authors: Chisolm J. Julian
Published: December 2021

Substantial progress has been made during the past two years in micro techniques for the detection of metabolic injury due to lead and for the measurement of lead in blood. The pediatrician now has at least one index of absorption and one index of toxicity which can be measured in blood. The report of Piomelli et al.1 on the relationship between the concentration of protoporphyrin (FEP test) and lead in peripheral blood is quite consistent with the reports of Granick et al.2 and Kammholz et al.3; namely, as with other heme precursors,4 there is a statistically significant positive curvilinear relationship between the concentrations of protoporphyrin and lead in peripheral blood.
Nitroblue Tetrazolium Dye Reduction by Neutrophils From Patients With Streptococcal Pharyngitis
Authors: Shapera Ronald M. , Matsen John M.
Published: December 2021

During peak clinical symptoms, 17 patients with culture proven group A streptococcal pharyngitis had less than 9% NBT-positive neutrophils. The NBT test thus does not appear to be useful in differentiating streptococcal from nonstreptococcal pharyngitis.
Handbuch der Kinderheilkunde: Tumoren IM Kindesalter, Vol. VIII/2, edited by H. Opitz and F. Schmid. Berlin/Heidelberg / New York: Springer-Verlag, 1972, 770 pp., $89.70
Authors: Eichenwald Heinz F.
Published: December 2021

Much to this reviewer's relief, and no doubt to that of the readers of this column, publication with subsequent review of the monumental Handbuch der Kinderheilkunde is nearly complete. The present book, which represents Part 2 of Volume VIII, leaves only one part of Volume I (Developmental Pediatrics) to be reviewed.

The reader will recall that this enormous publishing feat began in 1963, when Volume V (Infectious Diseases) was issued. In the intervening years, 12 massive books of nearly 1,000 pages each have appeared and have, almost without exception, become important reference sources in pediatric libraries.
The Merck Manual, David N. Holvey, Editor, John H. Talbott, Consulting Editor. Twelfth Edition, Rahway, New Jersey: Merck & Co., Inc., 1972, 1893 pp. (plus 70-page index). Bound for students, nurses, residents, interns $6.40; otherwise regular binding $8.00
Authors: S. C. A.
Published: December 2021

The reviewer, suddenly realizing that he saw his first Merck Manual more than 40 years ago, volunteered to review this twelfth edition for Pediatrics, provided the Merck, Sharp and Dohme Company would send him some background information. They did.

From information thus received, it appears that the reviewer's Manual of the late 1920s must have been the 592-page fifth edition. He remembers that it fitted without difficulty into the pocket of his white suit, and was often removed for prompt help with such matters as the conversion of centigrade into fahrenheit, the incubation periods of infectious diseases, the normal values of laboratory tests, the chemical symbols of the less commonly encountered elements, and the caloric values of the common foods.
THE NONOPERATIVE TREATMENT OF SURGICAL CONDITIONS IN CHILDREN
Authors: Ravitch Mark M.
Published: December 2021

As the derivation of the word surgeon from its Greek roots indicates–however much to the dismay of today's cerebral practitioners of the craft–the surgeon is a manual worker. The operative act is so central to surgery and to the life of the surgeon that it has come almost to be equated with surgery and, although I decry it, the word surgery frequently replaces the word operation.

The fact is, nevertheless, that operation, being the application of a mechanical technique to disease, is properly employed in the solution of mechanical problems. It is true that, in the past and in the present, some of the most brilliant achievements of surgery have been in the cure or correction of dangerous diseases certainly not mechanically caused, for which there was no nonoperative treatment. This was certainly true until recently for exophthalmic goiter and for that matter, while all would agree that ultimately some nonoperative method will prevail, there are many patients still–and children specifically–in whom I, among others, think hyperthyroidism is still best treated by operation. Nothing else is quite so successful as operation in the treatment of duodenal ulcer or most forms of cancer, yet all of us will accept the fact that in the end, since these are, except in their late stages, not mechanical diseases, specific and nonoperative treatments will be devised which will aim at directly reversing the causative mechanisms. It is precisely in this sort of a search that surgeons are constantly engaged. True enough, as surgeons, we believe that operations are unequivocally good for people.
DESCRIPTION OF A DAME OR PRIMARY SCHOOL IN BOSTON ABOUT 1825
Authors: C. T. E.
Published: December 2021

Many New England children in the early 1800s attended dame schools before being admitted to the common schools. In these dame schools, pupils as young as 3 or 4 years, were taught the alphabet and a little reading and writing by a maiden lady; but reading for the very small rarely extended beyond the criss-cross row of the horn book or the simple lessons of the New England Primer. Many towns in New England supported dame schools as their only source of primary education.1

Mrs. Livermore gives this vivid picture of one of these schools she attended in Boston about 1825:

The primary (dame) schools which received children at the age of three or four years were very shabby. As I remember them; they were kept, not taught by elderly or middle-aged dames, who dozed in the chairs, took snuff, drank tea, and often something stronger from a bottle stowed away in a cupboard. At one of these schools kept by Ma'am Adams, I was daily sent to the grocery store for the teacher's 11 o'clock dram of New England or Santa Cruz rum, until my mother discovered the practice, when my father called upon the mistress and forbade her to send me on such errands.

The school benches on which we sat were without backs and sometimes so high that we beguiled the weary school hours by swinging our feet violently back and forth, by which process we worked off a good deal of animal vigor. We sometimes tipped off the bench backwards, and fell atop the children behind us, when we all set up a prodigious howling; not because we were hurt, but we enjoyed the noise hugely and prolonged the commotion as long as we could.
Filled Milks, Coconut Oil, and Atherosclerosis
Authors: Fowler Richard L.
Published: December 2021

The Committee on Nutrition in its statement on filled milks, imitation milks, and coffee whiteners,1 points out the widespread use of coconut oil and hydrogenated corn oil as a substitute for butter fat. The only possible adverse effect mentioned is that of linoleic acid deficiency and the statement is made, "however, in general, filled milks usually offer no serious hazard in the diet of young children."

Recommendations concerning fat intake by the Inter-Society Commission for Heart Disease Resources2 indicate that a high intake of saturated fatty acids may not be harmless in terms of development of atherosclerosis.
Letters to the Editor
Authors: Helwig Helmut
Published: December 2021

Dr. Larkin is correct in noting that hyperammonemia is a complication of parenteral aumentation. When the note of caution was prepared by the Committee on Nutrition, little published information was available concerning hyperammonemia as a pediatric problem due to the administration of protein hydrolysates, although the presence of high ammonium concentration in protein hydrolysate preparations had been known for at least 15 years.1,2 Webster and Davidson1 and Finkbiner and coworkers2 demonstrated that normal subjects tolerated infusion of protein hydrolysates, while subjects with hepatic disease showed markedly increased ammonia levels during infusion.
Letters to the Editor
Authors: Neal William A. , Reynolds John W. , Jarvis Charles W. , Williams Hugh J.
Published: December 2021

As Dr. Helwig suggests, the rapid infusion of substances of very high osmolarity or alkaline pH, such as 50% glucose and THAM, through umbilical artery catheters is potentially harmful. Hyperosmolar solutions are known to cause localized intimal damage, predisposing to thrombus formation.

We did not mean to imply that all of the babies in our study continuously received THAM, 50% glucose, and sodium bicarbonate. The maintenance solution was indeed usually 10% dextrose with 200 units heparin/liter added, and many infants with RDS received slow infusions of diluted sodium bicarbonate solutions in doses sufficient to correct metabolic acidosis.
Letters to the Editor
Authors: Coburn Michael D.
Published: December 2021

Kattwinkel et al.1 state that "arginine is contraindicated in the treatment of cystic fibrosis." We do not accept this statement because their investigation was improperly controlled for studying arginine therapy in cystic fibrosis. Arginine enhances the activity of lipase and trypsin, and since pancreatic enzymes were completely absent in Kattwinkel's patients, it is not surprising to us that they failed to reduce steatorrhea. All they have proved is that their regimen of arginine without pancreatic enzyme supplements in older patients is ineffective in individuals who have complete pancreatic insufficiency.
Letters to the Editor
Authors: Cotton Ernest K. , Solomons Clive C. , Dubois Reuben , Kattwinkel John , Di Sant'Agnese Paul A.
Published: December 2021

We appreciate the comments by Drs. Cotton, Solomons, Dubois, and Coburn, but would like to express the following points:

1. The original paper by Solomons et al.1 speculated that arginine was effective because of its ability to buffer gastric acid, enhance ". . mixed micelle formation, . . . break hydrogen bonds, bind metal ions, and act as a detergent." It was with these properties in mind and also with the observation by Solomons et al. that five of their seven patients studied without pancreatic enzyme supplement seemed to have a significant reduction in steatorrhea when treated with arginine, that we decided to study the effect of the compound alone-without exogenous enzyme.
Childhood Poisoning: Importance of Early Rising
Authors: DeCastro Fernando J. , Kocur Janice L.
Published: December 2021

There are numerous studies on the epidemiology of childhood poisoning. Studies on the time of the day during which poisoning episodes are more likely to occur have shown a consistently higher incidence of poisoning during "mother's busiest time."1 However, the early morning hours are not included among the "mother's busiest time." Poison calls were tabulated in order to determine the time of greatest risk for childhood poisoning to occur.

The 276 poisoning calls which were recorded during four months showed that: 49 (18%) occurred between 6 and 9:59 am; 61 (25%) between 10 am and 1:59 pm; 59 (21%) between 2 and 5:59 pm; 89 (32%) between 6 and 9:59 pm; 17 (6%) between 10 pm and 1:59 am; and 1 (0.3%) between 2 and 5:59 am.
Child Psychiatry, ed. 4, by Leo Kanner, M.D. Springfield, Illinois: Charles C Thomas, 1972, 735 pp., $16.50
Authors: Aug Robert G.
Published: December 2021

During the 1930s, '40s, and '50s, Leo Kanner's Child Psychiatry was the textbook of the field. All other books on child psychiatry were much more limited in scope and point of view; only Kanner's book had the comprehensiveness (and the format) that could stand in the same class as a textbook of medicine, surgery, or pediatrics.

However, during the past 12 years, other child psychiatry textbooks have appeared, books which have compared more and more favorably with Kanner's especially in their having more current information; and as the years passed Kanner's last previous edition (1957) has seemed increasingly out of date.
VARIATION OF CORD IgM LEVEL WITH BIRTH WEIGHT
Authors: Yeager Anne S.
Published: December 2021

Analysis of 5,075 cord IgM levels according to birth weight shows an increase in the 97th percentile of about 0.5 mg/100 ml with every 200 gm increase in birth weight above the 1,800 gm level.

Cord IgM levels of infants weighing less than 1,800 gm are generally below 8.9 mg/100 ml which is significantly lower than the mean cord IgM level of 13.8 mg/100 ml for the group as a whole.
MENINGOENCEPHALITIS AND LABORATORY EVIDENCE OF TRIPLE INFECTION WITH CALIFORNIA ENCEPHALITIS VIRUS, ECHOVIRUS II, AND MUMPS
Authors: Balfour Henry H. , Seifert Gregory L. , Seifert Milton H. , Quie Paul G. , Edelman Charlene K. , Bauer Henry , Siem Robert A.
Published: December 2021

This report emphasizes that in acute central nervous system disease, multiple viral agents may be implicated in the same patient. A 6-year-old girl with meningoencephalitis had laboratory evidence for simultaneous or closely spaced infections with California encephalitis virus, echovirus type 11, and mumps.

Documentation of the finding of triple viral infection was based on at least two laboratory findings for each agent. The patient lived in an area where California encephalitis was prevalent.
THE CRITICALLY ILL CHILD: MANAGEMENT OF STATUS EPILEPTICUS
Authors: Carter Sidney , Gold Arnold P.
Published: December 2021

In the article, "The Critically Ill Child: Management of Status Epilepticus" (Pediatrics, 44: 732, 1969), the last sentence on page 732 should be modified to read:

"Diazepam is commercially dispensed as 10 mg in 2 ml of buffered solution, and should only be administered in the undiluted form."
Trivialization of Pediatrics
Authors: Watcher Emperor , S. C. A.
Published: December 2021

Was the layout editor making a sly comment on the present state of American pediatrics by juxtaposing Mrs. Seymour's letter with the articles concerning Child Health Associates in the January issue (Pediatrics 51:1-16, 1973)? If the word "pediatrician" is substituted for "surgeon " in the 1754 letter, it has a surprisingly modern ring.

One gets the impression from reading the four articles that CHAs have demonstrated that they are capable of doing good when compared with practicing pediatricians, but it is not clear whether evidence has been collected to deal with the question of whether the associates cause less harm (in testing hypotheses one is liable to two kinds of error, and the relationships between type I and type II errors is the basis for the Neyman-Pearson theory).
Doesn't This Country Need More Pediatricians?
Authors: Darby C. P.
Published: December 2021

Dr. Haggerty's statistical presentation1 that this country is headed for a surplus of pediatricians is interesting but deceiving. In practicality, one would have a difficult time convincing a couple who travels from one city to another and has encountered the frustration of enrolling their children with a pediatrician that there will ever be a surplus of pediatricians. It is almost a universal cry that the pediatric profession is unable to accept any additional new patients.
Letters to the Editor
Authors: Scanlon John W. , Walkley Edward I.
Published: December 2021

Drs. Scanlon and Walkley comment as follows:

Dr. Merenstein states: "The finding of significant anemia or hypotension warrants consideration for immediate transfusion." We heartily agree. The critical word in Dr. Merenstein's advisement is "significant." We can assure Dr. Merenstein that this infant did not have significant hypotension. Furthermore, the clinical observation of a systolic murmur and the roentgenological finding of an "upper limit of normal" for heart size are suggestive, not diagnostic, of cardiac decompensation in the newborn.
Cultural Deprivation in the Mind and Heart
Authors: Gruenwald Peter
Published: December 2021

Occasionally Pediatrics publishes one of those little gems, seemingly to fill an empty half-page, like the one quoting Philip Slater1 on our suburbs. I am reacting to it not as an expert (who is, anyway?), but as one of those middle-class citizens who have made it to the suburbs. We feel that we should not live and bring up our children in the city if we can afford not to, not only because of crime and poor schools in the cities, but also because we like grass and trees and squirrels.
Respiratory Physiology, ed. 2, by N. Balfour Slonium, M.D., Ph.D., and Lyle H. Hamilton, Ph.D. St Louis: The C. V. Mosby Co., 1971, 229 pp., $10.75
Authors: Wohl Mary Ellen
Published: December 2021

Respiratory Physiology, a slim, well-printed volume, is an introductory text designed primarily for use by medical students. A concise, understandable, yet comprehensive and current monograph in this field is needed and is a challenge to any group of authors. This book only partially meets this challenge.

The traditional material includes chapters on the gas laws, anatomy of the bronchopulmonary system, mechanics of breathing, pulmonary circulation, diffusion, ventilation-perfusion relationships, control of ventilation, and clinical evaluation of pulmonary function.
Primary Tuberculosis in Childhood, by Jacques Gerbeaux, M.D. Springfield, Illinois, 1970, 339 pp., $17.75
Authors: Nemir Rosa Lee
Published: December 2021

This compact and pleasantly readable book on childhood tuberculosis is written by Professor Gerbeaux, of the Université de Paris, whose work on many aspects of this subject has been appearing steadily in the literature for many years.

Composed of 22 chapters, the book progresses smoothly from etiology and epidemiology to antituberculous chemoprophylaxis. The early chapters are concerned with diagnostic techniques and contain carefully documented experiences with all methods of tuberculin testing, laboratory techniques and roentgenologic aids in establishing the diagnosis of tuberculosis and determining the progress of disease (chapters 2, 5, 6, and 7.).
Pulmonary Disorders, ed. 2, vol. 1 of the Respiratory Tract in Children, edited by Edwin L. Kendig, Jr., M.D., Sc.D. (Hon.). Philadelphia: W. B. Saunders Company, 1972, 852 pp., $32.50
Authors: Strieder Denise J.
Published: December 2021

Since its publication in 1967, Kendig's Disorders of the Respiratory Tract in Children has remained the only textbook offering a comprehensive presentation of pediatric pulmonary diseases. In the first edition several chapters were devoted to pediatric otolaryngology which, in the second edition, will receive greatly amplified coverage in a separate second volume, still to be published. The first volume, now entitled Pulmonary Disorders, has grown by some 100 pages, allowing the inclusion of new chapters.
PREFACE
Authors: Rausen Aaron R.
Published: December 2021

The symposium that follows brought together individuals from varied professional spheres, all of whom have evidenced deep concern and expertise in recognizing, caring about, and preventing abuse and neglect of children. The purpose of the symposium was several fold:

1.To present in a cohesive form the present knowledge concerning etiology, diagnosis, and treatment of the abused child.

2. To present in some detail the legal as well as the medical and social methods of handling the problem.

3. To illustrate current and possille future approaches to the handling of the child and family involved.

4. To allow those involved in the field to have the opportunity to direct questions and problems to the gathered group of experts.

While much of the material concerning law and social agencies relates to New York state and city, the implications for other parts of the nation are self-evident.

The symposium was organized by Dr. Edmund N. Jovner, III, in his capacity as Chairman of the Special Committee on Child Welfare of the Medical Society of the County of New York. Assisting Dr. Joyner in this effort were the members of his committee as well as Mrs. Ruth Altman, secretary to the committee, and Mr. David Beiles, public relations representative for the Medical Society of the County of New York.

The sponsor of the Symposium, the Medical Society of the County of New York, was given generous financial support by the Edwin Gould Foundation for Children, New York, Mead Johnson and Company, Evansville, Indiana, and Ross Laboratories, Columbus, Ohio, which made possible the presentation and subsequent publication of this symposium.
WELCOME
Authors: Saypol George M.
Published: December 2021

My official duty is to welcome you to a symposium which, I believe, will prove both interesting and informative.

I wish to thank the New York University School of Medicine for its kindness in permitting us to use this fine auditorium for the symposium. As a graduate of this school, I am proud that it cooperates so well with our Society and other medical organizations. As I look about me today, I see many members of our organization. These physicians are here because they are concerned about one of our most distressing social and medical problems, and wish to ameliorate it in some way.

I am also gratified that there are so many members of other professions interested in child abuse, including public health officials, educators, attorneys, hospital administrators, nurses, social workers, and officials and staff people of public and private social agencies. I am delighted that we have so distinguished a group of speakers on our program, representing government, the judiciary and bar, as well as the medical profession.

If, by the end of today's proceedings, we have come to some kind of understanding or consensus as to the best approach toward dealing with child abuse, then there is hope. In any event, we have to continue fighting the battle to correct the social ills in our society in order to achieve a measure of justice and civilization.
THE LAW AND THE ABUSED AND NEGLECTED CHILD
Authors: Isaacs Jacob L.
Published: December 2021

There are four broad areas of the law which impinge on the general field of child abuse and child neglect.

First are those laws which mandate the reporting of suspected cases of child abuse. They are found in all 50 states of the Union at this time.

The second are the traditional provisions of the penal law which make the parents or guardians, who are guilty of abusive physical conduct toward children, amenable to the normal criminal penalties.

Third are the recently enacted provisions of our Family Court Act in New York which establish the comprehensive procedure for the processing of child abuse cases on a civil basis.

Finally, there are the provisions of law that establish various protective services and designate the public and private agencies to deal with the problems.

I shall limit myself primarily to two areas of the law, namely reporting laws and what is now known as the child protective proceedings in the Family Court.

I'll do this in the form of posing questions, those questions that are most commonly raised about these matters, amid then attempting to answer them.

THE REPORTING LAWS

New York has one of the most comprehensive reporting laws in its Social Services Law. In New York, any physician, surgeon, medical examiner, coroner, dentist, osteopath, optometrist, chiropractor, podiatrist, resident, intern, registered nurse, hospital personnel engaged in the admission, examination, care or treatment of persons, or Christian Science practitioners, having reasonable cause to suspect that a child under 16 years of age has had serious physical injury inflicted on him other than by accidental means, or whose condition indicates some other form of abuse, is required to report to the City Department of Social Services.
ANSWERS FOR SOME PEDIATRIC PATIENTS (p. 821)
Authors: C. T. E.
Published: December 2021

1. James Phipps: first patient to be vaccinated by Dr. Edward Jenner (1796).

2. Joseph Meister: first patient to be given Pasteur's rabies vaccine (1885).

3. Daniel Oliver Waterhouse: first patient to receive cowpox vaccine in America (1803).

4. Laura Dewey Bridgman: Dr. Samuel Gridley Howe's most famous patient. She was totally blind and deaf and spent her life at the Perkins Institution in Boston which was founded by Dr. Howe.

5. Little Hans: Sigmund Freud's first pediatric patient (1908).

6. James Sarkett: patient with paralytic poliomyelitis from whom Salk isolated his type III strain of poliomyelitis (1949).

7. Eileen Saxon: the first patient with tetralogy of Fallot operated on by Dr. Alfred Blalock (November 24, 1944).

8. Victor of Aveyron: a wild child found in the woods in southern France and studied intensely by Dr. J. E. M. Itard (1801 and 1807). Victor, a so-called homo sapiens ferus, was the subject of François Truffaut's recent film "The Wild Child."
THE WORKING MOTHER AND CHILD NEGLECT ON THE NAVAJO RESERVATION
Authors: Oakland Lynne , Kane Robert L.
Published: December 2021

In this small retrospective study, child neglect was not found to be closely related to the mother's age, education, nor employment, but the significant factors appeared to be marital status and size of family. The clinical impression of physicians that child neglect was related to the phenomenon of working mothers was not substantiated by our findings.
THYROID CANCER AFTER RADIOACTIVE IODINE DIAGNOSTIC PROCEDURES IN CHILDHOOD
Authors: Pilch Ben Z. , Kahn C. Ronald , Ketcham Alfred S. , Henson Donald
Published: December 2021

The authors present a case of mixed papillary and follicular thyroid carcinoma, metastatic to cervical lymph nodes, in a 20-year-old woman who had undergone diagnostic radioactive iodine procedures at 4 and 12 years of age. In this patient, calculation of radiation dose to the thyroid suggests that these procedures may have significantly increased the risk of development of thyroid malignancy.
LEUKOCYTES AND FETAL MALNUTRITION
Authors: Munro Hamish N.
Published: December 2021

Leukocytes are among the few cells of human origin that can be relatively easily obtained from the living subject. For this reason, they have been periodically used to measure the tissue status of enzymes, metabolites, and essential nutrients such as vitamin C. Some years ago, Metcoff and his colleagues1,2 related changes in the energy metabolism of leukocytes to the degree of postnatal malnutrition of young children. They were able to demonstrate a deficit in the capacity for generation of adenosine triphosphate (ATP) in the leukocytes of infants with protein-calorie malnutrition and correlated this with reduced activities of the enzymes pyruvate kinase and adenylate kinase which are involved in the metabolism of ATP formed by glycolysis, the predominating energy-generating process in leukocytes.