bluuebunny/crossref_metadata_2025 huggingface dataset:
CHILD ABUSE: THE ROLE OF THE PHYSICIAN AND THE HOSPITAL
Authors: Joyner Edmund N.
Published: December 2021

We are attempting to do the job which our legislature mandated for public agencies. The legislature did not mandate the money to allow these agencies to effectively fulfill their responsibilities, nor were provisions made for a coordinating individual or agency to supervise and administer the procedures which were mandated.

Until these deficiencies are corrected, the hospital must assume a much broader role in child abuse. The hospital is the logical agency which can immediately bridge the wide gap now existing in long-term protection and rehabilitation. That hospitals may be willing to step in and perform this function is suggested by the fact that as of June 1, 1971, 18 hospitals formed Child Abuse Committees at the request of the County Medical Society of New York.

If under the present laws of New York state the hospitals are to take on this added burden–and we believe that they should–it is imperative that their work be given support and that recommendations of the hospitals' Child Abuse Committees carry great weight in the deliberations and decisions of the Bureau of Child Welfare and the Family Court.
HOW "REGULAR" IS THE "REGULAR SOURCE OF MEDICAL CARE"?
Authors: Starfield Barbara , Bice Thomas , Schach Elisabeth , Rabin David , White Kerr L.
Published: December 2021

This paper presents the characteristics of the regular source of care identified for children in a household survey and relates these to perceived accessibility of services. Except in the preschool age group, a minority of children have a pediatrician as their regular source of care. Availability of services at various times during the week is not consistently related to specialty or to board certification but geographic access to pediatricians, especially board-certified pediatricians, is more difficult than is access to other types of physicians. This is evidenced by a greater need to make appointments (except in emergencies), and more remote, less convenient lócation of physicians' offices. Family income is related to the type of physician identified even among families who pay out-of-pocket the entire office visit fee. Accessibility of services should be considered with quality and cost in evaluating the adequacy of health care.
SIR RALPH VERNEY WRITES TO HIS GODDAUGHTER ABOUT BOOKS SUITABLE FOR A YOUNG GIRL OF 1652
Authors: C. T. E.
Published: December 2021

As an example of what was offered to satisfy the intellectual curiosity of a mid-seventeenth-century English girl, an apt and entertaining document is Sir Ralph Verney's letter of 1652 to his goddaughter Nancy Denton which follows:

Good sweet hart bee not so covitous; believe me a Bible (with ye Common prayer) and a good plaine cattichisme in your Mother Tongue being well read and practised is well worth all the rest and much more suitable to your sex; I know your Father thinks this false doctrine, but bee confident your husband will bee of my opinion. In French you cannot bee too cunning, for that language affords many admirable bookes fit for you, as Romances, Plays, Poetry, Stories of illustrious (not learned) Woemen, receipts for preserving, makinge creames and all sorts of cookeryes, ordring (sic) your gardens and in Brief all manner of good house-wifery. If you please to have a little patience with yourselfe (without Hebrew, Greeke, or Latin), when I goe to Paris again I will send you halfe a dozen of the french (sic) bookes to begin your Library.1
A PEDIATRICIAN'S GUIDE TO THE RECOGNITION AND INITIAL MANAGEMENT OF EARLY INFANTILE AUTISM
Authors: Tanguay Peter E.
Published: December 2021

Research within the past decade has resulted in a considerable body of new information regarding early infantile autism. While organic factors are believed to play a primary role in the genesis of the syndrome, there is a degree of cautious optimism that autistic children may benefit from early intervention aimed at maximizing their social and cognitive skills. The clinical characteristics of infantile autism are presented, together with information regarding its prevalence and differential diagnosis. The pathophysiology of the syndrome is discussed, and current views regarding proper management are outlined. A multidisciplinary team approach is recommended in evaluating and managing the autistic child, with child psychiatrists, psychologists, social workers, teachers, and other specialized disciplines involved. Parents of autistic children may feel guilty and responsible for their child's condition, and their confidence as caretakers may have been seriously undermined. Once their confidence is restored, however, parents may become quite adept in helping their child to learn and to function socially. The need for special public school programs for autistic children is stressed.
Urinary Tract Involvement in Epidermolysis Bullosa
Authors: Kretkowski Ronald C.
Published: December 2021

Epidermolysis bullosa is an uncommon skin disease which manifests itself at birth or in early infancy. It is characterized by blister formation occurring spontaneously or after friction or slight trauma.1 Involvement of the skin and mucous membranes is the chief clinical feature in this disease. Various systems of the body are affected either primarily or secondary to bullae and scarring of their mucous membranes. These include the conjunctiva of the eye, the mouth, the larynx, the esophagus, and the lung secondary to dysphagic pneumonitis.2 Herein is reported the first case of genitourinary tract involvement found in this disease.

Case Report
Corticoids and Respiratory Distress
Authors: Holm William W.
Published: December 2021

Liggins and Howie1 have demonstrated the effect of antepartum dexamethasone in the prevention of the respiratory distress syndrome (RDS).

Contrary to the current concept2 that this prevention results from maturation of the lung, though this may be an added benefit, the writer proposes that the adrenal is the primary target organ. In a previous letter3 regarding the role of catecholamines in the etiology of RDS he advised that whereas the lung of the mature infant is perfused by the pulmonary arteries (inducing alveolar expansion),4 the lung of the infant in utero is perfused by the bronchial arteries (inducing atelectasis).4
SUCCESSFULLY TREATED CANDIDA ENDOPHTHALMITIS IN A CHILD
Authors: Haning H. A. L. , Johnston R. , Touloukian R. , Margolis C. Z.
Published: December 2021

A 12-year-old boy with ulcerative colitis developed persistent fever following colectomy and protracted medical management including central hyperalimentation. Candida sepsis, meningitis, and endophthalmitis were diagnosed on the basis of the eye lesions and early cultures, and the child was treated with amphotericin B. The neurological signs cleared, and visual acuity improved dramatically.
Letters to the Editor
Authors: Anderson Craig L.
Published: December 2021

Dr. Haggerty commenting on the article by Duff (Pediatrics, 50:839, 1973) raised several considerations in regard to effective student teaching in the outpatient setting. It would seem that one of the solutions to the many issues Haggerty raises lies in the office of the community pediatrician. (1) Patients with considerably less complex problems are seen in the private office in contrast to the complex problems usually presenting themselves in the university outpatient departments.
Progress In Pediatric Surgery, vol. 3, edited by P. P. Rickham, M.D., M.S., F.R.C.S., D.C.H., Prof. Dr. W. Ch. Hecker, and Prof. Dr. J. Prévot. Baltimore/London/Tokyo: University Park Press, 1971, 167 pp., $13.50
Authors: Randolph Judson Graves
Published: December 2021

This third volume of the Progress in Pediatric Surgery keeps up the high standards set by the previous editions. Each of these volumes in the series is of particular interest to pediatric surgeons since the subject matter deals with significant advances in areas of clinical or laboratory research in selected pediatric surgical topics. Most of these are covered by comprehensive reports of laboratory investigations or clinical trials which have evolved over a period of time and the reader is brought to the current status of the problem.
A GRADED PROBLEM ORIENTED RECORD TO EVALUATE CLINICAL PERFORMANCE
Authors: Margolis Carmi Z. , Sheehan T. Joseph , Stickley William T.
Published: December 2021

In order to see if the problem oriented record could be used to measure a student's facility at data collection, data recording, and clinical problem solving, the problem oriented record (POR) was divided into 14 sections, each of which was graded for structure and completeness. Maximum possible score was 162 points. Seven faculty members and a teaching resident at two institutions graded a single work-up, with a coefficient of variation of 2.8%. In two observed work-ups, there was a high correlation between observed and recorded data. Three clerkship groups of 9 to 16 students each, some of whom were taught by a teaching resident, handed in at different times during the clerkship a total of 66 PORs, with a mean score of 101.75 points (range, 10 to 152 points). It was concluded that the graded POR could objectively measure facility at data collection, data recording, and problem solving, and that students were taught these skills by grading a work-up themselves.
The Art of (Ambulatory) Pediatrics
Authors: Brem Jacob
Published: December 2021

Despite commentaries by two distinguished pediatricians on the article by Duff et al.,1-3 I cannot resist the urge to emphasize certain points only alluded to. Granted that complexities and frustrations of patient care exist in the modern pediatric clinic, are we in our zeal to pursue the science neglecting to teach the art of pediatrics?

Though many years have passed, I retain a mental imprinting of an entire lecture by Dr. Kenneth D. Blackfan devoted to the examination of infants and children.
Sulfur Dioxide, a Respiratory Tract Irritant, Even if Ingested
Authors: Kochen Joseph
Published: December 2021

Sulfur dioxide (SO2) is a well-known atmospheric pollutant and respiratory tract irritant. Inhalation of trace quantities may result in the rapid development of laryngeal and bronchial spasm, excessive bronchial secretions, and pulmonary edema. It has been suggested that the increasing incidence of asthma and chronic bronchitis in urban areas may be attributable to the rising SO2 content of the air owing to the combustion of high sulfur-containing fuels.

Sulfur dioxide is also widely used as a preservative in certain common foodstuffs, i.e., dried fruits.
Letters to the Editor
Authors: Mofenson Howard C.
Published: December 2021

Dr. Mofenson, for the Academy's Committee on Accident Prevention, comments as follows:

Dr. Fugazzotto should be complimented on his astuteness. The alert pediatrician can often identify potential or actual hazards in his practice and inform his colleagues.

I would like to mention that the Accident Prevention Committee has a tipsheet on safe toys in its Child Safety Suggestion series, Set No. 2.

Recently, two new safety slips have been added on infant furniture, including cribs.
Sudden Infant Death Syndrome and Child Abuse
Authors: Hick John F.
Published: December 2021

In reporting two siblings who succumbed to "sudden infant death syndrome," Steinschneider exposes an unparalleled family chronicle of infant death.1 Of five children, four died in early infancy and the other died without explanation at age 28 months. Prolonged apnea is proposed as the common denominator in the deaths, yet the author leaves many questions relevant to the fate of these children unanswered.

Apnea of greater than 15 seconds has been well documented for the two siblings studied.
Hypothyroidism and Precocious Sexual Development: Another Case
Authors: Comas Adolfo Perez
Published: December 2021

Recently, an article in Pediatrics by Costin et al.1 described two new cases of hypothyroidism and precocious sexual development. I would like to report another similar case with our available data.

M.L.M., a 13-year-old girl was first seen by us at age 12-4/12 for short stature. Her history included growth retardation, diminution of attention span, somnolence, anorexia with weight gain, and constipation beginning between ages 4 to 6. At 9½ years of age irregular menses began, breast development was first noticed at 10 years, and pubic hair at 11½ years. Her initial admission data are in Table I.
INTELLECTUAL AND PERSONALITY DEVELOPMENT IN CHILDREN WITH GALACTOSEMIA
Authors: Fishler K. , Donnell G. N. , Bergren W. R. , Koch R.
Published: December 2021

In the paper entitled "Intellectual and Personality Development in Children with Galactosemia", Pediatrics, 50:414, September 1972, a typographical error occurs. Table II, the eighth line from the top, in the column identified "Younger Sib" the value of listed IQ score reads 166 instead of the correct value of 116.
MEDULLARY CARCINOMA OF THE THYROID GLAND: THE COMPLETE SYNDROME IN A CHILD
Authors: Levin Daniel L. , Perlia Charles , Tashjian Armen H.
Published: December 2021

The history of a 16-year-old boy with medullary carcinoma of the thyroid, bilateral pheochromocytomas, diffuse visceral ganglioneuromas, peculiar facies, "Marfanoid" habitus, and profuse diarrhea is presented. Concentrations of calcitonin in serum were markedly elevated (54 to 61 ng/ml).

Metastatic tumor nodules contained high calcitonin concentrations (220 MRC units/gm). Serum parathyroid hormone levels (0.38 to 0.42 ng/ml) were near the upper limit of the normal range, and the patient was normocalcemic. Immunoassays revealed elevated concentrations of prostaglandins of the ABE series (8 to 12 ng/ml) in the peripheral serum. This syndrome may result from a disorder of a single cell system–the chromaffin cell system–and may be considered a systemic chromaffinomatosis.
INDICATION OF INTRINSIC RENAL DISEASE IN AZOTEMIC INFANTS WITH DIARRHEA AND DEHYDRATION
Authors: Brill Charles B. , Uretsky Stanley , Gribetz Donald
Published: December 2021

In an effort to differentiate transient renal impairment from more serious forms of renal disease in infants presenting with diarrhea and dehydration, serial blood urea nitrogen (BUN) values were obtained during rehydration. These were plotted against time on semilogarithmic paper. It was found that the BUN fell linearly with time. The half time (HT) of the BUN fall off, the time taken for the admission BUN to fall by 50%, was estimated from the graph. In patients with no intrinsic renal disease the half time was between 6 and 24 hours, mean half time was 15 hours.

Of nine children who had half times in excess of 24 hours, six had proven renal disease as manifested by oliguria, hematuria, or obstructive uropathy. This technique, the plotting of serial BUN values during rehydration, is suggested as a clinical method in evaluating the significance of azotemia in infants presenting with diarrhea and dehydration.
Can Language Disorder Not Due To Peripheral Deafness Be An Isolated Expression Of Prenatal Rubella?
Authors: Pinsky Leonard , Mendelson Jack , Lajoie Réal
Published: December 2021

Rubella embryopathy may not be clinically evident at birth because of covert symptoms, progressive abnormality, or the normal delay in expression of certain functions, such as speech.

In 1968, we treated a child with autism whose mother had rubella during the first trimester. The patient was not considered to have had the congenital rubella syndrome. Subsequently, others1,2 described autism, and other behavioral disorders in children with documented prenatal rubella infection.

These observations led us to ask whether evidence for prenatal rubella could be obtained in a sample of autistic children, under the age of 6 years, without overt signs of this infection.
Letters to the Editor
Authors: Kirkland Rebecca T. , Kirkland John L. , Rosenberg Harvey S. , Harberg Franklin J. , Librik Leon , Clayton George W.
Published: December 2021

We appreciated the information about the additional cases of suppurative thyroiditis in children. Regrettably, our review of the literature which was confined to English did not lead us to the two cases of Saenz de Rodríguez and Pírez-Comas2 or to references 4 through 8 in the foreign literature. The case of Barrata,3 as cited by Mora (Kirkland et al., reference 12), was included in the 36 cases in children. We do make it a practice to review the U.S. literature and we apologize for neglecting our neighbors in the commonwealth.
Skin Testing for Penicillin Allergy: Its Limited Value
Authors: Bergner Renee K.
Published: December 2021

In its statement, "Anaphylaxis," The American Academy of Pediatrics Committee on Drugs states in part: "If there is a possibility of sensitivity to . . . penicillin, skin testing for immediate hypersensitivity to the agent should be performed prior to its therapeutic administration."1 The Penicillin Study Group of the American Academy of Allergy reported in 1971 that only 17 (30.4%) of 56 patients with a history of immediate (including anaphylactic) reactions to penicillin exhibited positive skin tests to penicillin G.2
Letters to the Editor
Authors: Wegman Myron E.
Published: December 2021

Dr. Houck is quite correct that the perinatal death rate is very useful as a method of studying newborn mortality; many deaths just before birth have the same causes as those which occur immediately after a live birth. The major problem in using such a rate for international comparison relates to reliability of reporting and definition of the period of gestation. It is easy to give a precise and uniform definition of a live birth and the age period after birth may also be determined with exactitude.
Mrs. Seymour Heeds Emperor Watcher's Plea
Authors: Cone Thomas E.
Published: December 2021

As Mrs. Seymour's self-appointed American guardian and interpreter of her writings, I consider it my duty to tell Emperor Watcher that, if she were still with us, she would have applauded his recent letter (Pediatrics, 51:753, 1973).

Emperor Watcher will also be interested in Mrs. Seymour's advice about children's diets. She wrote:

If we look into the Generality of Families, in which there are Children, we shall find them eating ten Times a-day, and drinking all Day long.
Calcium and Magnesium Concentration in Sweat of Normal Children and Patients With Cystic Fibrosis
Authors: Paunier Luc , Girardin Eric , Sizonenko Pierre C. , Wyss Marguerite , Megevand Albert
Published: December 2021

Calcium and magnesium concentrations were measured in the sweat of 26 normal children and 16 patients with cystic fibrosis.

There was no significant difference between the two groups. In both groups, there was a highly significant correlation between calcium and magnesium concentrations suggesting that these two ions share or compete for a common transport mechanism.
Letters to the Editor
Authors: Pena Sergio Danilo Junho , Goodman Harold O.
Published: December 2021

Dr. Hall may be correct in thinking that thanatophoric dwarfism is a heterogeneous diagnostic category at present. However, the wide range of severity and body proportions per se is not a strong argument against polygenic inheritance. Myelomeningocele which is also compatible with polygenic inheritance exhibits wide variation.

We had not seen the later publication of Graff et al.,1 but having seen it now, the published x-rays do not appear clear enough to decide between achondrogenesis and thanatophoric dwarfism.
Pediatria, vols. 1 and 2, by Julio Meneghello. Buenos Aires: Inter-Medica, 1972, 582 pp. and 942 pp., no price given. (In Spanish)
Authors: Howard Jorge E.
Published: December 2021

This textbook of pediatrics written in Spanish by 112 Latin American specialists is intended for the Latin American medical student and the physician who treats children in his daily practice. It is the first multi-authored pediatrics textbook by Latin Americans and, thus, represents a pioneering effort. It is presented in two volumes with a total of almost 1,600 pages. There are many excellent figures, tables, and, in general, it makes easy reading. Unfortunately, both volumes are numbered starting from page 1 and, as there is a separate index for each one, this leads to confusion.

The first 120 pages analyze various aspects of pediatrics peculiar to Latin America, maternal and child health care, and the teaching of pediatrics.
HYPOGLYCEMIA AND BRAIN DEVELOPMENT
Authors: Chase H. Peter , Marlow Robert A. , Dabiere Carol S. , Welch N. Noreen
Published: December 2021

Though hypoglycemia has been a common clinical condition known to affect human brain development, little has been done to define the resultant brain biochemical alterations. Because a controlled study of hypoglycemia in the newborn human infant is impossible, the infant rat was chosen as a model. Hypoglycemia induced once daily for 18 days following birth resulted in a generalized diminution of brain weight, cellularity, and protein content. The rate of formation of the myelin lipid sulfatide was decreased, as was the quantity of cerebroside-sulfatide in brains of hypoglycemic animals. Phospholipids, gangliosides, and cholesterol were decreased only in proportion to the decrease in brain weight. Brain glucose and glycogen concentrations were low in the brains of hypoglycemic animals, although ATP and phosphocreatine levels were not decreased.
INTRAUTERINE DETECTION OF GM1 GANGLIOSIDOSIS, TYPE 2
Authors: Booth Carol W. , Gerbie Albert B. , Nadler Henry L.
Published: December 2021

GM1 gangliosidosis, type 2 is a familial disorder of sphingolipid metabolism characterized by progressive and unrelenting neurologic deterioration leading to death within the first decade of life. Amniotic fluid cells obtained early in the second trimester of a pregnancy at risk for this disease were shown to be deficient in β-galactosidase activity.

On the basis of these results, the parents elected to terminate the pregnancy.

Examination of the fetal tissues revealed marked deficiency of α-galactosidase activity, increased cerebral GM1 ganglioside and abnormal hepatic lysosomes confirming the diagnosis of GM1 gangliosidosis, type 2.
THE SYNDROME OF NEONATAL COPPER DEFICIENCY
Authors: Ashkenazi Azaria , Levin Stanley , Djaldetti Meir , Fishel Efraim , Benvenisti Dan
Published: December 2021

A syndrome of primary copper deficiency in a 6-month-old premature baby is described. Features which can be ascribed to lack of copper, include (1) a sideroblastic anemia resistant to other therapy, with vacuolation of erythroid and myeloid bone marrow cells, and iron deposition in the vacuoles and in some mitochondria; (2) neutropenia, especially segmentopenia, which was common and prominent; (3) long-bone changes on radiological examination, particularly osteoporosis with blurring and cupping of the metaphyses; (4) depigmentation of skin and hair, with distended blood vessels due to changes in the elastin of the vessel walls; and (5) central nervous system abnormalities including hypotonia, psychomotor retardation, and difficulties with sight. Besides this small premature infant, who had received a relatively copper-deficient milk diet for at least three months, a second case has been seen in a 2,100-gm premature infant, after three months of intravenous alimenation necessitated by neonatal bowel surgery. Treatment with oral copper, 1 to 3 mg/day, dramatically cured both patients. It is recommended that 100 to 500µg/day of copper be added to the diet of small premature infants until they are receiving other foods beside milk, and to prolonged intravenous alimentation beginning in the newborn period.
THE HAND SOCK, AN ARTIFICIAL HANDICAP TO PREHENSION IN INFANCY, AND ITS RELATION TO CLINICAL DISUSE PHENOMENA
Authors: Umansky Richard
Published: December 2021

Prehension was temporarily handicapped in 57 normal infants by enclosing one hand and forearm in a soft sock. In contrast to control performance infants frequently did not attempt to reach and grasp with the hand thus covered though use of the other arm continued. The disuse exceeded that attributable to the mechanical restriction of the sock.

In younger infants (4 to 6 months of age) it appeared to result from ignorance of the option to attempt prehension with the covered hand. In older infants (6 to 12 months of age) some of the disuse of that arm appeared deliberate, was reversible under circumstances of special need, and there was clearer awareness of the prehensile nature of the arm despite its functional and anatomical distortion by the sock. However, in older infants the unhampered arm and hand were more apt to substitute for the other, and in a few cases disuse and disregard of the arm with the enclosed hand was so extreme as to suggest an agnosia for the arm. The results, which link prehensile disuse to immature concepts of arm function, are relevant to pediatric conditions in which excessive arm disuse may occur, including sensory deprivation, hemiplegic cerebral palsy, brachial plexus palsy, and congenital arm amputations fitted with a prosthesis.
SERUM DIGOXIN STUDIES IN INFANTS AND CHILDREN
Authors: Hayes Constance J. , Butler Vincent P. , Gersony Welton M.
Published: December 2021

Serum digoxin levels in nontoxic patients obtained 6 to 24 hours after administration of a maintenance dose of digoxin were measured by means of a radioimmunoassay method. There were 31 infants, 33 children, and 24 adults studied; 19 digitalis-toxic patients were also investigated.

The mean serum digoxin concentration in the nontoxic infants was 2.8 (±1.9) ng/ml, a level significantly greater than that obtained in the older children or adults, 1.3 (±0.4) ng/ml and 1.3 (±0.6) ng/ml, respectively (P < .01). In the infant group, similar dosage schedules resulted in a higher serum concentration when the digoxin was administered intramuscularly rather than orally, but differences were also related to the age of the patients within the infant group. Sixty-five percent of the infants receiving standard maintenance therapy had digoxin levels > 2.0 ng/ml, a range which is commonly associated with toxicity in adults. whereas only 18% of the children had serum concentrations above this value.

Mean serum digoxin levels in the digitalis toxic infants was 4.4 ng/ml and in the toxic children 3.4 ng/ml. Eleven of these 15 patients had received digoxin intramuscularly. The mean serum level measured in digitalis-toxic adults was 2.9 ng/ml.

Serum digoxin levels may be of value (1) as an adjunct in the diagnosis of toxicity, (2) in the early evaluation of accidental ingestion, (3) in the assessment of the adequacy of digitalization, and (4) in the management of digitalization of patients with renal insufficiency.
POLLAKIURIA
Authors: Asnes Russell S. , Mones Richard L.
Published: December 2021

The distinction between polyuria and pollakiuria is discussed and the causes of both symptoms are enumerated. Four cases of pollakiuria are presented, demonstrating that the etiology of pollakiuria may be on a psychosocial basis. In addition, a therapeutic approach is recommended for physicians who may encounter such children and fail to discover an organic basis for the symptoms.
Common Clinical Cardiological Problems: The Absence of Arbitrary Answers
Authors: Silver Walter , Joos Howard A.
Published: December 2021

Certain common clinical pediatric cardiologic problems are encountered daily by pediatricians, family physicians, and house staff who may, in the absence of specific guidance, unwittingly commit therapeutic and/or diagnostic misjudgements. Recommendations from the Academy would be most helpful if they can be developed. Such problems include (1) the use of oxygen in infants in congestive heart failure (CHF) secondary to left to right shunting, (2) treatment for "physiologic" anemia (2 to 6 months of age) in the presence of CHF, (3) the use of digoxin in the treatment of patients with cardiac enlargement associated with congential heart disease (CHD) but without overt evidence of CHF, and (4) electrocardiographic changes associated with acidosis and electrolyte imbalance.
Criteria for Ventilatory Assistance in Hyaline Membrane Disease
Authors: Vidyasagar D. , Pildes Rosita S.
Published: December 2021

The suggestion of O'Boyle et al.1 for the need to develop earlier criteria for assisted ventilation in infants with hyaline membrane disease (HMD) is important and deserves further comment. The use of continuous distending pressure (CDP) whether applied as a positive pressure airway (CPAP) or as a negative pressure around the chest (CNP) has significantly improved the prognosis in HMD. Overwhelming support for the use of these measures in every sick infant with HMD comes from a number of centers.2-4
Carboxyhemoglobin Exchange Between Donors and Recipients of Blood Transfusions
Authors: Kandall Stephen R. , Landaw Stephen A. , Thaler M. Michael
Published: December 2021

The potential toxicity of carbon monoxide in transfused blood has received relatively little attention. Ayres et al.1 demonstrated that a rise in carboxyhemoglobin (COHb) percent saturation from approximately 1% to 5% to 10% causes a notable decrease in the arterial and mixed venous blood oxygen tension in normal adults. Engel et al.2 noted that COHb in newborn infants with hemolytic disease could be altered with exchange blood transfusions. When respiratory distress occurs in such infants, high COHb in transfused blood may, therefore, reduce tissue oxygenation to dangerously low levels.

The relationship between COHb in donor blood and in recipients of exchange blood transfusions was examined in 15 infants with neonatal hyperbilirubinemia not associated with pulmonary deficiency.
CHILD PSYCHIATRY TEACHING IN PEDIATRIC TRAINING: THE USE OF A STUDY GROUP
Authors: Lewis Melvin , Colletti Richard B.
Published: December 2021

Our purpose here is to draw attention to the use of a pediatric study group in a child psychiatry program integrated with pediatric training. Typically the pediatrician in training is motivated to develop expertise in a particular area (e.g., neurologic, cardiologic, hematologic, etc.) when stimulated by a particular patient to read about the problem, and to discuss it with teachers who specialize in that area or problem and are readily available. Consequently, the primary goal of the study group was to provide residents with precisely this mode of learning specifically for behavior problems.

Four residents, all committed to pediatrics, joined a senior child psychiatry faculty member to form a pediatric study group, meeting weekly on an unlimited time basis. They initially decided to review the literature on normal child development and then that on the clinical assessment of emotional development. A special bookshelf in the seminar room was provided to facilitate the reading.

Residents learned best from discussion of specific questions such as arose from residents' observations of their own normally developing child, or more often from a patient just seen. The accessibility of specialized information and guidance enabled exploration in depth of their patient's psychological and developmental status. As a result, they improved their skills in detection and management of common behavior problems and felt themselves better pediatricians, able to provide more comprehensive care.

Individual supervision and collaborative care around special cases took the form of a partnership, with mutual commitment in problems of failure to thrive, school learning, custody conflicts, adolescent turmoil, and even the issues in a difficult case of renal transplant between twins.
Role of Pharmaceutical Manufacturers in Pediatric Meetings
Authors: Parsons W.
Published: December 2021

As a visiting pediatric resident attending the recent meeting of the American Academy of Pediatrics in Boston I wish to object to the role which various pharmaceutical manufacturers were invited to play in the proceedings.

We are doctors, we are not employees or clients of pharmaceutical firms and should expect neither discounts on their products nor to be entertained by them in their hopes of wooing our business. I do not wish my entertainment to be paid for by my patients through increased drug costs to them.
Whole Milk, Low-Fat Milk, or Skim Milk: Which Is to Be Recommended?
Authors: Gorlick Gary
Published: December 2021

In the pediatric age group, which milk is most recommended by the Academy: skimmed milk or low-fat milk? The former I note is recommended as a possible preventative measure toward retarding or preventing atherosclerosis; yet the latter is higher in calcium and in caloric content.

The Chairman of the A.A.P. Committee on Nutrition answers as follows:

The Committee on Nutrition is preparing a broad statement on the use of milk, which will, when completed, provide you information on the questions raised.
The Physician and the Functioning of the Deaf Child
Authors: Mock Charles R.
Published: December 2021

I am very pleased that the American Academy of Pediatrics has presented a statement on "The Physician and the Deaf Child."1 However, the statement's definition of deafness needs further explanation, since many local regulations for educating hearing-impaired students use the nomenclature of the Conference of Executives of American Schools for the Deaf.2 A functional description is used, not based on the need to be educated in a school for the deaf, but based on how the hearing impaired person uses his hearing.
Amphetamines in Epilepsy
Authors: Livingston Samuel , Berman Wulfred , Pauli Lydia L.
Published: December 2021

In the February 1973 issue of Pediatrics, the Committee on Drugs presented a concise review of the use of d-amphetamine (Dexedrine) and related central nervous system stimulants in children. They stated, "At present there are only two valid indications for the use of amphetamines in childhood: (1) the hyperkinetic syndrome, and (2) the rare condition of narcolepsy." It is unforunate that the Committee overlooked the use of amphetamines in epilepsy as another valid indication.

The amphetamines play a very important role in the management of the epileptic patient, particularly in minimizing or alleviating anticonvulsant-induced drowsiness.
The Russell-Silver Syndrome? Or Trisomy 18?
Authors: Punnett Hope H. , Kistenmacher Mildred L. , Pileggi Anthony J.
Published: December 2021

In the February issue of Pediatrics, Haslam et al.1 report on the renal abnormalities in four cases of Russell-Silver syndrome. We are surprised by their inclusion of K.R., their case 2, in this series. We had seen K.R. as an outpatient shortly before his admission to the J. F. Kennedy Institute. Chromosome studies were initiated at that time because of the child's severe mental, psychomotor, and growth retardation. Mosaicism for trisomy 18 was found; 75% of his lymphocytes were 47, XY, + 18 and 25% were normal.
Letters to the Editor
Authors: Haslam Robert H. A. , Berman Wulfred , Heller Richard M.
Published: December 2021

Drs. Haslam, Berman, and Heller reply as follows:

We appreciate the comments and conclusions of Punnett and associates with respect to our recent report.1 The purpose of our article was to introduce a possible cause, albeit remote, for the growth failure in the Russell-Silver syndrome (RSS) because of the finding of significant renal anomalies in some patients with this condition

A syndrome such as the Russell-Silver complex is suggested by an assemblage of symptoms and signs which tend to characterize a particular abnormality, but an etiology for the condition is usually not implied.
Virology Monographs 12: Varicella Virus, by D. Taylor-Robinson and Anne E. Caunt. New York: Springer-Verlag, 1972, 88 pp., $9.60
Authors: Kibrick Sidney
Published: December 2021

This volume is another in the Virology Monograph series, which deals with specific viral agents or topics of current interest. These monographs have been appearing regularly since 1968 at the rate of several volumes per year. As with previous contributors to this series, both authors have been active in some phases of the subject that is covered.

The present monograph is devoted to a review in depth of varicella virus, covering references up to 1971. The authors have purposely entitled this volume "Varicella Virus" rather than "Varicella-Zoster Virus," the name in common use, to emphasize that it is a single viral agent that is responsible for both varicella and zoster.
MANAGING A PUBLICATION
Authors: Frazier Robert G.
Published: December 2021

Pediatrics, the Academy's official journal, came into being in 1948. Its establishment signified the effort of the Academy and the pediatric academic community to create an outstanding scientific publication in the field of pediatrics. Through the past 25 years this goal was achieved and maintained under the editorial direction of three eminent and respected editors: Dr. Hugh McCulloch, Dr. Charles May, and Dr. Clement Smith.

In the same period, there have been accomplishments in the publishing and management of the journal which have facilitated Academy objectives. Basic factors which sustain a scientific journal include scientific papers of high quality, the interest of authors in advancing and diffusing knowledge, and a broad readership supportive of the journal and the goals of the sponsoring society.
WHAT MOTHERS READ ABOUT TEETHING IN 1845
Authors: C. T. E.
Published: December 2021

Many mothers in the 1840s read a manual on child care written by Dr. J. W. Holman who was both a Fellow of the Massachusetts Medical Society and of The Boston Medical Association. This is what Dr. Holman told his readers about infant teething.1

Beside the general febrile symptoms attendant upon the teething of children, many other troublesome and sometimes fatal complaints follow. Much may be done for the safety and comfort of children at this critical period, by mothers and nurses.

If at this period the child is disposed to looseness, as is often the case, all kinds of food, and the various drinks that are calculated to increase this dependent or secondary trouble, should be carefully avoided; cold water, or mild before it is boiled, cider, spruce beer, and the like should not be allowed. Vegetables, such as beets, turnips, apples, potatoes, and fruits should be withheld. On the contrary, let the drink be prepared from some bark or herb that is gently astringent or binding and let the food be boiled milk thickened with wheat flour, dry crackers, and of such articles as will not tend to augment the diarrhea. But if there be no inclination to looseness, but symptoms of fever and nervous irritation, let acid and laxative drinks be given, and the food may be of a spare and loosening character.

Rice, with milk or molasses, tapioca, sago, arrow root, jellies, etc., are good articles of food, if the child be weaned. If the child is at the breast, the nourishment received from the mother is perhaps the best that can be given.
ANTIBODY-DEPENDENT LYMPHOCYTE KILLER FUNCTION AND AGE
Authors: McConnachie Peter R. , Rachelefsky Gary , Stiehm E. Richard , Terasaki Paul I.
Published: December 2021

A function of human lymphocytes was studied in 66 individuals ranging in age from newborn to 100 years. The test used was antibody-dependent lymphocyte-mediated cytolysis of HL-A antibody-coated 51Cr-labelled human lymphocytes. Lymphocytes from newborn infants were ineffective in producing cell-mediated lympholysis and lymphocytes from children 1 to 6 years of age were most effective.

Lymphocytes from adult and geriatric persons demonstrated variable ability in this test system. The ability of lymphocytes to perform this cytolytic function is acquired between 3 and 12 months of age.
Bithionol: A Possible Substitute For Hexachlorophene
Authors: Powell Henry C. , Lampert Peter W.
Published: December 2021

Adult mice were fed similar quantities of either hexachlorophene or bithionol. Whereas hexachlorophene-treated animals developed cerebral edema characterized by spongiform changes in myelin sheaths, animals fed bithionol showed no adverse effects. It is suggested that bithionol be considered as a possible alternative to hexachlorophene because of its equally potent germicidal effect but apparent lack of neurotoxicity. Measures to protect against photosensitivity are advocated.
SIR GEORGE FREDERIC STILL ON THE CHILD'S TEMPER
Authors: C. T. E.
Published: December 2021

Sir George Frederic Still (1868-1941), one of the greatest figures of British pediatrics, wrote, in addition to his superb textbook, a largely unappreciated book entitled Common Happenings in Childhood (1938). In this charming book consisting of essays, studies and stray thoughts about everyday phenomena of a child's life, Still had this to say about temper as seen in children.

"This is not a homily, nor is it philosophic discourse de moribus, it is just a collection of stray thoughts upon temper, especially as seen in children.

When we speak of being ‘in a temper’ we usually mean a bad temper, but temper in itself has no such one-sided significance, there is good temper as well as bad temper. I am no psychologist and shall not attempt to define temper in terms of psychology, indeed a study of works upon that subject rather suggests that the psychologist knows nothing about temper. He makes great play with the emotions, e.g. anger, but he has nothing to say about that attitude of mind which we call bad-tempered or good-tempered. We all know what we mean by these terms: on the one hand, the sullen, irritable, contrary-minded, passionate; on the other, the bright, cheerful, responsive, ‘not easily provoked.’

A stray ebullition of anger or irritation is not necessarily an indication of bad temper, by which we mean rather an habitual tendency. We all have our flash-point of anger or irritation, but in some the flash-point of irritation is lower than the average: these are they whom we call bad-tempered.
A Deluge of Protests
Authors: Wineberg Julius J.
Published: December 2021

I took my July issue of Pediatrics down from the shelf and casually turned to where Diagnosis and Treatment should be. Instead I found a penis with a Plastibell. Quickly I turned to see if someone on the C.R.P. (Committee to Re-elect the President) was the new editor. No, it was those same Boston Brahmins, Smith and Cone. Perhaps they feel in 100 years our bound copies will be valuable Americana with Plastibells and all that.
SALT INTAKE AND EATING PATTERNS OF INFANTS AND CHILDREN IN RELATION TO BLOOD PRESSURE
Authors: Holliday Malcolm A. , Anderson Arnold S. , Barness Lewis A. , Goldbloom Richard B. , Haworth James C. , Mauer Alvin M. , Miller Robert W. , O'Brien Donough , Weil William B. , Whitten Charles F. , Cravioto Joaquin , Filer L. J. , Kline O. L. , Winters Robert W.
Published: December 2021

Approximately 20% of children in this country are at risk of developing hypertension as adults. The factors that will induce hypertension are genetic, which cannot be modified, and environmental, which can be modified. Genetic factors assist in identifying the population at risk, i.e., family history of hypertension, myocardial infarction, stroke, or renal disease. The population with a negative family history is less at risk.

The role of salt intake as an environmental factor in the induction of hypertension has still to be defined. For 80% of the population in this country, present salt intake has not been demonstrated to be harmful, i.e., hypertension has not developed. Salt intake is likely to be only one of the contributing factors for those whose genetic makeup predisposes them to hypertension.

Salt appetite for some is an important expression of personal preference in relation to diet; for others, salt-containing foods have important cultural values. Present evidence does not provide a firm basis for advising a change in the dietary salt intake for the general population. There is a reasonable possibility that a low salt intake begun early in life may protect, to some extent, persons at risk from developing hypertension.

Salt consumption today is being determined to an increasing degree by food manufacturers and processors and quick-service food suppliers. To the extent that salt is added to a food prior to its being served, the individual has an obligatory rather than a selected intake of salt. The consumption of presalted foods may be producing significant changes in salt intake which are not perceived at this time.
The Art of (Ambulatory) Pediatrics
Authors: Silber Tomas J.
Published: December 2021

I couldn't agree more with the comments of Duff et al. in your July issue. I would add that the same problem which affects the training of students affects later the training of pediatric residents. In September of 1973, Dr. Edwin Harrington, former Director of the Jefferson Children and Youth ("C & Y") Program of Philadelphia, died suddenly leaving his work unfinished. I had trained under his guidance together with Dr. E. Williams, and as a tribute to his memory I would like to summarize this particular contribution to pediatric training.
TREATMENT OF MUCOCUTANEOUS CANDIDIASIS WITH TRANSFER FACTOR
Authors: Feigin Ralph D. , Shackelford Penelope G. , Eisen Seth , Spitler Lynn E. , Pickering Larry K. , Anderson Donald C.
Published: December 2021

Evaluation of a patient with chronic mucocutaneous candidiasis revealed that the patient lacked delayed hypersensitivity to candida and other skin test antigens and the patient's lymphocytes could not be stimulated in vitro with candida antigen. Phytohemagglutinin stimulation of lymphocytes in vitro was normal. Candidacidal function and myeloperoxidase activity of the patient's leukocytes were normal. The patient's lymphocytes produced migration inhibitory factor in response to candida antigen and the monocyte receptor sites for IgG were intact. Repeated treatments with amphotericin B, alone or with 5-fluorocytosine, were followed by immediate relapse. Four doses of transfer factor were administered and when coupled with amphotericin B on two occasions prompted remissions of 6 and 4 months, respectively.
THE OPTIMUM TIME TO OPERATE FOR CRYPTORCHIDISM
Authors: Lattimer John K. , Smith Arthur M. , Dougherty Louis J. , Beck Leah
Published: December 2021

On the basis of histological, cellular kinetic and clinical studies, but most importantly, the psychological considerations, it appears best to initiate and complete the treatment for both true crytorchid and for migratory testes between the 4th and 5th birthdays.
Purulent Otitis Media: Differences Between Populations in Different Environments
Authors: Manning Patrick , Avery Mary Ellen , Ross Alan
Published: December 2021

The paper by Kaplan and colleagues in a previous issue starts by emphasizing the unusually high incidence of otitis media among Eskimo children. Forty-one percent of their cohort of 489 Alaskan Eskimo children, followed for ten years, had perforations or scars of the tympanic membranes; significant hearing losses were present in 16% of the group. Among the 374 children with a history of otorrhea, 291 (78%) had their first attack before their second birthday. The adverse effects of hearing loss in early life on language development were underscored by the authors, who quite properly point out the need for special educational programs.
Institutional Care, Foster Home Care or Family Care?
Authors: Oyemade Adefunke
Published: December 2021

Three case histories and an account of an epidemic in a home have highlighted a few of the physical, social and mental problems encountered by motherless babies in their different environmental settings. The institutionalized child may have a normal physical development, but becomes mentally retarded because of lack of social stimulation and individual attention. On the other hand, a motherless baby reared in an environment with poor sanitation and inadequate diet may have poor physical but normal mental development. The study also showed that a child can have normal mental, social and physical development if the right choice of foster parent is made. It is also revealed that long-term, successful foster-home placement does not automatically lead to adoption, and feelings of frustration can arise from regarding a foster-home child as one's own without the legal support usually provided in the Adoption Laws.

As demonstrated by the epidemic described in this study, the course of a disease can be explosive in an institutional setting. This can be related to the quality of staff who have no knowledge or training in the causes of and modes of transmission of disease.