bluuebunny/crossref_metadata_2025 huggingface dataset:
DRUG TESTING IN CHILDREN: FDA REGULATIONS
Authors: Yaffe Sumner J. , Avery Mary Ellen , Gold Arnold P. , Kenny Frederick M. , Riley Harris D. , Schafer Irwin A. , Stern Leo , Shirkey Harry , Bishop Jeffrey , Farchione Louis A. , Lockhart Jean , Weiss Charles F.
Published: December 2021

The testillg of drugs for use ill cilildren is difficult to accomplish, and it is even difficult to write about. Anything that smacks of "experimentation" on a child or even the use of a placebo given to a sick child is an emotionally charged subject. To carry out procedures that cannot be considered as essential to therapy, especially when they are painful or tiresome, seems abhorrent.

However, it is recognized that the effects of many drugs on children may vary considerably from the effects on adults even when careful calculation is made to arrive at a dosage proportional to the body weight or estimated body surface area. Pharmacologically, children cannot be regarded as little adults. Intensified, or toxic effects of drugs administered to children, especially infants, may reflect immaturity in enzymatic mechanisms for drug metabolism, as well as other detoxification and excretory functions.

In view of these circumstances, there is need for special caution in prescribing medication in the treatment of childhood disorders, particularly when the medication is used for an extended period of time or when a newly marketed drug is employed. Even greater caution is needed with the use of a new drug under investigation, in advance of approval for marketing. Known serious adverse effects of drugs in children include the effects of sex hormones on growth, steroids on genital development, and antibiotics on tooth enamel.

According to the regulations of the Food and Drug Administration, a drug which has not been subjected to investigation in children may not be labeled for use in pediatric therapy.
Letter to the Editor
Authors: Smith Clement A.
Published: December 2021

The Editor cannot refrain from an additional note regarding Dr. Wallace's generosity and ability as critic, reviewer, and writer. Somehow he found the time to pick his way through many of the most confusing manuscripts received by this office, to crystallize out the actual contribution made, and to tell the authors what they had actually done-and what they had not done-in two or three neatly typed sheets of wonderfully expressed criticism. His humor-often tart but never bitter-made the whole review all the more delightful and must often have supplied palatability for those writers whose creations turned out to be less than significant. Indeed, his comments were largely responsible for a previously stated wish that "the reviews could be printed as well as most papers-and in place of many."
Testing the Patency of the Nasal Choanae, Continued
Authors: van Leeuwen G.
Published: December 2021

In our paper, "Screening for Hidden Congenital Anomalies" (Pediatrics, 41:147, 1968), the point of course was that we do just that, not that we develop arguments over the best method to diagnose choanal atresia. It was also not intended that we torture our little friends by "ramming foreign bodies down their nostrils" (Pediatrics, 42:873, 1968) and public apology is herewith rendered to all infants so molested.

There are two objections to Dr. Abel's rarely quoted reference.
Systemic Lupus Erythematosus
Authors: Stickler G. B. , Burke E. C.
Published: December 2021

The article, "Systemic Lupus Erythematosus in Childhood," by Drs. Meislin and Rothfield raises a number of questions because our group recently published our experience with this disease. The authors failed to define precisely what they mean by "systemic lupus erythematosus." We note that 10% of their patients had a negative LE clot test, and apparently patients with drug-induced lupus erythematosus were included. Furthermore, it is not possible to ascertain whether or not their group includes children with the clinical picture of degenerative rheumatoid arthritis with a positive LE clot test and absence of renal involvement.
Human Growth: Body Composition, Cell Growth, Energy, and Intelligence, edited by Donald B. Cheek, M.B., B.S., M.D., and D.Sc. Philadelphia: Lea and Febiger, 1968, 781 pp., $25.00
Authors: Forbes Gilbert B.
Published: December 2021

Structure is a necessary prelude to function. The tissue analyses of the nineteenth century chemists laid the foundation for modern electrolyte physiology. Recent decades have seen the development of techniques for the study of body composition in living subjects, which hopefully will lead to a better understanding of human biology and growth. Donald Cheek has been in the forefront of these modern developments.

The present book testifies to his indefatigability and his unbounded enthusiasm for the topic of human growth.
EFFEMINATE BEHAVIOR PRESENT IN BOYS FROM EARLY CHILDHOOD. II. COMPARISON WITH SIMILAR SYMPTOMS IN NON-EFFEMINATE BOYS
Authors: Zuger Bernard , Taylor Patsy
Published: December 2021

Data on the frequencies of certain feminine-type symptoms in two groups of boys, numbering 84 and 95 each, were obtained from their parents. These frequencies were much lower than those in a comparable group of 26 effeminate boys. The individuals of the non-effeminate group who did show possible symptoms generally had fewer of them than did the individual effeminate boys. A shorter duration and other characteristics of the symptoms usually clearly differentiated the non-effeminate from the effeminate boys.
INFANT INJURIES: ACCIDENT OR ABUSE?
Authors: Gregg Grace S. , Elmer Elizabeth
Published: December 2021

Observations were made of 146 children who were accidentally injured or abused, and 113 children were studied in detail. The injuries of the abused group tended to be more severe and to be followed by serious sequelae more often than those of the accidentally injured, but the two groups, accident and abuse, were difficult to differentiate on the basis of history alone. Other findings such as developmental retardation, patient's ordinal position, family density, and ability to cope with stress were more useful. The physician must be aware that any infant accident or injury reflects a lapse in child care and requires more than emergency treatment.
"Ectopic" Liver in the Umbilicus: An Unusual Focus of Infection in a Newborn Infant
Authors: Shaw Anthony , Pierog Sophie
Published: December 2021

Liver tissue rarely occurs in ectopic sites.1 Intra-abdominal liver fragments (accessory or supernumerary lobes) attached to the main portion of liver are also uncommon.1,2 When liver is found outside the abdominal cavity, it most often forms part of the contents of an omphalocele or diaphragmatic hernia and constitutes all or part of the liver proper protruding through a broad defect. The following case report describes an extra-abdominal fragment of liver which formed a serious focus of neonatal infection.

Case Report

Baby boy R. was born on June 22, 1967, after a 28-week gestation. He weighed 1,247 gm. The mother was a 19-year-old gravida II, para II Puerto Rican.
Letter to the Editor
Authors: Berenberg William
Published: December 2021

I appreciate Dr. Nader and Dr. Allmond's comments and share their apparent distaste for the voguish label of "minimal brain damage." Certainly "soft" neurologic signs do not answer the question of the child's need for special education technique. Too often there is no neuroanatomic correlation in patients with major gross motor and intellectual abnormalities. On the other hand, the presence of significant numbers of "soft" signs does indicate neurologic disorganization which may pave the way toward identifying the child's needs for special and particular assistance or concessions.
Treatment of Hemorrhagic Disorders, edited by Oscar D. Ratnoff, M.D., with 15 authors. New York: Hoeber Medical Division, Harper and Row Publishers, 1968, 242 pp., $8.50
Authors: Strauss Herbert S.
Published: December 2021

This practical guide to the treatment of both the inherited and acquired types of hemorrhagic disorders is a welcome addition to a series of recent books dealing with this rapidly changing topic. Special chapters discuss orthopedic, dental, and psychiatric aspects of therapy, areas in which patient care has often been neglectful. Brief theoretical considerations are followed by concise outlines of therapy. The references are representative and generally well chosen. Occasional differences of opinion among the various contributors are encountered, for instance, those relating to the incidence of circulating anticoagulants among patients with hemophilia.
The Lung and Its Disorders in the Newborn Infant (Vol. I in the series Major Problems in Clinical Pediatrics), ed. 2, by Mary Ellen Avery, M.D. Philadelphia: W.B. Saunders Company, 1968, 285 pp., $9.50
Authors: Cook Charles D.
Published: December 2021

The first edition of Dr. Avery's monograph, published in 1964, was rapidly accepted as an extraordinarily useful and definitive summary of the available information on development of the fetal lung and the function of the respiratory system in the perinatal period. It served also as an excellent review of the important respiratory conditions affecting newborn infants as well as a useful guide to treat these conditions. Some may not believe that such a comprehensive work would require revision in only 4 years, but it is obvious from reading this new edition that a great deal has been learned during the last few years about this rapidly expanding field.
Infant, Perinatal, Maternal, and Childhood Mortality in the United States: Vital and Health Statistics Monographs, American Public Health Association, by Sam Shapiro, Edward R. Schlesinger, M.D., and Robert E.L. Nesbitt, Jr., M.D. Cambridge, Massachusetts: Harvard University Press, 1968, 388 pp., $7.95
Authors: van den Berg Bea J.
Published: December 2021

This book, one in the series of "Vital and Health Statistics Monographs" of the American Public Health Association, is a well documented study of childhood mortality in the United States up to 1964. The data, supplemented by information from special studies, are mainly derived from vital statistics of the United States and upstate New York.

Some 80 tables and figures in the text and about half this number in the Appendix review mortality data in different age periods from 1935 to 1964, with emphasis on comparison of the years around 1950 with those around 1960 in relation to such variables as sex, birth weight, ethnic group, cause of death, age of mother, parity, geographic area, and socioeconomic group.
ANTIBIOTIC TREATMENT OF PERTUSSIS
Authors: Nelson John D.
Published: December 2021

The whoop is heard in the land ever less frequently with the passing decades since pertussis immunization has become widespread. Pediatricians sequestered in suburbia may have relegated it to the status of a medical curiosity; but, pertussis remains an important cause of infant morbidity. In 1967, there were 9,718 cases reported to health officials; this is an impressive reduction from the 32,148 cases reported 10 years earlier, but it still represents more than four times the number of meningococcal infections recorded in 1967.

Pertusis persists endemically in the disadvantaged segment of the population not reached effectively by preventive medicine, and there is occasional spillover to the rest of the population.
A CHILD'S DAYDREAMING BEAUTIFULLY DESCRIBED BY JAMES GATES PERCIVAL, M.D. (1795-1856)—A FORGOTTEN AMERICAN LITERARY GENIUS
Authors: C. T. E.
Published: December 2021

Few contemporary physicians—or for that matter students of American literature—will know the title of even a single poem written by Dr. James Gates Percival. And yet, he has been considered our nation's foremost poet during the 1820's and early 1830's, a position he held until the ascendency of William Cullen Bryant.1

One of Percival's early poems, entitled "The Pleasures of Childhood," contains this engaging description of a child's daydreams.

Along the stream, that flowed in summer's Mildness o'er its bed of rounded pebbles, with Its Scanty waves encircling many an islet, and its Banks in bays and havens scooping, I would stray, And, dreaming, rear an empire on its shores. There cities rose, and palaces and towers Caught the first light of morning; there the fleet Lent all its snowy canvass [sic] to the wind, And bore, with awful front, against the foe; There armies marshall'd their array, and join'd In mimic slaughter: there the conquer'd fled— I follow'd their retreat, until secure, They found a refuge in their country's walls; The triumphs of the conqueror were mine,— The bounds of empire widen'd, and the wealth Tom from the helpless hands of humbled foes; There many a childish hour was spent; the world, That moved and fretted round me, had no power To draw me from my musings, but the dream Enthrall'd me till it seem'd reality; And, when I woke, I wonder'd that a brook Was babbling by, and a few rods of soil, Cover'd with scanty herbs, the arena where Cities and empires, fleets and armies rose.
ACUTE HEMANGIOMA-LIKE LESIONS ASSOCIATED WITH ECHO VIRAL INFECTIONS
Authors: Cherry James D. , Bobinski John E. , Horvath Frances L. , Comerci George D.
Published: December 2021

In the summer and fall of 1968, during clinical rubella vaccine trials, clinical and laboratory surveillance of acute exanthematous illnesses was carried out. During this period, four children with acute transitory hemangioma-like lesions were noted; ECHO 25 virus was isolated from two of these patients and ECHO 32 was recovered from the other two children. All four children had four- fold or greater neutralizing antibody titer rises to their respective viruses. It is suggested that the individual lesions of the reported exanthems have a pathogenesis similar to other enteroviral maculopapular eruptions, except that vascular dilatation is arteriolar as well as capillary.
VEXATIOUS BEHAVIOR OF CHILDREN VIVIDLY DESCRIBED IN 1624
Authors: C. T. E.
Published: December 2021

William Whately, Preacher of the word of God in Banbury, Oxfordshire, wrote a fascinating treatise on marriage in 1624. The description below of the behavior of some English children of Whately's time, will seem all too familiar to a few contemporary parents:

Many a child puts his mother to after-throes more terrible, than those with which she brought him into the world at first. . . . Sometimes they prove stubborn, sometimes riotous, sometimes unclean, sometimes false, and sometimes bring themselves to infamous punishments, and untimely deaths. Sometimes they be lewd before marriage and vex the parents, with beholding a bastard of their names. . .

Set them to learning they learn nothing but vanity: set them to labour, they labour for nothing, but to undo themselves; running away from their Masters; it may be also robbing them, and having run themselves out of breath, come home ragged, and miserable, but not penitent, ready to do as bad again, and put their parents to extremity of care, so that they are even distracted, and at their wits ends, not knowing what course in the world to take with them, because both fair means and foul means have been used, and none will avail. .

Or if thou escape these petit [sic] crosses, in thy children, how could thou brook a stubborn, rebellious son, or a daughter, that will interchange words with thee, and snap thee up short, and chide faster than thyself? That will cast upon thee a leering, horse-like, contemptuous eye and will stab thy soul, with a lowering, pouting, scornful look . . . that will steal thy goods from thee, and consume it in ill company, whores and drunkenness that wastes all that thou hast gotten and given to him. . . .
NEURONAL CEROID-LIPOFUSCINOSIS (BATTEN'S DISEASE): RELATIONSHIP TO AMAUROTIC FAMILY IDIOCY?
Authors: Zeman Wolfgang , Dyken Paul
Published: December 2021

From the conditions generically classified as amaurotic familial idiocy, two distinctly different groups have emerged. One is characterized by grossly abnormal profiles for cerebral sphingolipids and consists of GM1-gangliosidosis and GM2-gangliosidosis or Tay-Sachs disease. The other group is composed of cases with normal sphingolipid profiles, but with neuronal accumulation of lipopigments of the ceroid/lipofuscin type, designated as neuronal ceroid-lipofuscinosis (NCL) or Batten's disease. Clinical data on 26 patients with this disorder reveal the course and symptomatology to be variable, but pathomorphologic and biochemical findings are reasonably constant. The course of the disorder is directly influenced by the presence or absence of intractable seizures.
HOW TO FEED THE INFANT WHEN BREAST MILK WAS NOT AVAILABLE, ACCORDING TO SIR ARTHUR CLARKE, M.D., WRITING IN 1828
Authors: C. T. E.
Published: December 2021

One of the best known books written for mothers in the early part of the nineteenth century was Sir Arthur Clark's: The Young Mother's Assistant; or a Practical Guide for the Prevention and Treatment of the Diseases of Infants and Children.

If breast milk should not be available, Sir Arthur recommended the following:

Should an infant, from accidental or other circumstances, be deprived of its food from the breast of its mother or nurse, an artificial substitute for it must be supplied; and it is evident that in this case the closer we can imitate nature the better. For this purpose a suckling bottle should be procured, the mouth of which should be as wide as that of an eight-ounce viol, [sic] which is to be stopped with sponge, covered with gauze, and made in size and shape to resemble a nipple.

The following preparation is most suitable for an infant, as it comes nearest in quality to the mother's milk, and may be sucked through the sponge.

On a small quantity of a crum [sic] of bread pour some boiling water; after soaking for about ten minutes, press it, and throw the water away, (this process purifies the bread from alum or any other saline substance which it may have contained); then boil it in as much soft water as will dissolve the bread and make a decoction of the consistence of barley water: to a sufficient quantity of this decoction, about a fifth part of fresh cow's milk is to be added, and sweetened with the best soft sugar.
BENIGN FAMILIAL HEMATURIA
Authors: Marks Melvin I. , Drummond Keith N.
Published: December 2021

Asymptomatic persistent renal hematuria of 6 months to 8 years' duration was observed in seven of eight siblings. There was no family history of renal disease or deafness, and other family members examined showed normal urinalyses; none of the other known forms of hereditary renal disease were detected. Abnormalities of renal function or general physical health and development were not detected. Renal biopsies were performed in the two patients with the longest history of hematuria (7 and 8 years). Light and immunofluorescence microscopic study of renal tissue revealed no abnormalities of glomeruhi or interstitial tissue.

This familial condition is characterized by persistent microscopic hematuria with episodic gross hematuria and a favorable long-term prognosis. Although the pathogenesis is unclear, an immune process does not appear to be involved. Microscopic examination of the urine of family members in hematuria without an obvious etiology is warranted.
HOW OFTEN SHOULD ONE TAKE A BATH?
Authors: C. T. E.
Published: December 2021

During the Victorian era, children, if bathed at all, usually found Saturday evening the day chosen by their parents. Daily bathing was not considered necessary, and might even be harmful. A good example of mid-eighteenth century medical advice written for children about this matter is given below:

A late writer in the Medical and Surgical Journat utters the opinion that once a week is often enough to bathe the whole body for the purpose of luxury or cleanliness. Flannel worn next to the skin at all seasons is proper, and is infinitely more healthful than all the daily baths now so fashionable. The oil which is secreted by the sebaceous glands of the skin, serves the purpose of lubricating its surface. Now if this secretion is constantly removed as fast as exuded, its destined object is thereby defeated. The excretory ducts of the perspiratory glands, and the glands themselves, require this unctuous matter of the skin, to keep them in health and action. If very frequent bathing of the whole body is practiced, it must be obvious that this matter cannot be long present to perform its office. As to the assimilation of functions of the skin and lungs, it will be apparent, that when the skin acts imperfectly, or ceases to act at all, the lungs have an extra amount of duty to perform; and it is generally in just such cases that engorgement takes place, constituting infiammation or pneumonia.

While a great number of health statisticians attribute the increase of modem longevity to this and that cause, we believe that the benefits of cheap flannel, linen and cotton clothes are overlooked. We can well understand how necessary it is for savages to bathe once a day, but not those who enjoy the luxury of clean linen.
Grounding and Electrical Leakage of Photo Therapy Equipment
Authors: Stein Bernard
Published: December 2021

I am the director of the Bio Electronics Lab at Wilson Memorial Hospital. We have a safety program in which electrical leakage on all electrical and electronic equipment is checked. Our standards are set in accordance to the American Heart Association at 5 microamps. This brings me to the purpose of this letter.

We received an Air Shields photo therapy unit which is used in the prevention and treatment of neonatal hyperbilirubinemia. This lamp has a leakage of 70 micro-amps when it is ungrounded.
The XYY Condition in Childhood: Clinical Observation
Authors: Elbualy M. S.
Published: December 2021

R. F. Daly, et al. recently suggested some features that may be associated with the condition named above. I wish to present a case that does not support this association.

MW, a 10-year, 1-month-old Negro boy, is the product of a term, normal, first pregnancy. He was born to a 21-year-old mother and a + 30-year-old father. Birth weight was 6 lb, 15½ ozs; length was not recorded. Both parents are about 5 ft, 5 in.
Letter to the Editor
Authors: Marks James F. , Fink Chester W.
Published: December 2021

We find Doctor Cohen's observations interesting. He has reported a recent incidence in his clinic of the salt-losing form of congenital adrenal hyperplasia at an even higher level than we reported. The purpose of our original letter was not only to present our own findings but also to find out what other centers were observing with regard to their distribution of patients with congenital adrenal hyperplasia. Further reports from other investigators may require a change in the stated incidence of the various forms of this disease.
Genussmittel und Suchtgefahren im Jugendalter: Medizinische und Paedagogische Jugendkunde, by Dr. K. von Biener. New York: Albert J. Phiebig (P.O., Box 352 White Plains, New York 10602), 1968, 113 pp., no price given
Authors: Brooksaler Fred
Published: December 2021

This monograph evaluates the answers obtained from the questionnaire completed by 2,565 Swiss adolescents from a wide variety of socioeconomic backgrounds ranging in ages from 16 to 20 years concerning the present-day problems-as they view them-of smoking, alcohol, and drug abuse.

The book is small and contains three chapters; the first examines the reasons why young people smoke, the ages when they begin, and the influence-if any-of their parents on their smoking. A brief survey is also included of the health hazards of prolonged cigarette smoking and why some adolescents will even abstain from smoking in the face of peer drive in this direction.
THE INFANTILE FORM OF GAUCHER'S DISEASE IN AN INFANT OF JEWISH SEPHARDI ORIGIN
Authors: Drukker A. , Sacks M. I. , Gatt S.
Published: December 2021

A case of the infantile form of Gaucher's disease in a Sephardi Jewish infant is described. Evidence of the disease was present at birth, and death occurred 48 hours later due to intracranial hemorrhage following a tentorial tear. The diagnosis of Gaucher's disease was confirmed by the histological, histochemical, and biochemical findings at autopsy. Typical Gaucher cells were present in the brain of the patient described. The rarity of the infantile form of Gaucher's disease in Jews, especially in those of Sephardi origin, is stressed.
ON THE TREATMENT OF FEVER (IN CHILDREN AND ADULTS) IN FIFTEENTH CENTURY ENGLAND
Authors: C. T. E.
Published: December 2021

The treatment of children with a fever, or for any other symptom, was rarely mentioned in most medical treatises compiled before the eighteenth century. One widely used method to treat fevers in English patients, of all ages, during the fifteenth century, was as follows:

For Fevers: Take half an ounce of pepper, and kermes (round reddish, pea-sized grains found on scarlet oak trees) half an ounce, and (an equal amount) of ginger, two or three good raisins and make all this into a powder; and then take as much of senvy (mustard) seed as of all these others, and stamp it small in a mortar; and then mingle all these with six spoonfuls of vinegar, and the third part of a quart of stale ale; and seethe it till it be almost boiled away unto eight Sups [about a teaspoonful], and then sip it up and do so three days during (the time of fever) until the cold beginneth to come, and thou shalt be whole on warranty (certainly), for it hath been proved. But when thou dost so, let the bed (either for children or adults) be made with fresh sheets, and cover up warmly, and if thou do so three [days], the patient will shake (shiver, or tremble) no more.1
Letter To The Editor
Authors: Levin Herbert S.
Published: December 2021

My sincere thanks and appreciation for the new spine on Pediatrics—this is exactly what was needed. As I have responsibility for filing and finding my pediatrician husband's journals, this will save a great deal of time in often futile searches for just the right issue. I've even colorcoded the spines of back volumes as an aid, and occasionally thought of writing to request what now appears in 1970. Now if only all the other journals would simplify their spines in bold, dark lettering. . .

Many sincere thanks—it was about time we had a break.
The Child and His Symptoms: A Comprehensive Approach, ed. 2, by John Apley, M.D., F.R.C.P., J. P., and Ronald MacKeith, D. M., F. R.C.P., with a foreword by professor Milton J. E. Senn. Philadelphia: F. A. Davis Company, 1968, 299 pp., $7.50
Authors: Green Morris
Published: December 2021

This book presents a highly effective and unique approach to important problems that confront the practitioner daily but for which he often believes he is insufficiently trained. The clinician will feel better about himself after reading this volume because it underlines the practitioner's special diagnostic and therapeutic capabilities and points the way to their mastery. This is not an ordinary textbook of pediatrics in that it deals as much with the problems of life as with disease.
Neurology in Pediatrics, by Patrick F. Bray, M.D. Chicago: Year Book Medical Publishers (35 E. Wacker Drive, Chicago, Illinois 60601), 1969, 514 pp., $23.50
Authors: Barlow Charles F.
Published: December 2021

It was a pleasure to review this book, which in itself indicates that it is possible to give it an excellent review. It is refreshing to encounter a hard cover publication, in these days when most volumes have multiple authorship, where the responsibility for the entire task is accepted by a single individual. Moreover, Dr. Bray is an individual who is clearly up to the job from the point of view of his extensive personal clinical experience and imaginative approach to the presentation of the subject of neurology in pediatrics.
Urinary Tract Infection in Childhood and Its Relevance to Disease in Adult Life: by Victoria Smallpeice, M.A. (Oxon.), M.D. (Lond.), F.R.C.P. St. Louis: C. V. Mosby Company, 1969, 171 pp., $9.50
Authors: Pryles Charles V.
Published: December 2021

This text of 171 pages is a first edition, and is written in its entirety by Victoria Smallpeice, Consulting Paediatrician to the United Oxford Hospitals, London. There are seven chapters: one devoted to general remarks about pyelonephritis in children, including what is known about its incidence; two are devoted to an exploration of the causes of urinary tract infections; two to clinical and laboratory diagnosis; one to treatment; and the last to the natural course of these diseases and their prognoses.
SEVERE CANDIDIASIS ASSOCIATED WITH THYMIC DYSPLASIA, IgA DEFICIENCY, AND PLASMA ANTILYMPHOCYTE EFFECTS
Authors: Schlegel Robert J. , Bernier George M. , Bellanti Joseph A. , Maybee David A. , Osborne George B. , Stewart James L. , Pearlman David S. , Ouelette John , Biehusen Frederick C.
Published: December 2021

Evidences of impaired cell-mediated immunity were found in a boy having mucocutaneous candidiasis and chronic pulmonary disease. The thymus gland and peripheral lymphatic tissues were dysplastic. IgA was absent from serum and secretions. The patient's plasma clumped leucocytes in suspension, an effect enhanced by bovida antigens. In vitro lymphocyte transformation, proliferation, and replication were normal in systems free of patient plasma but were partially inhibited by his plasma and totally inhibited by his plasma and bovida antigens. Large amounts of antibovida antibodies were found in the patient's plasma; and, when they were removed, lymphocyte functions were partially restored, even in the presence of bovida antigens. A plasma lymphocvtotoxic assay was positive. This appears to be a distinct syndrome comprising thymic dysplasia, IgA deficiency, antibovida antibodies, various types of plasma-mediated antilymphocyte effects, defective cellular and humoral immunity, and severe candidiasis.
FETAL GROWTH
Authors: Babson S. Gorham , Behrman Richard E. , Lessel Richard
Published: December 2021

Fetal growth in weight is presented on 40,000 single, newborn infants between 27 and 44 weeks' gestational age. They were delivered of white mothers who lived near sea level and received obstetric care from private physicians. Their mean birth weights were greater at term and after term than previously reported in the United States and were similar to those presented from the Scandinavian countries.
ARE SKINFOLD MEASUREMENTS OF VALUE IN THE ASSESSMENT OF SUBOPTIMAL NUTRITION IN YOUNG CHILDREN?
Authors: Keet Marie Paulowna , Hansen John Derek Lindsell , Truswell Arthur Stewart
Published: December 2021

Weight, height, head circumference, triceps and subcapsular skinfolds, mid upper arm circumference, and mid upper arm muscle circumference values were obtained from well children, children suffering from dehydrating gastroenteritis, and children suffering from severe protein calorie malnutrition to determine if these measurements could be used to assess nutritional status.

The results indicate that, in Cape Town, there is a significant correlation between skinfold thickness for age, and weight and height for age, and that skin-fold measurements can be used as an additional, reliable, objective measure of suboptimal nutrition and early protein calorie malnutrition in group surveys, particularly where the exact ages of children are not known.
URINARY AMINOIMIDAZOLECARBOXAMIDE LEVELS IN CHILDREN WITH ACUTE LEUKEMIA
Authors: Lulenski Gary , Donaldson Milton , Newcombe David
Published: December 2021

Urinary 5-amino-4-imidazolecarbox-amide (AIC) was studied in 10 leukemic children to determine whether it reliably indicates relapse of the disease. Mean AIC in normal children was 0.92 µg/mg creatinine/24 hours; in leukemic remission it was 1.44, and in relapse it was 5.01. AIC levels correlated significantly with marrow blast cell content. less so with peripheral blood blasts, and inversely with platelet counts. Data suggest AIC may differentiate between leukopenia of relapse and that of drug toxicity, and that it may predict leukemic relapse even before diagnostic morphologic marrow changes occur. AIC is unreliable in patients on methotrexate because the drug causes an elevation of the urinary AIC level.
GLOMERULAR FILTRATION RATE IN CHILDREN WITH SICKLE CELL DISEASE
Authors: CALCAGNO PHILIP L. , MCLAVY JOHN , KELLEY THOMAS
Published: December 2021

Renal function has been studied quantitatively in five patients with sickle cell anemia, all of whom were proved to have reduced glomerular filtration rates. Two patients with sickle cell trait revealed normal glomerular filtration rates. Possible mechanisms responsible for reduced glomerular filtration flows are discussed.
Round Table Discussion
Authors: GOETTSCH ELVIRA , LIPPMAN RICHARD W. , LUETSCHER JOHN A. , BATES TALCOTT , PETERMAN M. G.
Published: December 2021

By considering the mechanisms of Na-balance systematically, it is possible to derive a rational approach to the restoration of balance, with relief of edema, in the presence of renal disease. The most promising approach, at the present time, utilizes Na-adsorbent ion-exchange resin. The possibility of immunologic neutralization of the biologic antidiuretic substances offers further hope, after further investigation.

Recent work has emphasized the importance of K-balance in the presence of impaired renal function. It is especially important to remember this when instituting measures, such as those mentioned, which substantially alter the rate at which electrolytes are absorbed and excreted.
TEACHING THE BROADER ASPECTS OF PEDIATRICS
Authors: SPOCK BENJAMIN
Published: December 2021

THE PHYSICIAN who cares for children and the parents who consult him tend nowadays to be less occupied in their visits with physical disease, more with growth and development, behavior problems, school and social adjustment. There are well known reasons for this shift, which include the minimizing of infection by means of sanitation, immunization and the antibiotic drugs, the increased awareness on the part of parents and physicians of the importance of fostering the child's total development and total adjustment, the interest in preventive psychiatry and psychosomatic medicine. The trend will probably continue, especially as more physicians are trained who are interested and helpful in these areas.

If pediatrics does not accommodate itself to the increasing desire of parents for preventive guidance, the vacuum might be filled by a new specialty, perhaps from within the field of psychology. In some ways this would seem a logical development, since the cost of training a physician to be competent in all aspects of child care tends to put his services beyond the means of many. But it would be an unfortunate backward step to divide again the child's emotional well-being from his physical well-being, to divide his development from his diseases, and to entrust them to two separate specialists.

At the present time departments of pediatrics and pediatric hospital services, in their training programs, are going on the assumption that the physician who practices pediatrics, part or full time, is the person who ought to treat the child's illnesses, immunize him, supervise his physical growth, guide his emotional development, especially in the early years, and be able to advise his parents whenever any problem arises, even though the assistance may consist only in knowing to which other expert or agency to refer him.
URETEROCELE IN INFANCY AND CHILDHOOD
Authors: GROSS ROBERT E. , CLATWORTHY H. WILLIAM
Published: December 2021

Ureteroceles are abnormalities which result from congenital stenosis of a uretero-vesical junction. That portion of the ureter which obliquely traverses the bladder wall becomes ballooned out so that it projects into the lumen of the bladder. This bulging mass in the bladder may be one to several centimeters in diameter. The lesions are more common in females. The outstanding symptoms are referable to pyuria, which appears in most cases. There may be abdominal or flank pain from the ureteric obstruction. In some patients the ureterocele may lodge in the bladder outlet and block the urinary flow from the entire urinary tract, in this way giving rise to damage in both kidneys. In rare instances a ureterocele may prolapse through the urethra of the female. Ureteroceles are apt to give rise to symptoms in infancy or childhood, but in some cases they are not manifest until later years. Intravenous pyelography and cystography will often give conclusive evidence of the presence of the abnormality, but in some patients cystoscopy will be necessary to establish the diagnosis.

Ureteroceles are not difficult to treat. They should never be excised, because such surgical attack is apt to destroy the uretero-vesical valve and permit reflux of urine from the bladder to the upper urinary tract, a complication which results in increasing hydronephrosis and pyelonephritis. A ureterocele mass will collapse by merely incising its dome in a longitudinal manner for a distance of 2 to 4 mm. This effectively relieves the ureteral obstruction and is the most important step in the therapy of any existing urinary infection. Chemotherapy is a valuable adjunct in the treatment of pyuria, but will have permanent benefit only if the mechanical obstruction has been completely eradicated. In babies and small children it is preferable to avoid incision of a ureterocele by cystoscopic instrumentation; it is safer to open the bladder and incise the structure under direct vision. The results of this latter type of therapy are extremely gratifying and in most instances such conservative measures will permit saving of the kidney on the affected side.
CARCINOMA OF THE CERVIX IN THE FIRST YEAR OF LIFE
Authors: HECKEL GEORGE P.
Published: December 2021

Two cases of adenocarcinoma of the cervix in girls 7 and 11 months old are described. There is probably but one previously reported case under 1 year of age. The first patient reported here died of the disease on the day of admission to the hospital, having had vaginal bleeding for about a month. The second is surviving normally 21 months after total hysterectomy. Vaginal bleeding had begun eight days before operation.
FROM FANCY TO FACT
Authors: Greenberg Robert E.
Published: December 2021

Recognition of a given symptom, sign, or abnormal laboratory finding represents the start of a long, often tortuous path. The trail soon broadens, as combinations of findings coalesce into syndromes. Blind alleys, thick forests, and divergent roads beguile and confuse the traveler. One may stumble onto the main route by application of rational, physiologic patterns of thought. Charting a discrete map to finite understanding and effective therapy is dependent upon delineation of underlying cellular mechanisms.

Similar parables have often been utilized to indicate the applicability and essentiality of studies of cellular and intercellular processes in relation to human physiology and disease.
ATYPICAL MEASLES IN CHILDREN PREVIOUSLY IMMUNIZED WITH ATTENUATED MEASLES VIRUS VACCINES
Authors: Cherry James D. , Feigin Ralph D. , Lobes Louis A. , Shackelford Penelope G.
Published: December 2021

During the winter and spring of 1970 to 1971, an epidemic of measles occurred in the St. Louis area. During a study of this epidemic, 12 children had clinical illnesses suggesting the "atypical measles" syndrome, but six of these children had received only live attenauted measles vaccines. The illnesses in these six children were qualitatively similar to those in the six children who had been immunized with killed measles vaccines, but they were quantitatively less severe. Acute-phase measles HAI antibody titers in the recipients of live vaccines were greater than those of killed vaccine recipients, whereas the converse was true of the convalescent-phase serum titers.
WHAT CHILDREN READ ABOUT VOLTAIRE IN 1811
Authors: C. T. E.
Published: December 2021

Once upon a time children's readers contained chapters describing the weaknesses of famous people. That Voltaire's character left much to be desired is evident from the following lesson read by school children more than a century and a half ago.

He loves the court, yet grows weary of it: he has sensibility without connections, and is voluptuous without passion. He is attached to nothing by choice, but to every thing through inconstancy. As he reasons without principle, his judgment has its intervals, like the folly of others. He has a clear head, but a corrupt heart. He thinks of every thing, and treats every thing with derision.

He is a libertine, without a constitution for pleasure; and can moralize without morality. His vanity is excessive, but his avarice still greater; he therefore writes less for fame than money, for which he may be said both to hunger and thirst. He is in haste to work, that he may haste to live: lie was made to enjoy, and determined only to hoard. Such is the man, and such is the author.

Voltaire has much foreign and much French literatune; nor is he deficient in that sort of mixed erudition that is now so fashionable. He is a politician, a naturalist, a geometrician, or whatever he pleases; but he is always superficial, because he is not able to think deeply. He could not, however, flourish as he does upon those subjects, without great ingenuity.

His taste is rather delicate than just; he is a witty satirist, a bad critic, and a dabbler in the abstracted sciences: imagination is his element, and yet strange as it is, he has no invention.
DRUG USE AND ATTITUDES OF HIGH SCHOOL STUDENTS
Authors: Yancy W. S. , Nader Philip R. , Burnham Katherine L.
Published: December 2021

A random survey of 7,414 10th, 11th, and 12th graders in Monroe County, New York, revealed alcohol to be the most commonly used drug (85%). Twenty-seven percent had used marijuana. Experience with LSD (8.6%) and heroin (2.6%) was lower. Frequent and continued use was less prevalent for all drugs. Students indicated that curiosity was the main reason for beginning drug use.

Except for marijuana the students tend to view drugs as dangerous. The youth state that "drug centers" are needed and would he used but should not be staffed by parents or police.
HEROIN INTOXICATION IN ADOLESCENTS
Authors: Kaufman David M. , Hegyi Thomas , Duberstein Joel L.
Published: December 2021

Three Bronx, New York hospitals have admitted 49 cases of heroin intoxication (overdose) in adolescents during a period of three and a half years.

The patients were aged 14 to 17 years, male in 42 cases, and addicted in only two cases.

Patients presented with miosis, respiratory depression, obdundation, and, in 33 cases, thoracic rales, or rhonchi. Chest x-ray revealed infiltrates in 34 cases and blood gas analysis showed hypoxia and acidosis in 14 cases. Their course was complicated by pulmonary edema in 28 cases, pneumonia in 16, aspiration in 9, and permanent cerebral damage in 2 cases. Three cases were fatal.

Therapy of choice is immediate institution of an airway and ventilation with oxygen. Naloxone (Narcan), a new narcotic antagonist should be administered intravenously, 0.01 mg/kg, with additional doses as clinically indicated.
LONG-TERM PHYSICAL ILLNESS IN CHILDHOOD: A CHALLENGE TO PSYCHOSOCIAL ADAPTATION
Authors: Mattsson Ake
Published: December 2021

Pediatricians and psychiatrists long have recognized that many psychosocial problems facing children with long-term physical disorders can lead to social disability far more serious to an individual than the direct effects of his physical ailment. The physician who provides comprehensive care to a chronically ill child and his family wants to promote realistic and normal child-rearing attitudes, so that the child can develop a self-image as a socially competent and productive citizen. In meeting this task, the physician may be helped by knowledge of the major causes for emotional stress in serious illness and by familiarity with the child's and the parents' various means of coping with their burden. This paper reviews long-term disorders in childhood from the standpoint of the attendant psychologic stresses and the related adaptational techniques used by the child and his parents in their attempt to master their negative and distressing emotions. Such techniques include the use of cognitive functions, motor activity, emotional expression, and certain psychologic defenses. Clinical examples illustrate how these coping mechanisms can support or hinder good psychosocial adaptation due to the degree of their employment and the nature of the parent-child relationship. Children with chronic illness as well as their parents show a rather predictable sequential pattern in adapting to their difficult situation. The parents' early acceptance of their child's disability and its impact on the family is crucial in promoting a healthy personality development of the child.
Dr. and Mrs. Alfred Washburn
Authors: Gordon Harry H.
Published: December 2021

This letter is written in tribute to Dr. and Mrs. Alfred H. Washburn, who died in Denver on March 19 and June 24, 1972, at ages 77 and 73, respectively—he after seven years of circulatory disability, she after a short illness with cancer.

Dr. Washburn, white-capped and towering like the Colorado peaks he loved so well, came to Denver in 1930 from Amherst and Harvard via Presbyterian Hospital in New York, Boston Children's and City Hospitals, practice in Portland, Oregon, and combined teaching and practice at the University of California Medical School in San Francisco.
Letter to the Editor
Authors: Wegman Myron E.
Published: December 2021

Dr. Cunningham's points are well taken. The most easily preventable deaths in the groups still experiencing higher infant mortality are those due to infectious disease and nutritional problems. The two measures emphasized by Dr. Cunningham would have highly salutary effects and should be supported by all pediatricians.

Despite the evidence that bottle-feeding can be safe and effective, breast-feeding offers obvious advantages in simplicity, security against infection, and suitability of nutrients. The observed decline in breast-feeding with advancing development or "civilization" is deplorable and it is reprehensible that we have not undertaken sufficient investigation as to how the trend can be reversed.
Letter to the Editor
Authors: S. C. A.
Published: December 2021

With what has already appeared in our columns on this subject (Pediatrics, 49:267, 1972 and 50:311 and 341, 1972), and the hope that today's readers can lay hands on the immortal comments of Dr. Gellis (Year Book of Pediatrics 1960-61, p. 366), we believe this covers the matter until next season.
Immunological Effects of Injection Therapy
Authors: Glaser Jerome
Published: December 2021

This is with reference to the publication by May and associates regarding the subject noted above.

I am very puzzled by this report. If I understand correctly, the conclusions are or at least the inference is that it was not possible to show a hyposensitizing effect of the customary injection treatment of children with allergic rhinitis or asthma or both because in no case did intradermal skin tests with the allergens become negative. It is also stated that "as judged by the review of the clinical records and physician's and parent's opinions, improvement or worsening of clinical manifestations did not seem to be different in injected and uninjected subjects."
Letter to the Editor
Authors: Conners C. Keith
Published: December 2021

Dr. Johnsen quite reasonably wished for more operational definitions of such elusive terms as short attention span and impulsivity than were provided in my paper. He is apparently referring to the labels attached to the factor scores and profile analysis used to assess subtypes of children and treatment progress. Limitations of space in the article precluded full explication of the methods of factor analysis and cluster analysis which are likely to be unfamiliar to most pediatricians.