bluuebunny/crossref_metadata_2025 huggingface dataset:
Respirator Management in Hyaline Membrane Disease
Authors: Stern Leo
Published: December 2021

Experiences with the use of mechanical sistance to respiration in severe hyaline membrane disease or respiratory distress syndrome (RDS), have resulted in a recent increase in papers dealing with the subject.1-6 To these is now added the report of Reynolds7 appearing in this issue, detailing such an experience with a Bennett (positive pressure) respirator at University College Hospital in London.

In evaluating the applicability to other centers of such reports, it is necessary to bear in mind some variables which may profoundly influence the results and which would appear virtually impossible to standardize.
HOW TO TREAT WHOOPING COUGH ACCORDING TO DR. THOMAS HAYES OF LONDON IN 1786
Authors: C. T. E.
Published: December 2021

Whooping cough, which was first described as a disease sui generis by Baillou in 1640, was treated for many years by a plethora of fanciful regimens, ranging from covering the affected child's head with a cowl, supposedly to keep the disordered flux (causing the disease) from the brain entering the lung, to subjecting afflicted children to sudden frights or terrors.1

In 1786 Dr. Thomas Hayes published a plan of therapy for this disease which was followed by physicians both in the United Kingdom and the United States for more than 60 years. Dr. Hayes' regimen for managing infants and children with whooping cough was as follows:

As I have had some hundreds of children under my care ... in the Hooping [sic] Cough, and have not lost one by it; I shall give my general mode of treatment....

I begin, by giving a couple of purges, with sal polychrest, (editor's comment: probably potassium sodium tartrate or Rochelle Salt) and rhubarb....

After two or three purges have been given, I puke them twice or thrice in a week or oftener if need be, especially if children....

An efficacious mixture to puke children with is emetic tartar, four grains; pure water, four ounces; sugar, two drams. Mix (and give) one to three tea spoonfuls [sic] to a child of a year old, early in the morning and repeat it every quarter of an hour, till it puke freely.

When the fits of coughing are very violent, and disturb their rest, from half a drop of Laudanum to three or four; or a tea spoonful of syrup or white poppies ... either in water, or in other drinks. . .
How Safe is Pupil Transporatation
Authors: Johnson Charles F.
Published: December 2021

The January 1970 Supplement to Pediatrics1 was provocative enough to cause me to write a letter to the local school bus authorities decrying Iowa's bus accident record and safety regulations. This letter resulted in a chain of letters, and ultimately a reply from Arthur Roberts, Director of the Division of Transportation in the Iowa State Department of Public Instruction. The letter pointed out several difficulties which might arise from inappropriate interpretation of the data:

Table I, on pages 168 to 170, reported accident rate in actual miles instead of thousands of miles, as was the case.
Cytomegalovirus and Microcephaly
Authors: Nakao Tooru , Chiba Shunzo
Published: December 2021

We read with interest the report by Dr. Baron and his colleagues1. We also have studied cytomegalovirus (CMV) infection in children. CMV isolation and complement-fixing (CF) antibody in microcephalic and normal normocephalic children are shown in Table I. The differences betwen microcephalic and normal normocephalic children are not statistically significant. CMV macroglobulin was tested by an indirect fluorescent-antibody technique2 in newborn infants, and no association was found in seven microcephalic infants including those with developmental anomalies.
New Cover
Authors: Silverman William A.
Published: December 2021

In contrast to the dismay noted in the Letters column in June, I write to tell you how "mayed" I am with the clean uncluttered look which you have given the new cover of Pediatrics. Up with the arts!
VITAMIN B12 DEPENDENCY AND COBALT-DEPENDENT METABOLISM
Authors: Scriver Charles R.
Published: December 2021

An excellent report on a form of Vitamin B12 dependency appears in this issue of the Journal. This Commentary, which has been written in response to the article, is the third on the subject of vitamin dependencies, the two previous discussing the Vitamin B6 dependencies (Pediatrics, 37:553, 1966) and Vitamin D dependency (Pediatrics, 45:361, 1970).

The term "vitamin dependency" has been used to describe certain types of genedependent nutritional disorders. In such conditions the nutritional intake of vitamin which is required to maintain a state of health is much greater than normal; patients evidently inherit these peculiar requirements in Mendelian fashion.
BEHAVIORAL STATE AND PLASMA CORTISOL RESPONSE IN THE HUMAN NEWBORN
Authors: Anders Thomas F. , Sachar Edward J. , Kream Jacob , Roffwarg Howard P. , Hellman Leon
Published: December 2021

Four normal human infants were studied on 20 occasions between the first and fifteenth week of their life to assess the relation of four behavioral states (crying, quiet wakefulness, rapid eye movement, and non-rapid eye movement sleep) to plasma cortisol levels. Marked rises in plasma cortisol occurred after 20 minutes of crying. In the other behavioral states, plasma cortisol remained low and relatively constant. The pattern did not change with age, and within the limitations of this study no circadian rhythm was demonstrated. It is suggested that measurement of plasma cortisol can be as useful in psychophysiological investigations in infancy as it has proved to be in the adult.
MULTIPLE ORGAN TRANSPLANTATION AND THE CREATION OF SURGICAL SIBLINGS
Authors: Schowalter John E.
Published: December 2021

Most of the psychiatric literature regarding renal transplantation concerns the donorrecipient relationship. Nothing has been written about the implications of multiple transplants from a cadaver donor, although such procedures are becoming increasingly common. This paper describes a symbiotic syndrome which formed between two adolescent girls who received kidney transplants from the same cadaver. The significance and possible causes of this reaction are discussed.
CHILDREN OF DIVORCE
Authors: Sugar Max
Published: December 2021

One (or more) out of three marriages in the United States ends in divorce, involving numerous children. The result of a broken home by divorce may be similar to the death of the parent, affecting the emotional growth and development of children. Attention is focused here on the confusion in the parents and children, their projection and compensation for guilt feelings, retaliation by the use of the children, feelings of helplessness and magic in the children, their wishes to reunite the parents, the effects of relocation, and the influence of internal realignments on external realities. The initial emotional response is that of separation anxiety; following divorce finalization, there is a mourning reaction. The manifestation of these responses vary according to the child's age, sex, level of psychosexual development, previous history, and current arrangements. Some understanding and definite guidelines to visitation rights, parental dating, and remarriage are considered. If in spite of their own emotional upheaval the parents are alert to the child's anxiety or depression, they may be able to institute prophylactic measures. This requires parental cooperation which may be quite difficult. Here the advice and explanations of an informed and perceptive pediatrician may be of unique value.
THE BOOK OF ACCIDENTS
Authors: Cone Thomas E.
Published: December 2021

Scalding liquids continue to cause over half of the burns in childhood.1 Harper2 (1963) points out that scalding burns most commonly are caused by a child pulling a coffee or tea pot on himself, usually from a stove, less often from a table.

Figure 1 from a children's book on accident prevention (1830)3 could well be used to document the above statement. Once again one is reminded that "there is no new thing under the sun." (Ecclesiastes 1:9)
PEDIATRIC ASPECTS OF AIR POLLUTION
Authors: Wehrle Paul F. , Yamazaki James N. , Brent Robert L. , Chisolm J. Julian , Doyle John L. , Fagan Emmett L. , Finberg Laurence , Nahmias Andre J. , Thompson G. D. Carlyle , Farr Lee E. , Horton Robert J. M. , Miller Robert W.
Published: December 2021

Public concern regarding air pollution has increased rapidly in recent years. Because air pollution may present special problems in the pediatric age group, available information on the effects of various air pollutants on children has been reviewed with the purpose of: (1) defining the potential ill effects of air pollution in this age group, (2) making information regarding these effects readily accessible to pediatricians, and (3) delineating further areas of study which may be necessary to safeguard child health from this environmental hazard.

Three general conclusions became apparent to the Committee after reviewing more than 100 publications from the world literature dealing specifically with the health effects of air pollution on children * The first is that children as a group may serve to delineate more clearly the effect of air pollution on health. They (1) spend most of their lives and attend school in limited geographical areas where air quality and meteorological effects can be measured and school absenteeism may also be ascertained tamed, (2) are more susceptible to most respiratory infections, (3) are not largely affected by smoking because it becomes a factor in only a small subgroup, and (4) are not exposed to the occupational hazards to which many adults are exposed. Another observation is that some aspects of growth and development in children may be affected by certain air pollutants. Finally, our review of studies on air pollution in children has shown that the majority of publications have originated from countries outside the United States; this suggests a relative lack of serious consideration of the problem in this country.
PARTIAL DELETION OF THE LONG ARM OF CHROMOSOME E-18
Authors: Curran John P. , Al-Salihi Farouk L. , Allderdice P. W.
Published: December 2021

A male infant with growth failure and multiple somatic abnormalities is described. Karyotype showed deletion of material from the long arm of an autosome identified autoradiographically as a number 18.

Abnormalities commonly associated with this chromosome deletion have been mental retardation, growth failure, microcephaly, hypertrophic ear parts, mid-face retraction, increased digital whorls, developmental retardation, ocular anomalies, fusiform fingers, carp mouth, hypoplastic ear canals, and genital abnormalities occurring in males.

The subject of this report presented with extreme growth failure and developmental retardation. Mid-face dysplasia was mild and microcephaly was absent. External genitalia were normal though all previously described males had cryptorchidism or penis abnormality. Findings not previously reported are ankylosis in extension of both knees, palatal pigmentation, and an extra thoracic vertebrum.

Phenotypic analyses of patients with an 18q- or 18r chromosome suggest that genic loci influencing the development of ear canals and the incidence of digital whorls are located near the ends of the long arms.
Two Family Outbreaks of Perianal Cellulitis Associated with Group A beta-hemolytic Streptococci
Authors: Hirschfeld A. James
Published: December 2021

Three of seven children in one family and both children in another family proved to have symptomatic perianal cellulitis due to group A beta-hemolytic streptococci. This is the first report of family outbreaks of this entity.
UTILIZATION OF A PEDIATRICIAN IN A MENTAL HEALTH CLINIC
Authors: Stone William E.
Published: December 2021

The field of psychiatry, and certainly the subspecialty of child psychiatry, is currently involved in an identity crisis which has particular relevance to the relationship between the pediatrician and the psychiatrist in the delivery of mental health services to children. This crisis is related to the move from patient-oriented psychiatric treatment to the newer methods of community mental health. A good community mental health program is founded on the knowledge and skills learned from careful work with individual patients, but the techniques and goals of treatment require modification. While individual psychotherapy is still an essential part of patient care, it is frequently impractical in the light of the demands and needs of our current culture. In the community mental health center which I am serving, we are currently involved in a major reassessment of our techniques in order to meet the needs of the community rather than the demands of a small group.

Ours is a relatively affluent community, generally considered to be sophisticated, well-educated, and knowledgeable about psychiatry. An easy pitfall in developing a mental health center would be to assume that this is an accurate picture of the entire community and base the whole program on the model of private psychiatric care. However, the city has its pockets of poverty and has large numbers of people who would not respond to insight therapy if it were available to them.

Psychiatrists have been, until very recently, poorly trained for work in the community. Their work has been principally in mental hospitals and in outpatient clinics that offered treatment to a very select group of patients.
In Reply: Evaluation of Routine Examinations: Is the Private Practice of Pediatrics by the Pediatrician Ineffective?
Authors: Anderson Frederic P.
Published: December 2021

Thank you for the opportunity of clarifying some of the points made in my article that have troubled Dr. Heller.

I hope that few readers of the article were led to feel that my conclusion was "that the private practice of pediatrics by the pediatrician (his italics) is ineffective." My premise is precisely the opposite: that because of the great value placed on the reception of the pediatrician's services by the public, all aspects of pediatric services must be carefully scrutinized in order to allocate them rationally and most efficiently.
Possible Hazards of Handling Anti-neoplastic Drugs (Continued)
Authors: Yaffe Sumner J.
Published: December 2021

As I read Dr. Ng's letter,1 I am struck by two erroneous assumptions which are made. In the first place, the necessity for fresh preparation of many of the drugs used in cancer chemotherapy is a reflection only of the stability of the drug and has nothing to do with its cytotoxicity. Secondly, cytotoxicity itself does not necessarily imply that the drug has a vesicant action. Some of the drugs listed by him are vesicants but most of them are not.
LANGUAGE LEARNING AND COMMUNICATION DISORDERS IN CHILDREN, by Gertrud L. Wyatt. New York: The Macmillan Company, 1969, 372 pp., $11.50
Authors: Woodbury Charles B.
Published: December 2021

This volume, by a psychologist who has devoted much of her interest and attention to problems of language and communication, goes far beyond the usual medical treatment of speech and language development. Wyatt has dealt, in a manner thoroughly useful to pediatricians, with the social and interpersonal bases of speech and language.

Besides explicating the general viewpoint of normal language development as a transactional phenomenon in which emotional sharing and repetitive feedback play crucial early roles, she presents two extensive case histories which portray the vicissitudes of speech development in its personal-emotional context.
ON THE ETYMOLOGIC DERIVATION OF SOME COMMONLY USED WORDS IN PEDIATRICS: INFANT, CRETIN, MECONIUM, AND ICTERUS
Authors: Cone T. E.
Published: December 2021

infant-from Latin infans; in (neg.) + fans speaking (fans is the participle). In Roman law infant means a child not old enough to talk...

Cretin-Old French-chretien, a Christian. Perhaps used first as a perjorative term by the ancient Romans because to them the first Christians were stupid enough to "turn the other cheek" when attacked by mobs or by the lions in the Roman amphitheater.

Meconium-from Greek mekonion meaning the poppy juice obtained from pressing the whole plant which gives a thick Juice of black, greenish-brown color. The intestinal content of the newborn infant has a similar consistency and appearance and so Galenadopted the term for the content of the bowels of newborn infants. (Meconism means the opium habit).

lcterus-from Greek ikteros, a yellow bird, probably the golden thrush or a species of oriole. Pliny relates that if a person suffering from jaundice looks at a yellow bird, the bird will die and the patient recovers. Icterus was first used in pediatrics by Ludwig von Buhl (1816-1880) when he described icterus neonatorum.
Response to Medium Chain Triglycerides in von Gierke's Disease
Authors: Cuttino John T. , Summer George K. , Hill Hoyle D. , Mitchell B. Jean
Published: December 2021

Dietary studies have been carried out on the effects of ingested carbohydrate and fat (as MCT and LCT) on hyperlipemia in a patient with von Gierke's disease. Increased carbohydrate in the diet resulted in increased serum lipid levels represented predominantly in the triglyceride fraction. Substitution of MCT for LCT in the diet when carbohydrate consumption was at normal levels resulted in significantly decreased serum lipid levels, disappearance of eruptive xanthomas, and reduction in liver size. We suggest on the basis of this preliminary study that excess carbohydrate should be avoided in the diet and substitution of MCT for LCT should be considered as a rational approach to management of lipid abnormalities in von Gierke's disease.
Surgical Therapy of Glycogen Storage Disease
Authors: Boley Scott J. , Cohen Michael I. , Gliedman Marvin L.
Published: December 2021

Portacaval shunt was successfully employed in the treatment of Type I glycogen storage disease. Severe hypoglycemia, acidosis, hyperlipidemia, and hyperuricemia were corrected and have not recurred although the child is on a regular diet without medication. Based upon our result and the limited experience of others, total portal venous diversion is recommended in early infancy in children with severe hypoglycemia before permanent cerebral damage has occurred.
A Primer on Immunologic Disorders, by Heinz J. Wittig, M.D., William A. welton, and Robert Burrell, Ph.D. Springfield, Illinois: Charles C Thomas, 1970, 123 pp., $6.75
Authors: Stiehm E. Richard
Published: December 2021

To quote from the preface, this little book is intended "to present . . . basic information on immunologic mechanisms and their application to diagnosis and treatment of human disease." Unfortunately, the book fails in this undertaking, and might be renamed "A Brief Review of Clinical Allergy." There are 96 pages of actual text, and 48 pages (50%) are in the second chapter on clinical allergy-diagnosis, management, and treatment, all in considerable detail. There are sections on colic ("belching and gaseous distention of the abdomen . . . can be relieved by the avoidance of allergenic foods") , vernal catarrh, and the tension-fatigue syndrome.
Severe Postural Hypotension Due to Imipramine Therapy
Authors: Koehl George W. , Wenzel James E.
Published: December 2021

The use of imipramine in the treatment of childhood enuresis has recently gained wide acceptance. The drug is known to be quite toxic to children who accidentally ingest it.1-4 Instances of incapacitating toxic effects caused by therapeutic dosages of the drug have not, to the best of our knowledge, been reported in children. It is our purpose to report a case of severe postural hypotension associated with therapeutic dosages of this drug.

Report of a Case

A 9-year-old Caucasian female was evaluated because of enuresis which had been present since toilet training was begun at age 2 years. A complete history and physical examination were nonrevealing; her pulse was 82 beats per minute and blood pressure was 110/75 mm Hg.
Agammaglobulinemia and Thymic Dysplasia Associated with Ectodermal Dysplasia
Authors: Feigin Ralph D. , Middelkamp J. Neal , Kissane John M. , Warren Richard J.
Published: December 2021

A 5-month-old female with agammaglobulinemia, thymic dysplasia, ectodermal dysplasia, and an erythematous icthyosiform dermatitis has been presented. Death at 7 months of age was the result of pneumocystis carinii pneumonia. The association of a broadly based immunologic deficit with ectodermal defects noted at birth lends support to the concept that a basic genetic abnormality may disturb the development of a number of mesenchymal components. It also suggests that skeletal anomalies are not invariably associated with the immunologic and ectodermal defects.
Letters to the Editor
Authors: Work Henry H.
Published: December 2021

No one could have more sympathy with Dr. Shatkin than I. Indeed, the thesis of my material is not that all pediatricians should not be involved in comprehensive care, but that this has not proved feasible for a variety of reasons over the last 40 or 50 years. Therefore, rather than continue to exhort individuals to adopt a comprehensive stance when they feel uncomfortable with it, I think we should realize realities and accept the fact that there are tasks for everyone.
Fecal Impaction (Urinary Retention): A Diagnostic Posture
Authors: Toksöz Ülkü
Published: December 2021

The article, "Urinary Retention Due to Fecal Impaction in Children" which appeared in Pediatrics (45:292, 1970) reminded me of a very remarkable case in which I had been involved some time ago. After reading the article, I realized another aspect of this case which had not occurred to me until then.

During my residency, a 4-year-old boy came from the outpatient clinic to be hospitalized. I was told that the child had not been able to void for 24 hours but urine was constantly dripping.
HEMOPHILIA: A Study in Hope and Reality, by Alfred H. Katz, D.S.W. Springfield, Illinois: Charles C Thomas, 1970, 159 pp., $9.00
Authors: Strauss Herbert S.
Published: December 2021

This book is mainly about the social and psychological problems of hemophilia as determined primarily by the results of questionnaires returned by more than a thousand patients with hemophilia aged 16 years or over. In the author's words, "In hemophilia are encapsulated most of the problems of adaptation to chronic illness and social limitation found in other disabling conditions." Thus the conclusions of this study should have applicability beyond the confines of hemophilia. The book repeatedly deplores the widespread misinformation about the nature of hemophilia and the general low expectations of potential achievements of persons afflicted with this disease.
PREDICTING THE RESPONSE OF CHILDREN WITH LEARNING DISABILITIES AND BEHAVIOR PROBLEMS TO DEXTROAMPHETAMINE SULFATE
Authors: Barcai Avner
Published: December 2021

This is a clinical study using a phenomenological, office practice approach to diagnose the hyperkinetic child who responds with improved concentration and organization of his mental facilities to the amphetamines. The combination of anamnestic items, information from the teacher, and the clinical interview were found to be effective in correctly predicting approximately 85% of behaviorally disturbed children who would respond favorably to the stimulating drugs. The finger twitch test and a list of selected questions, which could be used by the pediatrician in his office, were found to lead to a weighted, non-inferential assessment of the child's mental status, as a help in determining the advisability of prescribing the stimulant for some behaviorally disturbed children.
NEUTRON ACTIVATION ANALYSIS TECHNIQUE FOR NAIL SODIUM CONCENTRATION IN CYSTIC FIBROSIS PATIENTS
Authors: Johnson G. Frank , Thompson Max F. , Fetteroff S. , Fasano A. N.
Published: December 2021

This study reports nail sodium values in milliequivalents per kilogram as determined by neutron activation analysis in a variety of normal, hospitalized, and cystic fibrosis children. The elevated sodium values thus determined in cystic fibrosis indicate the usefulness of the method, though they are not in themselves diagnostic.

The nails are porous to sodium and reflect the sweat sodium levels. The results are influenced by age, environment of the nail, and other disease conditions.
XE133-RADIOSPIROMETRY FOR EVALUATION OF CONGENITAL MALFORMATIONS OF PULMONARY ARTERIES
Authors: Arborelius Mans , Gustafsson Thomas , Kjellman Bengt , Lundström Nils Rune , Mortensson Wigher
Published: December 2021

Investigation of regional lung function with Xe133-radiospirometry and I131-MAA- scintigraphy in children with congenital malformations of the pulmonary arteries gave information above that obtained with angiographies. The new information was of value for the management of the patients.

Xe133-radiospirometry and I131-MAA-scintigraphy were found to be complimentary methods but radiospirometry is considered to be the first choice method: it gives information not only of regional perfusion but also of regional volume and ventilation and, furthermore, the absorbed radiation dose with radiospirometry is much lower than that with scintigraphy.
THE ROLE OF RED BLOOD CELL ORGANIC PHOSPHATES IN ADAPTATION TO CONGENITAL HEART DISEASE
Authors: Rosenthal Amnon , Mentzer William C. , Eisenstein Esther B. , Nathan David G. , Nelson Nicholas M. , Nadas Alexander S.
Published: December 2021

The role of red blood cell (RBC) 2,3- Diphosphoglycerate (DPG) as a prime regulator of oxygen release by hemoglobin in congenital heart disease (CHD) was evaluated in 73 catheterized children. Although a decrease in arterial oxygen tension (Pao2) was associated with an increase in RBC DPG and P 50 (oxygen tension at 50% hemoglobin saturation), there was a great variability in the DPG concentration at any given Pao2. This variability may in part be related to the apparent influence of congestive heart failure (Pao2 > 60 mm Hg) and systemic oxygen transport (systemic blood flow times arterial oxygen content) on RBC DPG. Cardiac surgery, palliative or corrective, as well as noncardiac surgery (one patient) resulted in an unexplained, paradoxical rise in RBC DPG in the immediate postoperative period (3 to 14 days) despite normal or improved Pao2. RBC DPG and P 50 values returned to normal levels within a month after surgery in patients with successful cardiac repair, but remained elevated in those with palliative surgery. These observations suggest that in addition to a low Pao2, an increase in RBC DPG and consequent rightward shift of the oxygen hemoglobin dissociation curve in CHD may occur as a response to congestive heart failure, reduced systemic oxygen transport, and a major surgical procedure. The reversibility of this adaptive mechanism was demonstrated following successful surgical correction of cyanotic CHD.
QUINTILIAN AND THE EDUCATION OF CHILDREN
Authors: C. T. E.
Published: December 2021

Marcus Fabius Quintilianus, or Quintilian (c. A.D. 35-c. 95), in his celebrated Institutio Oratoria wrote extensively and wisely about the education of children. A sampling of his ideas cited below will show that they remain as timely today as they were two thousand years ago.

Above all things we must take care that the child, who is not yet old enough to love his studies, does not come to hate them and dread the bitterness which he has once tasted, even when the years of infancy are left behind. His studies must be made an amusement.1

Study depends on the good will of the student, a quality that cannot be secured by compulsion.2

I will content myself with saying that children are helpless and easily victimized, and that therefore no one should be given unlimited power over them.3
Zollinger-Ellison Syndrome in a Nineyear -old Child: A Case Report and Review of this Entity in Childhood
Authors: Buchta Richard M. , Kaplan J. M.
Published: December 2021

In 1955, Zollinger and Ellison1 described a syndrome consisting of peptic ulceration, marked gastric hypersecretion, and non-beta islet cell tumor of the pancreas.

Although there have been over 300 cases in the adult literature2-5 only 19 patients, 16 years old or younger have been reported. We add one more child to this growing list and review the clinical data of the known cases described.

Case Report

The patient (R.L.) was a 9-year-old Negro male with a 7-month history of intermittent episodes of mid-epigastric abdominal pain. The pain was somewhat relieved by eating, or the use of antispasmodics. During this period of time, the child had occasional episodes of vomiting, but no melena or hematemesis.
IMMUNODEFICIENCY AND IMMUNOBIOLOGY
Authors: Wedgwood Ralph J.
Published: December 2021

Almost 20 years ago in this journal, Bruton1 described a young boy afflicted with recurrent severe infections, who lacked gamma globulin. His description identified a new disease and heralded a new era in immunobiology. "Agammaglobulinemia," the term he coined, described a condition of immunodeficiency in a manner analogous to the use of the term "anemia" in the description of abnormalities in erythrocytes. The delineation and treatment of immunologic defects require a conceptual framework for the understanding of immune responses in man, just as the specific diagnosis and therapy of anemia require knowledge of iron metabolism, hemoglobin synthesis, and erythrocyte production.
MUSCLE SURFACE pH: A NEW PARAMETER IN THE MONITORING OF THE CRITICALLY ILL CHILD
Authors: Filler Robert M. , Das John B.
Published: December 2021

In three severely ill infants, muscle surface pH was recorded continuously with a new miniaturized pH electrode for periods up to 100 hours.

The clinical findings correlate with experimental results and indicate that muscle pH is a reflection of both arterial pH and the adequacy of tissue perfusion. Since muscle pH changes often precede changes in vital signs and arterial pH, muscle pH monitoring may provide the earliest warning of a deteriorating clinical situation. Although the present clinical experience is small, the findings appear to justify further trials with this method of monitoring sick infants.
Automobile Safety for Children, Seat Belt Division
Authors: Rowley William F. , Lariviere Eugene , Dietrich Charles W.
Published: December 2021

I would like to call your readers' attention to the effective date of the Motor Vehicle Safety Standard No. 213, Child Seating Systems, which is April 1, 1971.1

This ruling provides that child seating systems offered for sale have to meet specifications set by the National Highway Traffic Safety Administration. Now, for the first time, a physician, who can and should recommend that parents of young children purchase restraining devices, can be assured that these devices will provide effective restraint.
Reye's Syndrome as a Cause of Hypoglycemia
Authors: David Simeon , Greenberg Robert E.
Published: December 2021

I would like to suggest to Drs. Greenberg and Christiansen the addition of another entity to the Table of Causes of Hypoglycemia in Childhood which was listed in their article "The Critically Ill Child: Hypoglycemia"1 This is the Reye's syndrome2 or if one prefers, encephalopathy and fatty degeneration of the viscera. Some authors3 consider that the etiology is related to salicylate ingestion and if indeed this is the case then this disease would be listed under the section of pharmacologic or toxic alterations in glucose homeostasis.
Failure to Thrive
Authors: Fraser Graham C. , Cohen Michael I. , Smith Clement A. , Berenberg William
Published: December 2021

I note with interest the Commentary of your November issue1 with regard to the concept of failure to thrive. I think that the effort at elucidation and definition of this concept is much to be commended.

I would like, however, to underline the frequency with which this description is met in infants who are suffering from surgical conditions. Your writers (Smith and Berenberg) refer, briefly, first to infections, "then congenital malformations."

With respect, I would rephrase that as "especially congenital malformations."
THE PREPARATION, UTILIZATION, AND EVALUATION OF A REGISTERED NURSE TRAINED TO GIVE TELEPHONE ADVICE IN A PRIVATE PEDIATRIC OFFICE
Authors: Strain James E. , Miller J. Darrell
Published: December 2021

A registered nurse, specifically trained for the telephone evaluation and management of the health problems of children, is a valuable addition to a pediatric office staff.

The training of the nurse by the physicians, through a series of teaching sessions, is described here.

To evaluate the results of her training, more than 16,000 incoming telephone calls were tabulated over a period of 1 year. Approximately half were administrative calls and half medical calls. An average of 25 medical calls daily were taken by the nurse. In 92% of the cases she was able to manage the problem either directly or after consulting with the physician.

Patient acceptance was excellent.

The expansion of the nurse's role broadened the scope of services and significantly increased and improved pediatric care in our office. The nurse provided prompt, accurate advice which met the patient's specific needs and resulted in more efficient use of the physician's time in providing direct care to the patient. Through her assistance, an additional 2 to 3 hours of physician's time became available for patient care.
Urinary Retention Due to Fecal Impaction
Authors: Berman Wulfred
Published: December 2021

With reference to the article, "Urinary Retention Due to Fecal Impaction in Children" which appeared in Pediatrics (45:292, 1970), I would like to mention that during a few months period spent at the Government Hospital, Ashkelon, Israel, quite a number of cases of urinary retention due to fecal impaction were seen. The presenting cases were mostly young school age children who had eaten large amounts of cactus fruit, the seeds of which caused fecal impaction followed by urinary retention.
Disseminated BCG in Twin Boys with Presumed Chronic Granulomatous Disease of Childhood
Authors: Esterly John R. , Sturner William Q. , Esterly Nancy B. , Windhorst Dorothy B.
Published: December 2021

Twin male infants, immunized with BCG at birth, died at 4½ months and 9 months of age with dissemination of this organism, as well as other infections. Disorders of humoral and cellular immunity were excluded by laboratory findings, but evidence of defective phagocytic activity in a surviving relative strongly suggests that the twins represent the first known instance of BCG-osis complicating chronic granulomatous disease of childhood.
NEONATAL NARCOTIC ADDICTION: 10 YEAR OBSERVATION
Authors: Zelson Carl , Rubio Estrellita , Wasserman Edward
Published: December 2021

During the 10-year period 1960 through 1969, 384 infants were born to 382 heroin addicted mothers. One hundred ninety (49.4%) of the infants were under 2,500 gm in weight. Seventy -seven (40%) of these were low weight for date infants. Two hundred fifty-nine (67.4%) of the total group of infants developed signs of withdrawal within the first 4 days of life. One hundred seventy-eight or 68.7% of these manifested signs severe enough to require treatment. Eighty-one infants had mild withdrawal signs which cleared without treatment. The 178 treated infants represented 46.3% of the entire group of heroin exposed infants.

Our data indicated that there was a direct correlation between the length of maternal addiction and the occurrence of withdrawal signs in the infants; that with an increase of maternal intake of heroin, there was an increased incidence of neonatal withdrawal; and that the closer to delivery the last dose of heroin was taken, the higher and earlier was the occurrence of withdrawal signs in the neonate.

Response to treatment with chlorpromazine was excellent. The incidence of congenital anomalies was no higher than in the general newbron population. Morphine and quinine could be demonstrated in the urine of the newborn infants within the first 24 hours of life. Fourteen infants (3.6%) died in the neonatal period; nine of these within the first 9 hours after birth. No evidence of Hyaline Membrane disease was found at autopsy in those that died in respiratory distress.
OUR ADOLESCENTS IN 1857 ARE WARNED OF THE EVILS OF PARISIAN LIFE
Authors: C. T. E.
Published: December 2021

In the America of the 1850's, France, and particularly Paris, were thought to be places possessing singularly malevolent influences over young men. The following item from the Boston Traveller (1857) is a good example of this belief:

La Belle Paris! the synonym of all that is beautiful; the city of gayety and revelry, of music and mirth, where pleasure lures, dazzles, intoxicates, and then destroys! is this the sad end to which your young men of culture and intellect arrive, in a short quarter of a century? Then let it be a loud warning to the youth of our own time and nation, that a better path is marked out for them in the Book of all books, which counsels to be temperate in all things, to take hold of wisdom whose ways are ways to pleasantness-whose paths are peace.1
Solitary Eosinophilic Granuloma of Lymph Node: Five-year Follow-up
Authors: Morgenfeld Marcos Carlos , Schajowicz Fritz
Published: December 2021

A case of eosinophilic granuloma involving a single submaxillary lymph node occurring in a boy who is now 7 years old is reported. The patient was followed for 5 years and has not presented any other manifestation of disease in the skeleton or extraskeletal tissues.

A complete cytohistopathological, cytochemical, and biochemical study of the excised lymph node was carried out. This is the first case recorded of a solitary eosinophilic granuloma of a lymph node followed for more than 5 years.
Colon Carcinoma in Childhood
Authors: Donaldson Milton H. , Taylor Peyton , Rawitscher Robert , Sewell John B.
Published: December 2021

Two cases of colon carcinoma in children without a family history of polyposis or gastrointestinal malignancy are reported. Details of the post-surgical treatment with 5-fluorouracil are stated, along with a brief recounting of the literature which served as a basis for the therapeutic approach utilized in these two patients. The tumor-free intervals of 14 and 20 months are impressive in view of the advanced stages of the lesions and, thus, suggest 5-FU should be utilized in children with colon cancer as it is in such adults.
Hallucinogenic Effect of Propellant Components of Deodorant Sprays
Authors: Kramer Robert A. , Pierpaoli Paul
Published: December 2021

Spray deodorants are presented as another example of the innovation of the drug subculture in its persistent search for escape through the world of chemistry. The accuracy of the folklore as exemplified by the difference between the two products described and the rapidity with which the new idea is transmitted through the subculture necessitates communication to the medical profession in order to alert it to the problems in dealing with this hallucinogenic experience.
THE ADOPTION OF BLACK CHILDREN
Authors: Feiertag Richard B. , Baratz Merrill A. , Daniel William A. , Earlywine Josephine L. , Lewis Donald , Seidel Henry M. , Tillman Mary A. T. , Work Henry H. ,   Committee on Adoptions and Dependent Care
Published: December 2021

The large number of black children needing adoptive homes is an urgent problem of our time. Though an immediate solution may not be available, a vigorous, cooperative effort will assure that each child waiting will be provided a secure and loving home. The welfare of the child remains the primary consideration when selecting a home.
Palpating the Kidneys of the Newborn
Authors: Askin John A. , Museles Melvin , Gaudry Charles L. , Bason William M.
Published: December 2021

I am always delighted to see an article published lished: (1) emphasizing the importance and difficulty of diagnosing a developmental anomaly of the urinary tract; (2) emphasizing the incidence of 3.5 to 5% of all children having an anomaly of tile urinary tract; ard, (3) emphasizillg that these anomalies are demonstrated, by the ordinary physical examination, but only if oiÄ±e has developed a meaningful list of indications for urological evaluation.

I would like to take exception to several remarks in the report regarding the abdominal palpation of the newborn.1
Artificial Sweeteners and Fetal Malformations: Negative Experimental Evidence
Authors: Farkas Gerald , Ropp Michael , Fraser F. C.
Published: December 2021

In a Letter to the Editor of Pediatrics,1 Doctors Hillman and Fraser reported two cases of lobster claw abnormality which they tentatively linked with cyclamate consumption during pregnancy. In an attempt to investigate the likelihood of this phenomenon we used transparent Zebra Fish (Brachyrerio danio) eggs. This organism was chosen because it: was a vertebrate; enabled large numbers of individuals to be tested; and had a development time of about 72 hours. Four hundred eggs were exposed to buffered 1% cyclamate solution from the two cell stage to hatching.
The British Pediatric Association 1952–1968, vol. 2, by Victor Neale, F.R.C.P. England: Pitman Medical & Scientific Publishing Co., Ltd., 1970, 121 pp., no price given
Authors: Steen Robert Elsworth
Published: December 2021

The late Victor Neale has done a great service not only to the British Paediatric Association (B.P.A.) but to Pediatrics in general by his masterly 2nd volume of the history of the association. It covers the years 1952 to 1968; the fact that during this period the membership rose from less than 150 to nearly 500 reflects the advance of pediatrics during that time. Further, the importance of the B.P.A.'s influence, both scientifically and politically, is emphasized by the association's setting up of an academic board to organize the scientific side of the annual meetings, by its vigorous efforts to further pediatric research and training, by strengthening its contacts with other similar societies, and especially by the B.P.A.'s increasing influence on the British Ministry of Health which has tended increasingly to consult the association as well as having observers on its council.
Genetic Counselling, by Alan Carruth Stevenson and B. C. Davidson, with assistance from Michael W. Oakes. Philadelphia: J. B. Lippincott Company, 1970, 355 pp., no price given
Authors: Zellweger Hans
Published: December 2021

Everyone in clinical practice, notably general practitioners, pediatricians, and obstetricians are asked by patients conscious of their genetic endowment about the implications of hereditary and congenital disorders. Referrals to genetic counseling (counselling in the United Kingdom) clinics are not always feasible considering the ever increasing workload of the latter. Thus, the primary physician is compelled to answer some of the questions himself. The book, written by three members of the British Medical Research Counsil, Population Genetics Unit, Oxford, provides exactly the information which may be needed to answer such questions.
THE SHIFT TO THE LEFT
Authors: Oski Frank A. , Delivoria-Papadopoulos Maria
Published: December 2021

For many years it appeared that physiologists, and physiologists alone, puzzled over the causes and significance of alterations in the position of the oxygen-hemoglobin equilibrium curve. The reports by Benesch and Benesch1 and Chanutin and Curnish2 in 1967, concerning the role of red cell organic phosphates in determining the affinity of hemoglobin for oxygen, have served to rekindle curiosity in this problem of oxygen transport and produced a common focus of clinical interest for neonatologists, hematologists, biochemists, and the now nearly forgotten physiologists.

The oxygen-hemoglobin equilibrium curve of normal adult blood is depicted as the center curve in Figure 1.
MATERNAL TOXEMIA, FETAL MALNUTRITION, AND MOTOR BEHAVIOR OF THE NEWBORN
Authors: Schulte F. J. , Schrempf Gerlind , Hinze Gabriele
Published: December 2021

Twenty-one small-for-gestational-age newborn infants of toxemic mothers had normal nerve conduction velocities indicating normal peripheral nerve myelinization. Muscle tone and general excitability were lower than normal, resembling in some respects the motor behavior of preterm infants. Thus, neonatal motor behavior is unsuitable for a conceptional age estimate in small-for-gestational-age infants of toxemic mothers. In the infants of this study, the abnormal motor behavior was not due to symptomatic hypoglycemia, neonatal asphyxia, or any other overt postnatal illness. The maturation of the fetal nervous system was adversely affected by maternal toxemia and intra-uterine malnutrition.
PERCUTANEOUS VENOUS CANNULATION IN NEONATES AND INFANTS: A METHOD FOR CATHETER INSERTION WITHOUT "CUT-DOWN"
Authors: Filston Howard C. , Johnson Dale G.
Published: December 2021

A technique for successful and consistent cannulation of extremity veins of neonates using a plastic catheter with inner needle stylet has been used in over 150 neonates for surgical and postoperative management at the Children's Hospital of Philadelphia and has all but eliminated the use of the incisional "cut-down."

Advantages of this method over the incisional "cut-down" include: ease of changing insertion sites, preservation of function and subsequent usefulness of the veins, the ability to use larger caliber cannulas, increased duration of function without phlebitis, and the elimination of the unsightly "cut-down" scars.

Although meticulous attention to the details of insertion and immobilization are essential for success with this technique, it has been easily taught to our rotating junior level surgical residents and to many of the pediatric interns and pediatric residents.
NEONATAL MORTALITY, THE MALE DISADVANTAGE
Authors: Naeye Richard L. , Burt Leslie S. , Wright David L. , Blanc William A. , Tatter Dorothy
Published: December 2021

Male infants have an excessive risk of neonatal death by comparison with females. It has never been clear whether this male disadvantage is due to specific disease processes or is a general biologic feature of being male. In an analysis of 2,735 consecutive newborn autopsies, the ratio of males to females was 1.28:, which differs significantly from the 1.05:1 ratio for all U.S. livebirths. There was a near equal male to female ratio for most disorders in stillborn infants while disorders arising after birth demonstrated a strong male disadvantage. The still-born ratios presumably reflect a predominant maternal influence while birth and removal from the maternal environment uncovers an inherent biologic disadvantage of being male, a disadvantage not selectively related to specific disease processes. This nonspecificity is confirmed by the finding of several disorders in which sex ratios for stillborns are quite different than the ratios recorded for liveborn infants. The sex ratio for liveborn Caucasians was significantly greater than for nonwhites, and the nonpoor had a significantly greater ratio than the poor. About half of these differences appear related to a greater incidence of prenatal bacterial infections in the poor and nonwhites.
BIOCHEMICAL ASPECTS OF INTRAVENOUS ALIMENTATION
Authors: Ghadimi H. , Abaci F. , Kumar S. , Rathi M.
Published: December 2021

Biochemical aspects of total parenteral alimentation in 10 patients (two low birth weight newborn infants and eight infants) for periods of 5 to 24 days were studied by:

A. Determination of concentration of amino acids and ammonia of two commercially available protein hydrolysates.

B. Analyses of blood and urine obtained before, during, and after parenteral alimentation for various biochemical parameters including amino acids, urea nitrogen, glucose, and osmolality.

The results showed that the protein hydrolysates contained a very high concentration of ammonia.

This inordinate amount of ammonia taxes the Krebs urea cycle and in premature infants enhances acidosis and respiratory distress syndrome. It also explains the abnormal liver function tests and hyperammonemia found concomitantly with infusion of protein hydrolysate. Another effect of infusion of protein hydrolysate, in conventional amount, is persistent hyperaminoacidemia.