bluuebunny/crossref_metadata_2025 huggingface dataset:
ENTEROVIRUSES
Authors: Syverton Jerome T.
Published: December 2021

IT IS AN HONOR and responsibility to present this Tenth Annual Don W. Gudakunst Lecture. Dr. Gudakunst, as first Medical Director of the National Foundation for Infantile Paralysis, was administrator and participant in a productive research program. In 1950, the year Dr. Charles Armstrong gave the first Annual Lecture, the program received new impetus with results now familiar to us all. The list of distinguished lecturers of succeeding years, including Sabin, Bodian, Paul, Salk, Enders, Francis, Horstmann and Huebner, is a record of workers and achievement that opened the way to control of poliomyelitis, and vastly expanded our understanding of viruses, nucleic acids, cells, and their interaction to produce cellular infection. Dr. Gudakunst would be proud of his early association with and contribution to the research program which continues under generous support of The National Foundation. Apart from its record of outstanding contributions to prevention of poliomyelitis, this annual series of lectures is evidence that the distinction between pure and applied research has less and less meaning. With this example before me, in discussing enteroviruses I shall proceed freely from epidemiologic to basic research. Work done at Minnesota represents contributions of a group of associated investigators.

THE ENTEROVIRUS TRIBE

In the days when our virologic tools were limited, we used to speculate that the human environment might include many viral nonpathogens or opportunist pathogens, as well as the viruses of known diseases. Study of the enteroviruses illustrates technologic advances achieved since 1950, to uncover more than 100 viruses now characterized, and many others unidentified but distinguished from known types.
DIAGNOSIS OF CYSTIC FIBROSIS OF THE PANCREAS
Authors: Barbero Giulio J.
Published: December 2021

THIS PAPER is a discussion of present concepts in diagnosis of cystic fibrosis of the pancreas. Such concepts should develop from an examination of the definition of this disease. Cystic fibrosis is now known as a disease which appears as focal involvement of various exocrine glands in the body, with its principal symptomatic manifestations in two main anatomic areas. These two areas are the gastrointestinal tract where symptoms are exhibited as more frequent, foul-smelling and bulky stools, and the respiratory tract where involvement is shown principally as cough, wheezing or respiratory distress.

PARTICULAR CLINICAL FEATURES

My purpose here is not to discuss the well-recognized picture, but rather to emphasize some of the clinical characteristics. The clinical picture has widened in its range because of improved diagnostic tests such as determination of electrolytes in sweat and greater awareness by physicians. As a result, there are now known to be patients who show more or less gastrointestinal or respiratory involvement. On the one hand, there is an enlarging group of patients who have principally respiratory involvement and very little gastrointestinal disorder. These patients, of course, are frequently confused with patients with other chronic pulmonary disease or asthma. On the other hand, there is now a small group of patients with gastrointestinal symptoms and very little respiratory disease. These patients often are confused with those having chronic diarrhea or celiac disease.

There are a few points which might be emphasized as clinically diagnostic characteristicis. Cystic fibrosis is often associated with the diarrheal group of diseases, but it is not truly a diarrheal disease in the sense of more fluid bowel movements with acute exacerbations. The stools are bulky, foul-smelling and unformed movements, usually passed three to four times a day. A very large appetite has been constantly emphasized, but among a large enough group of such children one is impressed that this is not a constant symptom.
ASSOCIATED RECTAL AND JEJUNAL ATRESIA IN THE NEWBORN
Authors: Schultz L. R. , Lawrence G. H.
Published: December 2021

A report of a premature infant with multiple congenital diaphragms of jejunum, ileum, and rectum has been presented. The etiology and treatment have been reviewed. Barium enema preoperatively to establish patency of the colon in cases of congenital obstruction of the small bowel is recommended.
THE USE OF HYPOTHERMIA IN CHILDREN
Authors: Shields John R. S.
Published: December 2021

So MUCH has already been said and written about hypothermia in the past decade that one hesitates to add yet another paper. The excuse for doing so is that our experimental and clinical work over the last 5 or 6 years has led to some practical results and conclusions which have greatly reduced the mortality and increased the usefulness of this technique.

There are so many occasions on which benefit can be seen from the lowered metabolism resulting from the reduction of the body temperature and so many cases where the ill effects of anoxia may be lessened by hypothermia, that we believe many cases must benefit from its application, provided the method of cooling is safe and readily controlled.

General Considerations

The principal advantages from cooling are:

1. Reduction in metabolic rate and a lowering of oxygen consumption to something in the order of 50% of normal at 30°C.

2. Reduction in cardiac output.

3. Reduction in clotting time, which may prove useful in cases of cardiac disease with polycythemia.

Our clinical experience has been predominantly in the surgical field, but hypothermia does also have important applications in other than surgical cases and its employment should be extended. In particular, we firmly believe that children are often most suitable subjects for this technique. Not infrequently one hears a physician doubting if an infant on small child should be subjected to the "stress" of hypothermia; the truth would appear to be just the opposite—that hypothermia, properly managed, actually protects against shock.
Genital Abnormalities in Infants Associated with Administration of Progesteroids to Their Mothers
Authors: Leibow Sheldon G. , Gardner Lytt I.
Published: December 2021

PRESENTATION OF CASES

Dr. Sheldon G. Leibow: Case 1. The first patient is an infant girl who was first seen here on October 6, 1958 at the age of 2 months by Dr. Gardner. She was referred for evaluation because of an enlarged clitoris present since birth.

The child was born on August 5, 1958, the ninth pregnancy of a 39-year-old mother. Her mother had a history of three spontaneous abortions, two of which had preceded the birth of the patient. In view of this obstetric history, her mother was given hormone therapy in her second month of pregnancy (December 9, 1957). Treatment consisted of: U.S.P. desiccated thyroid, 65 mg/day; 17-alpha-ethinyl-19-nortestosterone (Fig. 1), 5 mg twice daily; and diethylstilbestrol 5 mg twice daily. On December 30, diethylstilbestrol was increased by 5 mg/day, once weekly, until a daily dose of 75 mg was achieved. The other hormones were continued at the original dosage. All therapy was discontinued in the thirty-fifth week of gestation.

Two other developments of interest occurred during this pregnancy. Glycosuria was noted for the first time during the second month and was treated with a 1,500 calorie diet and 27 units of isophane (NPH) insulin daily. There was no antecedent history of maternal diabetes, and insulin was not required after termination of the pregnancy. The child's mother fell during her fifth month of pregnancy, developing some spotty vaginal bleeding which ceased promptly after several days of bed rest.

A full-term infant weighing 3,430 gm was delivered on August 4, 1958.
In Reply: Myleran and Malformations
Authors: Diamond Israel
Published: December 2021

I am indebted to Dr. Sherman for calling attention to the two Myleran case reports; and apology is more than due for having overlooked them. As he says—"the dosage was lower and therefore the experiences may not be comparable."

He is also quite right in pointing out that the experimental evidence suggests that 6-mercaptopurine exerts its damaging effect at the time of implantation. Perhaps our position on this point must stand solely on Mersky and Regal's experience; although the administration of the drug during both pregnancies is too striking a coincidence to be ignored.
Mental Subnormality, Richard L. Masland, Seymour B. Sarason, and Thomas Gladwin. New York, Basic Books, Inc., 1959, 442 pp., $6.75
Authors: Kugel Robert B.
Published: December 2021

This is an extraordinary book in many respects. In this volume one sees the unusual collaboration of a physician, a psychologist and an anthropologist who bring together the very different points of view that each discipline has in a highly skillful manner. This is an exceedingly useful and comprehensive book on mental retardation and without a doubt it will certainly be a must for anyone dealing with any aspect of mental retardation.

Perhaps there is some mark of distinction the autors have already received in the fact that the first section written by Masland was published in the A.M.A. Journal of Diseases of Children (Vol. 95, Jan. 1958, No. 1), and the second portion by Sarason and Gladwin was published in Genetic Psychology Monograph (1958-57, pp. 3-290).
SURGICAL EXPLORATION IN OBSTRUCTIVE JAUNDICE OF INFANCY
Authors: Santulli Thomas V. , Harris Ruth C. , Reemtsma Keith
Published: December 2021

From a review of 71 cases and an evaluation of frozen-section examinations of liver biopsies, the authors propose the following method of management of infants with prolonged obstructive jaundice.

All patients are carefully selected on the basis of history, clinical findings and appropriate laboratory investigation. Laboratory studies found to aid in the differential diagnosis are: serial determinations of bilirubin (conjugated and unconjugated) in the serum, zinc sulfate turbidity test, cholesterol and cholesterol esters in serum, estimation of bile pigment in urine and stool, studies of the maternal and infant blood factors and erythrocyte fragility. Determinations that have not been useful in the differential diagnosis are: cholesterol esterase, alkaline phosphatase and cephalin fiocculation.19 The activity of transaminases in the serum may prove helpful and are currently under study. The measurement of the prothrombin time should be included in the preoperative studies.

If the diagnosis is impossible by the age of 7 weeks, then surgical exploration is carried out. This consists of exposing the liver, taking a biopsy for frozen-section examination and performing a cholangiogram, if possible. With increasing experience, confidence has been acquired in interpretation of the frozen-section of the liver biopsy at this age. The authors are convinced of its value in helping the surgeon establish the diagnosis before proceeding with further exploration of the bile ducts.

By this method of management, surgical exploration need not be delayed beyond 7 weeks of age. Thus a patient with congenital atresia of the bile ducts, who may be fortunate enough to have a correctable lesion, will not be deprived of the only possible chance of cure. At this age it is unlikely that biliary cirrhosis will have progressed to a severe degree. Admittedly, it would be preferable to explore such a case earlier, but more experience is needed in diagnosis by frozen-section examination at an earlier age.

It does not appear that any patient with hepatitis or other non-surgical condition has been harmed either by the anesthesia or surgical trauma attendant on this limited procedure. One of the greatest advantages of the frozen-section examination has been the information provided to the surgeon at a crucial time during the exploration. With this information the surgeon should be able to avoid unnecessary exploration of the bile ducts and possible injury to patent ducts, as well as unnecessary biliary-intestinal anastomoses which have been performed in the past because of mistaken diagnoses.
THE RELATIONSHIP OF PULMONARY HYALINE MEMBRANE TO CERTAIN FACTORS IN PREGNANCY AND DELIVERY
Authors: Cohen Myron M. , Weintraub David H. , Lilienfeld Abraham M.
Published: December 2021

A review of neonatal mortality at the Maternity Division of the Buffalo Children's Hospital from 1948 to 1957 has been presented, with primary emphasis on the occurrence of pulmonary hyaline membrane.

During this period there were 26,109 infants born alive, including 2,001 below 2,500 gm in weight, a prematurity rate of 7.7%.

Using a factor to correct for dead infants not necropsied, an incidence of hyaline membrane of 39.1 per 1,000 live-born prematures and 0.7 per 1,000 live-born full-term infants was obtained. These rates are compared to those previously reported.

Among singleton infants under 2,500 gm birth weight the frequency of hyaline membrane was greater for those infants born to mothers with either bleeding or toxemias as complications of pregnancy. An increased rate among premature infants delivered by cesarean section was also obtained, but this increase was limited to those pregnancies with bleeding.

Infants delivered of mothers with a history of prior stillbirths had a nearly three-fold greater incidence rate of hyaline membrane than did those mothers without such history. However, mothers with previous premature births or miscarriages did not show this increase.

The suggestion is advanced that hyaline membrane, and perhaps other instances of respiratory distress of the newborn, may result from a process of intrauterine asphyxia, which in many instances is manifested also by maternal bleeding.
Present status of the prevention of neural tube defects
Authors: Nadler Henry L.
Published: December 2021

During the past two decades, a number of dramatic changes have taken place in the treatment of infants born with myelomenmgocele. Since the development in the 1950's and early 1960's of more effective methods for treating hydrocephalus, urinary incontinence, and paraplegia, aggressive treatment regimes have been initiated. Numerous articles and editorials have questioned these various treatment modalities based on the lack of objective long-term studies documenting their effectiveness. More recently, dissatisfaction with the results of current surgical prodecures for children with myelomeningocele has led to the development of selective criteria for early treatment.1,2

The purpose of this commentary, however, is not to discuss the merits of selective treatment for myelomeningocele but rather to discuss some of the recent developments for the prevention of this disorder.
WHAT IS AN ADULT?
Authors: Erikson E.
Published: December 2021

Erikson asks, what is an adult? The answer comes with some difficulty. "To know that adulthood means to be generative, does not necessarily mean that one must produce children. But it means to know what one does if one does not. And it means that one participate otherwise in the establishment, the guidance and the enrichment of the living generation and the world it inhabits."
EMPATHY AND REPRESSION
Authors: Vaux Kenneth
Published: December 2021

Today's physician and scientist, indeed any human, faced with a malnourished child or a young adult dying from leukemia cannot accept [a] verdict of resignation . . . Consider the following: the delicate decisions requiring a balancing of needs against limited resources, decisions of triage and priority; decisions to impede, accelerate or merely attend a patient in the dying process.

In these cases the ability to understand the conflicting values of hope and resignation is necessary to avoid two unfortunate responses. On the one hand there is empathy that can foster debilitating guilt; the biologist Gilbert Hardin has pointed up in recent papers the destructiveness of thoughtless benevolence. On the other hand there is that systematic repression that slowly renders one an automation without conscience. Those forced to render decisions in medicine must delicately transact the tension between hope and resignation.
A NATIONAL HEALTH PROGRAM: ORGANIZED DIVERSITY
Authors: Starr P.
Published: December 2021

The pivotal long-range question in medical reform is whether medicine should be viewed as a technical activity with occasional moral or social overtones or, alternatively, as a social and moral activity with a technical substratum. Is . . . medical care . . .more like the supply of water or the provision of education?

If medical care is ultimately a technical activity like water supply, its management can be safely entrusted to experts in the field.

If, on the other hand, medical care is primarily a moral and social activity like education, the situation is quite different . . . . Consequently, in organizing our institutions, we have good reason to provide for both participation and diversity. We may also wish to sacrifice some of the "efficiency" of a single, professionally run system for the relative inefficiency of variegated institutions sometimes in conflict with one another.

In the system advocated . . . the government would pay the basic annual cost, although families would choose to spend more for additional services.

What I am proposing here is an organized system that uses competition in a premeditated fashion: competition under constraint.
Children Out of Step With Immunization
Authors: Phillips Carol F.
Published: December 2021

From the many studies cited several points can be seen.

(1) Diphtheria and tetanus are good immunizing agents which produce long-term immunity. (2) A series of two diphtheria-tetanus plus a booster one year later is adequate for basic immunization. (3) Two injections of pertussis at least 60 days apart produce levels of agglutinin that are equal to the amount produced by three injections. (4) Prolonged time between the injections of the basic series of diphtheria-tetanus does not interfere with the final immunity. There is no need to "restart" a DPT series. (5) After the basic series and booster a DT every ten years is adequate to preserve immunity. (6) A series of two trivalent oral polio doses eight weeks apart and a booster one year later is adequate for basic immunization. (7) Live viral vaccines can be given together, and, if desired, oral polio, smallpox, measles, and mumps can be given simultaneously.

For a child over the age of 1 year who has had no immunizations, the following schedule could be utilized. First visit: DPT (or DT), trivalent polio, tine test; two months later: DPT (or DT), trivalent polio, measles; and one year later: DT, trivalent polio. If desired, mumps and rubella can also be given at the time of the second visit. With current information available, it is now possible for us as physicians to adequately immunize in three visits the child who is out of step with immunization.
Lettrt To The Editor
Authors: Rucker Ralph W.
Published: December 2021

Dr. David's letter regarding potential problems of noncompliance and home follow-up in the use of outpatient intravenous antibiotics points out the need for this type of therapy to be instituted only in those centers in which these facets can be well controlled. Our patients had all been followed for a number of years, had been in the hospital previously, and were quite aware of the techniques and the benefits of intravenous medications. Mostly older patients, they were taught this procedure to our satisfaction.
Question on Diphenylhydantoin Dosage
Authors: Schwartz Irwin L.
Published: December 2021

I note in the article "Psychomotor Epilepsy," which appeared in Pediatrics, that Dr. Gold recommends a dosage of 10 mg/kg of diphenylhydantoin (Dilantin). He states that "when phenobarbital is not tolerated or seizures are not controlled," the diphenylhydantoin should be added or substituted. This is the first time I have ever seen such a high dose recommended, the usual upper limit recommended in most textbooks being 7 or 8 mg/kg. Would you please reply to this in view of the fact that high doses may yield high blood levels which could be toxic to the liver.
Comments on a Startling Article: "Loss of Limb Following Intravenous Diazepam"
Authors: Tassinari C. A. , Roger J. , Dravat C. , Gustaut H.
Published: December 2021

Referring to the article "Loss of Limb Following Intravenous Diazepam,"1 we would like to comment on two points, one related to the case itself and the other concerning the use of diazepam in status epilepticus.

Concerning the case reported by Drs. Schneider and Mace, it is a matter of an injection during status epilepticus of "2 ml containing 10 mg of diazepam (Valium), intravenously in the volar aspect of the left wrist," followed by hand and forearm necrosis due to the thrombosis of the ulnar radial and brachial arteries which necessitated amputation above the elbow six days later.
Ileoscopy in the Diagnosis of lleal Lymphosarcoma
Authors: Katz Seymour , Katzka Irwin , Schneider Keith , Silverberg Mervin
Published: December 2021

Recent advances in flexible fiberoptic endoscopy have permitted direct visualization of segments of the gastrointestinal tract hitherto considered inaccessible. Preoperative diagnoses of diseases of these areas are subject to the vagaries of roentgen interpretation. The following case report illustrates the value of the colonoscope in distinguishing intralumenal ileal neoplastic disease from an inflammatory process (e.g., ileitis, appendiceal abscess).

CASE REPORT

W. M., a 15-year-old white youth, was referred for eveluation of intermittent lower abdominal pain of six weeks' duration. Prior to his admission, he experienced cramping abdominal pain, fever, cough, emesis, and diarrhea. This gradually abated, leaving a residuum of recurrent abdominal pain which was relieved partially with fiexion of the right thigh.
A Case of Down's Syndrome Complicated by Retinoblastoma and Celiac Disease
Authors: Bentley Donald
Published: December 2021

The association of retinoblastoma with Down's syndrome has been described previously but the incidence of these two conditions coupled with celiac disease is either rare or such cases are not being cited in the literature. I have not to date seen a case reported of celiac disease and mongolism and so wish to describe the problems of a male mongoloid with these conditions.

CASE REPORT

At the age of 2 years he was noted to have a moving opacity behind his right pupil with a grey reflex. As a consequence of these ominous findings, the eye was enucleated for a suspected tumor and pathology confirmed a retinoblastoma endophytum with seedling deposits scattered throughout the vitreous and anterior chambers.
EPSDT and Poor People's Medicine
Authors: Hass Gerald , Scovell Melvin E.
Published: December 2021

We are most concerned that Early and Periodic Screening, Diagnosis and Treatment (EPSDT) as advocated by Foltz and Silver in Pediatrics, may result in a reaffirmation of "poor people's medicine," across the country. The figures cited by Foltz and Silver that show that only 800,000 out of 10,000,000 eligible children have been screened after 18 months are misleading. These figures do not include hundreds of thousands of children who are receiving comprehensive care from pediatricians, family physicians, and health centers and who therefore do not show up in screening statistics.
More Critical Comments on Therapy of Cryptorchidism
Authors: Hurley John K.
Published: December 2021

The therapy of cryptorchidism is a controversial subject, principally because not enough good clinical studies have been done to evaluate the various therapeutic schemes that have been advocated. Unfortunately, Lattimer et al. have added to the confusion by stating categorically that "the cryptorchid testes not brought down into the scrotum by age 5 or 6 would definitely suffer." Biopsy and electron microscopic evidence has been collected by several authors which clearly shows that during the resting stage (age 0 to 4 years) and the growth stage (age 5 to 9 years) the cryptorchid testis does not differ from its scrotal mate.
A Plea for Facts, Not Opinions
Authors: Martin Lester W.
Published: December 2021

Some of the opinions expressed by Lattimer et al. in the January 1974 issue of Pediatrics, regarding the time to operate for cryptorchidism, are based on personal opinion rather than scientific fact, and are therefore open to serious question.

The concept of treating "migratory testes" or "bashful testes" with hormone injections would appear unwise. On the basis of a personal experience over a 20-year period with approximately 500 patients with this condition, not a single testis has been encountered which failed to descend of its own accord at the time of puberty.
CAUSES OF REDUCTION IN INFANT MORTAUTY
Authors: Morris N. M. , Udry J. R. , Chase C. L.
Published: December 2021

From 1965 to 1970 infant mortality dropped from about 25 to 20 deaths per 1,000 live births. The decline has continued at about the same rate since. Analysis of rates for each maternal age-birth order group were calculated and compared to expected rates. Likewise reduction in infant mortality rates in maternal-infant-care areas were calculated. Twenty-seven per cent of the reduction is attributable solely to shifts in age of mother and birth order of infant. Seventy-three per cent of the reduction is not accounted for by agebirth order changes but very little of this unexplained reduction can be attributed to the MIC programs. Individual "family-planning" has thus made a greater contribution to reduction of infant mortality than has been previously realized.
SCHOOLS AND AUTHORITY
Authors: Postman Neil , Weingartner Charles
Published: December 2021

If you go through the daily papers and listen attentively to the radio and watch television carefully, you have no trouble perceiving that our political and social lives are conducted to a very considerable extent, by people whose behaviors are almost precisely the behaviors their school environments demanded of them. We do not need to document for you the pervasiveness of dogmatism and intellectual timidity, the fear of change, the ruts and rots caused by the inability to ask new or basic questions and to work intelligently toward verifiable answers.

The best illustration of this point can be found in the fact that those who do question must drop out of the "Establishment." The price of maintaining membership in the establishment is unquestioning acceptance of authority. acceptance of authority.
Frequency of tuberculin testing
Authors: Steigman Alex J. , Kendig Edwin L.
Published: December 2021

In a statement from the Section on Diseases of the Chest of the American Academy of Pediatrics entitled "The Tuberculin Test,"1 the second paragraph of a comprehensive article begins as follows: "A routine tuberculin test should be performed sometime during the first year of life and annually or biennially thereafter."

This recommendation for the frequency of routine tuberculin testing differs from that currently proposed by others.

The same issue of Pediatrics contains an article by Dr. Phyllis Q. Edwards entitled "Tuberculin Testing of Children."2 The Summary of the article states "The pediatrician should review and analyze tuberculin test results based on his personal experience.
"THINGNESS"
Authors: Postman N. , Weingartner C.
Published: December 2021

The structure of our language is relentless in forcing upon us "thing" conceptions. In English, we can transform any process or relationship into a "thing" by the simple expedient of naming "it" into a noun.

We have done this with "rain" and "explosions," with "waves" and "clouds," with "thought" and "life." Professor Allen Walker Read in researching the origin and uses of the word "psychosomatic" provides us with a recent example. The word was evidently coined to express a relationship and process, explicitly to deter us from thinking that illness can always be categorized as either physical or mental. What happened is typical. We began to use "psychosomatic" as a synonym for "mental." ("Give it to me straight, Doc. Am I sick or is it only psychosomatic?")

Even the term "the whole child," in spite of its good intentions is as static a metaphor as any of the others. "Child" is a "thing" word, and there is no stage of human growth that is more visibly a process than "childhood."
The Pediatric Internship as a Teaching Technique: A Comparison of Learning Experiences in Five Hospitals
Authors: Roghmann Klaus , Pizzo Philip , Graham Elinor , Graham David , Guyer Bernard , Harris Peter
Published: December 2021

Five interns joined in a collaborative study to assess their learning experiences during the internship year. A 3x5-inch data form was completed for each patient for whom the intern was responsible. Information was gathered on demographic characteristics of the patient, the teaching that involved this patient, and what skills were acquired.

Nearly 30% of the patients were under 1 year of age; 55% were boys. More than one half of the contacts were in an outpatient or emergency department. Over 80% of the patients had not been seen before; continuity patients made up less than 9% of the contacts. Well-child care was the largest care category (19%), followed by respiratory problems (15%) and injuries (9%).

About 40% of the contacts involved a teaching input, mainly from residents, attending physicians, and faculty. Care skills most frequently acquired were physical examination (49%), reading (15%), and interviewing (11%). Crosstabulations showed that most learning was reported for inpatients, for patients with rare diseases, and when some teaching was involved.
EVALUATION OF HEALTH SERVICES
Authors: Carlson R.
Published: December 2021

". . . one of the dangers, then, of too rigorous an examination of medicine, requiring proof beyond a reasonable doubt, is that ‘caring’ might be lost in the ‘house cleaning.’"
Non-Treatment of Screened Children With Intermediate Blood Lead Levels
Authors: Klein Michael C. , Schlageter Mary
Published: December 2021

An aggressive screening and follow-up program for children at risk for lead poisoning was conducted by a nurse practitioner in a small family practice unit. Subsequent venous blood lead determinations in untreated cases show the natural fall in lead level over 12 to 18 months. Many of these children would have been chelated by others, yet individualized, specific, personalized care by a nurse practitioner permitted monitoring without treatment even in persistently leaded environments. No chelation therapy was necessary until the third summer, when coincident with a long, hot, dry season, the city's abatement system became nonfunctional. Nontreatment requires close follow-up, a relatively small population, and cooperation from the city.
A Different View of the Facts
Authors: Demetrakopoulos George E.
Published: December 2021

In response to the article, "Why Circumcision," where the authors conclude that "the medical and economic advantages of neonatal circumcision far outweight the disadvantages tages,"1 I would like to review their arguments.

Medical Reasons—The authors assert that "In 1942 Ravich postulated that circumcision decreased the incidence of cervical cancer and prostatic cancer."Dr. Ravich's "statistics are as follows:

"In a survey of the prostatic operations performed by me from 1930 to date (1942) . . . on patients whose religious status was readily available to me, the following ...reveals very interesting data" [tabulation summarized from Ravich]:
Pneumopericardium
Authors: Purohit Dilip M.
Published: December 2021

There have been quite a few case reports in the last few years about pneumopericardium in the neonatal period, including the one by Yeh et al. which appeared in the October issue of Pediatrics,1 where they also reviewed the previous reports. The majority of the infants have had hyaline membrane disease and intermittent positive pressure ventilation (IPPV) with a bag or a respirator. Some have had IPPV with positive end-expiratory pressure (PEEP). Information regarding ventilatory therapy, viz., the type of respirator used, rate, inspiratory pressure, and inspiratory/ expiratory ratio is either not mentioned or very scanty.
Propranolol-Augmented, Exercise-Induced Human Growth Hormone Release
Authors: Maclaren Noel Keith , Taylor Glen Edward , Raiti Salvatore
Published: December 2021

Serum growth homone (HGH) responses to 20 minutes of exercise 90 minutes after orally given propranolol (0.5 mg/kg; maximum, 40 mg), were assessed in 15 short but otherwise normal children, in 2 obese teen-agers, in 3 hypopituitary children, and in 8 healthy adult volunteers. In six adults HGH responses to exercise alone were also assessed one week previously.

Normal children responded with a peak serum HGH concentration of 10 ng/ml or greater, except one whose peak was 7 ng/ml (normal,7 ng/ml). The obese girls showed smaller responses to exercise with propranolol (ex/prop) (peak HGH, 6 ng/ml), to hypoglycemia, and to levodopa (peak HGH, 7 and 4 ng/ml). The three hypopituitary children did not respond to ex/prop or to two other stimuli. In the volunteer adults, the mean HGH responses were greater to ex/prop than to exercise alone, although two out of six did not have increased levels with exercise. There were also elevations of fasting serum HGH levels before exercise and propranolol on repeat testing.

These results suggest that orally given propranolol improves the exercise-HGH stimulation test both in the number of responders and in the degree of response. Some individuals have an anticipatory HGH secretion before exercise due to a conditioned response.
Parent's Guide to Allergy in Children. Edited by Claude A. Frazier, M.D. New York: Doubleday. $7.95; 338 pp
Authors: Wright William C.
Published: December 2021

The purpose of Dr. Frazier's book, as stated in the preface, is to "discuss allergy in children in such a way as (1) to be helpful to parents and, thus, to allergic children, and (2) to assist in making the complex business of allergy a bit more comprehensible to the nonmedical reader. " It is a very readable book, in which the author clearly presents information obtained from his own experience in the practice of clinical allergy and from traditional teaching. Particularly helpful to parents might be the chapter describing the allergist's evaluation of their allergic child, emphasizing the importance of a thorough history, and chapters containing descriptions of common allergens, references and recipes for those on restricted diets, information concerning camps and homes for asthmatic children, and the detailed review of reactions to biting and stinging insects.
Beyond the Best Interests of the Child. By Joseph Goldstein, Anna Freud, and Albert J. Solnit. New York: The Free Press, 1973. $7.95; 170 pp
Authors: Sherry S. Norman
Published: December 2021

Occasionally a book is written that is so full of memorable one-liners that one is tempted to overquote in a review. Such a book has been written by, to paraphrase a child's game, a doctor, lawyer, and analyst chief. Joseph Goldstein is a professor of law at Yale who specializes in the application of psychoanalysis to law; Albert Solnit is a professor of pediatrics and psychiatry at Yale; Anna Freud heads the Hempstead Child Therapy Clinic in London, and probably knows more about the emotional lives of young children than any other authority.
"Family Practitioners" and Pediatrics
Authors: Bloom Henry Robert
Published: December 2021

I am a second-year resident in family practice who has been reading Pediatrics since medical school. More and more, especially with the new "Pediatrics for the Clinician" series" series, it is a journal of distinct value to those who deal with children in primary care. As such, I have recommended it to many other students, interns and residents, in family practice and in pediatrics.

I think, though, that the references to the "unique position" of pediatricians as primary care practitioners for children should not go without remark.
Are We Giving Too Many Shots?
Authors: Gorlick Gary
Published: December 2021

As a member of the Academy and a practicing private-office ice pediatrician, I should like to note in the journal another type of "child abuse." I refer to needless pain which is inflicted by physicians upon children in the form of intramuscular ular injections which are simply not necessary! How many such "shots" are given to generate increased income when oral medication alone will suffice (e.g., tonsillitis, otitis media)? Why must children live in fear of the doctor? I believe they should not.
Etiology of Respiratory Tract Infections in Children in Cali, Colombia
Authors: Escobar Jorge A. , Dover Arthur S. , Dueñas Alvaro , Leal Ermilson , Medina Pablo , Arguello Antonio , de Gaiter Mercedes , Greer Donald L. , Spillman Rupert , Reyes Marco A.
Published: December 2021

One hundred eighty children hospitalized for acute respiratory disease were studied in Cali, Colombia. In the majority of patients, pneumonia was the reason for hospitalization and remained the final diagnosis. Fifty-one cases of pneumonia of indeterminate etiology comprised the largest single diagnostic category, followed by 38 cases of pneumonia associated with measles, and 22 cases associated with serologic evidence of infection with other viral agents or Mycoplasma pneumoniae.

Etiologic diagnosis could be assigned with a reasonable degree of confidence in 116 of the 180 patients (64%). The laboratory procedure found most likely to provide the etiologic diagnosis in this series was paired sera specimens for demonstration of rise in antibody titer against the common viral respiratory pathogens. Those most frequently implicated serologically as etiologic agents in the cases studied were, in order of decreasing frequency, measles, influenza, parainfluenza, and adenoviruses.
Dr. Grossman Replies
Authors: Grossman Herman
Published: December 2021

I appreciate Dr. Scheidt's concern about the use of diagnostic ultrasonography. However, I do not think his statements negate any part of the report on ultrasonography in children by the Committee on Radiology.1

Dr. Scheidt refers to neurological lesions being caused by ultrasound in the treatment of Meniere's disease; the level of ultrasound used for patients with Meniere's disease is much greater than for diagnostic ultrasonography. The level of pulsed ultrasound used in diagnostic work is many times less than that for any measurable effects.2
Comments by Drs. Soyka and Neese
Authors: Soyka Lester F. , Neese Allen L.
Published: December 2021

In response to the letter of Drs. Ivey and Kattwinkel pertaining to the safety and efficacy of Actifed-C, we would like to make the following points.

The definition of a therapeutic serum level for codeine is difficult at present. Table I contains a tabulation of the three studies in adult patients we could find in the literature and depicts this problem. The 700-fold range in serum levels shown renders any sort of therapeutic range based on these data meaningless.
Questions Regarding Arginine Hydrochloride Inhalation
Authors: Solomons Clive
Published: December 2021

With regard to the recent study of Dietzsch et al.1 on the use of arginine hydrochloride inhalation in cystic fibrosis patients, I wish to point out that these investigators acted irresponsibly in exposing their patients for an appreciable period (seven weeks) to a preparation which is known to be irritating. They chose to disregard published instructions which are devised to protect the patients.2 Specifically, they used sodium hydroxide instead of arginine free base for neutralization to obtain a solution which was about three times as acid at pH 7.0 as the recommended solution (pH 7.4 to 7.6).

In addition to exposing their patients to this hazard, they also leave the reader with the mistaken impression that the previously reported arginine treatment is dangerous or ineffective.
Pediatric Familial Type II Hyperlipoproteinemia: Therapy With Diet and Colestipol Resin
Authors: Glueck C. J. , Fallat R. W. , Mellies M. , Tsang R. C.
Published: December 2021

Effects of a low-cholesterol, polyunsaturate rich diet and a synthetic organic bile sequestrant polymer (U26,597A, colestipol) were studied in 21 children, heterozygous for familial hypercholesterolemia. Total cholesterol, β-lipoprotein cholesterol, and triglyceride were measured twice on habitual diet, monthly for six months on a low-cholesterol diet, and monthly for six months on low-cholesterol diet plus 10 gm of colestipol per day. Total cholesterol (mean ± 1 SD) was 295 ± 37 on habitual diet, 278 ± 29 on low-cholesterol diet, and fell significantly to 242 ± 29 mg/100 ml on diet plus colestipol. Low-density lipoprotein (LDL) cholesterol was 234 ± 37 on habitual diet, 220 ± 28 on low-cholesterol diet, and fell significantly to 179 ± 26 mg/100 ml on diet plus drug. Plasma triglyceride levels on habitual diet were 79 ± 31, remained unchanged on low-cholesterol diet, 86 ± 22, and were unaffected by low-cholesterol diet plus drug, 85 ± 17 mg/100 ml. On diet alone, plasma LDL was not normalized (< 170 mg/100 ml) in any of the 21 children, and cholesterol fell to within normal limits (< 230 mg/100 ml) in only one child. The combination of diet plus colestipol resin normalized total and LDL cholesterol in 52% of the children. Cholesterol was lowered to a "moderately elevated" range of 230 to 250 mg/100 ml in an additional 14% of the children and LDL was lowered to a range of 170 to 190 mg/100 ml in an additional 29%. In 33% of the children, cholesterol remained > 250 mg/100 ml despite diet plus colestipol, while LDL was > 190 mg/100 ml in 19%. Colestipol is an effective and well-tolerated cholesterol lowering compound which, in conjunction with diet, may prove to be very useful in the treatment of children heterozygous for familial hypercholesterolemia.
The Effect of Age, Sex, Race, and Economic Status on Dental Caries Experience of the Permanent Dentition
Authors: Rowe Nathaniel H. , Garn Stanley M. , Clark Diane C. , Guire Kenneth E. , Lowe Charles U. , Forbes Gilbert , Garn Stanley , Owen George M. , Smith Nathan J. , Weil William B. , Nichaman Milton Z. , Johansen Erling , Rowe Nathaniel
Published: December 2021

The Ten-State Nutrition Survey data show a consistent, dramatic, and meaningful difference in dental caries experience between black and white children at all ages. This difference transcends socioeconomic grouping, nutritional level, and developmental status. This study also has shown an apparently protective effect of poverty insofar as dental caries is concerned. Children from lower-income families experienced less dental caries than children from higher-income families.
Drs. Russo and Gururaj Reply
Authors: Russo Raymond M. , Gururaj Vymutt J.
Published: December 2021

The involvement of health care providers, whose patient records are to be reviewed, in evolving a set of audit criteria would appear to be an important compliance determinant. And, while its degree of importance remains to be determined, ideally all providers should be involved in creating self-audit criteria.

There is, however, an issue of practical importance that arises when large staffs are to be audited, and particularly when a part of this staff is assigned only temporarily to the outpatient service, e.g., house staff officers or medical students.
Is It Big Brotherness?
Authors: Reiss G. Russell
Published: December 2021

Once again, Dr. Kempe has spoken on behalf of children everywhere in his article on family intervention.1 Certainly this tireless crusader from Colorado has few peers when it comes to expounding on the rights of children. However, on reading his plea for home visitors such as those used in Scotland and Holland, I can't help but hear the bells of the socialistic society ringing through our land. One recalls the old adage "You can lead a horse to water but you can't make him drink."
Comment on Commentaries
Authors: Schowalter John E. , L. J. F.
Published: December 2021

After savoring the commentaries which inaugurate the March 1975 issue of Pediatrics, I am moved to respond. These parsimonious but learned callings of attention to important issues in pediatrics provide a very useful service, and I wish to cast an enthusiastic vote for this increasingly important section. Keep up the good work.

Editor's Note: It is nice to have compliments. We will continue to try harder.
READING, A CURE FOR POOR MEDICAL WRITING
Authors: H. R. J.
Published: December 2021

Dr. Inglefinger, editor of the New England Journal of Medicine, pointed out that part of the difficulty in medical writing today arises from the "massive infiltration of language by the words of an extravagant technology, authorship by committee, and the failure—even inability!—of doctors to read." The cure, he points out, lies neither in "scolding" nor "the occasional writing course." "The only hope, and perhaps a faint one, is to encourage the student and graduate in medicine to take up serious non-professional reading .... Only by determined practice will they read more fluently .... Only by efforts of this type will the prose of their articles change ... provided, of course, some busybody editor does not delete the colorful in favor of the drab."1
PEDIATRICS
Authors: O'Neill Richard
Published: December 2021

There's no business like pediatrics.

It's not the Cadillac of the medical specialties, but it holds many deeper rewards.

Our patients still view the world with awe, and believe in us and Santa Claus.

They haven't learned rich or poor, black or white.

They're growing instead of declining, and haven't yet found the degenerative diseases.

They know when the newest Walt Disney is in town, what the plot is, what the ending is, and how to wheedle us into taking them.

They turn off their tears when mission is accomplished.

Their youthful enthusiasm is contagious, and if you're not careful, they'll sprinkle you with the fountain of youth.

They'll go to school with a temp. of 103, because it's picture day.

What the teacher says is gospel, straight from the top.

They'll make you laugh during the school play, and weep at the teacher conference.

They cart old milk cartons off to kindergarten, and mysteriously return with your Christmas gift. You'll open it first, look surprised, and feel very proud.

They'll squeeze every present under the tree, and ask, "Is this one for me?"

Halloween is their Mardi Gras, and when they don those masks and costumes, they're monster, ghost or vampire, and you'd better be scared.

They still haven't deduced who disposed of that bag of goodies they tricked and treated for.

They will listen to you read the same story over and over, and you don't dare skip any pages.

Cartoons are their passion, and you could do a spinal tap while Bugs Bunny weaves his magic spell.
A SHORT MEDICAL HISTORY—1984 VERSION
Authors: C. T. E.
Published: December 2021

All but one of the words and phrases included in the medical history below were either heard at medical meetings or seen in recent medical journals.

I leave it to the reader to judge whether my 1984 version enriches or debases our language. My only contribution was the neologism homized.

Ms. A. Z., age 24, S.S. #987-65-4321, a randomized, computerized investigatee of a federally-funded on-going study of the parameters of behavior modification on biofeedback mechanisms in pregnancy, was ante-nated at an H.M.O. managed entirely by lay community workers. She had evolutionized from a homebody to a somebody in 1975 at age 18.

Automated multiphasic health maintenance checkup detected the presence of paroxysmal hypertension for which she was hospitalized in the twentieth week of pregnancy. She was radiographed, I.V.P.'d, and a right suprarenal mass was outlined. The patient was then cardiac catheterized, catecholaminized, laparotomized, and partially adrenalectomized on the right. Recovery was maximized and optimized by an automated programmed computer print-out protocol of therapy.

Twenty weeks later, patient delivered a healthy 3000 gr. newborn person; in-depth health-oriented physical evaluation on both mother and infant was performed by specially trained nonprofessional testing personnel.

Two days later, patient and newborn person were homized after being P.S.R.O.'d and H.M.O.'d to a nontraditional Health Depot for follow-up.