bluuebunny/crossref_metadata_2025 huggingface dataset:
A PAGE FROM A TEXTBOOK ON THE DISEASES OF INFANCY AND CHILDHOOD WRITTEN IN 1858 CONCERNING A TOPIC NOT INCLUDED IN CONTEMPORARY PEDIATRIC BOOKS
Authors: C. T. E.
Published: December 2021

In 1858, Dr. L. H. Tanner of London published an excellent book entitled, A Practical Treatise on the Diseases of Infancy and Childhood.1 The quotation below illustrates both the style of Victorian medical writing as well as the concern of physicians of that era for the moral training of children:

The rectitude of the father, the self-denial of the mother, and the earnestness with which both pursue their daily avocations, make a great impression on the youthful mind; and even much slighter incidents, which the thoughtless may only regard as trifles, often serve either to develop good qualities, or to pervert the yet unformed judgment.
Letter To The Editor
Authors: Bullock Joseph D. , Deamer William C. , Frick Oscar L. , Crisp James R. , Galant Stanley P. , Ziering William H.
Published: December 2021

This is in regards to "Recurrent Abdominal Pain in Childhood," by R.T. Stone, M.D. and G.J. Barbero, M.D. Recurrent abdominal pain and associated symptoms in 102 children were explained on a functional basis, as "irritable bowel syndrome." We should like to draw attention to another organic diagnostic possibility for at least some of the cases.

The tension fatigue syndrome (T.F.S.) is a symptom complex occurring mainly in children but also in adults1-10. The T.F.S. is usually due to food allergy.
Letter To The Editor
Authors: Kemp James P.
Published: December 2021

The authors of the lead article in the May issue either were unaware of the article by Dr. Crook and his colleagues in this journal on "Systemic Manifestations of Allergy"1 in children, or chose to disregard his findings. Other physicians who at least attempt to diagnose food allergy by dietary eliminations and provocations have also reported on this condition.2,3 The list of associated symptoms and signs which are presented in Table I seem to be almost identical to those in Table I of the forementioned report.
Treatment of Hyperkinetic Child with Dextroamphetamine and Ephedrine
Authors: Scanlon John
Published: December 2021

The following case may prove interesting to readers who treat hyperkinetic children.

The patient, a 7-year-old boy, was noted to be hyperactive at school. He was easily distractible during group activity, easily frustrated, and under achieving despite above average intelligence. He also had a cough for several days.

Physical examination revealed a quite hyperactive male unable to sit still or concentrate on tasks for more than 15 to 20 seconds. Other than this, neurological examination was within normal limits.
Reye's Syndrome and Salicylate Intoxication
Authors: Shaw Edward B.
Published: December 2021

The Paper by Pross, Bradford, and Krueger, "Reye's Syndrome Treated by Peritoneal Dialysis," (Pediatrics 45:845, 1970) is of extreme interest, and the successful therapy which they employed is most praiseworthy. It appears, however, that fatty hepatomegaly, which is a cardinal finding in Reye's syndrome, was not demonstrated. It seems unlikely that, if present, this could have been reversed by dialysis for 24 hours and followed by steady improvement. Fatty infiltration of the liver and a confirmed diagnosis is usually revealed only at autopsy and not by clinical findings.
Letter To The Editor
Authors: Olurin Oyin
Published: December 2021

Dr. Olurin commented as follows:

Dr. McEnery is of course entitled to his opinion about the innocence of high fevers with or without convulsions. There is ample evidence in the literature for and against his views and I would refer him to the references, 8, 12, 13, and 14 dealing with "febrile convulsions." I agree with him, however, that more basic research on fevers is necessary, and this hospital is hoping to partake in this.
Methoden in der Medizinischen Cytogentik, edited by Professor Dr. Hans Georg Schwarzacher and Privatdozent Dr. Ulrich Wolf. Berlin/Heidelberg/ New York: Springer-Verlag, 1970, 186 pp., $13.20. (In German)
Authors: Zellweger Hanz
Published: December 2021

Technics used in cytogenetic laboratories have reached a state of sophistication which makes it desirable to collect them in a hand or guidebook such as that written by Schwarzacher and Wolf in cooperation with several other experienced German cytogeneticists and one American (Ohno).

The subject matter is divided into eight chapters. Chapters 1 to 4 deal with culture methods for blood, bone marrow (Pfeiffer) and other tissues, preparation of karyotypes, and autoradiography (Gey) of chromosomes.
Orbis Pictus, by John Amos Comenius. A facsimile of the first English edition of 1659, introduced by John E. Sadler. London: Oxford University Press, 1968, 450 pp., (35s = $4.20)
Authors: Cone Thomas E.
Published: December 2021

The name Jan Amos Komesky (Latinized as John Amos Comenius) and the title of his famous children's book, Orbis Pictus will probably be known to few, if any, readers of Pediatrics. And yet he and his book did more to take the drudgery out of learning to read than anyone else for at least 200 years.

The busy practitioner will properly ask who Comenius was and why the book he wrote more than 3 centuries ago (1656) is worth this review.
Juvenile Rheumatoid Arthritis, vol. VI in the series Major Problems in Clinical Pediatrics, by Earl J. Brewer, Jr., M.D. Philadelphia: W.B. Saunders Company, 1970, 231 pp., $12.50
Authors: Fink Chester
Published: December 2021

As stated in the Preface, this is a book written for the physician in clinical practice. The sections devoted to the differential diagnosis and therapy of rheumatoid arthritis will thus be found most helpful to the average practicing pediatrician.

The initial chapter described the variable patterns of the onset and course of rheumatoid arthritis, utilizing both the author's extensive experience and data from other published Series. Tables of frequency of findings are ineluded which not uncommonly point out the marked variability seen in series from different centers.
Comprehensive Care
Authors: Shatkin Eugene P.
Published: December 2021

Dr. Work's commentary on Pediatric Globalism (Pediatrics, 46:173, 1970), up to the last paragraph, stresses the point of teaching "total pediatrics" or "comprehensive care" to trainees.

His reasons are clearly stated and understandable up to that point, but from there on I lose his logic. He then says, because some physicians, those subspecialists who prefer to intensify their interest in certain areas, may not include the learning of "comprehensive care" in their armamentarium, perhaps we needn't teach this special area to them.
The Dying Child: The Management of the Child or Adolescent Who is Dying, by William M. Easson, M.D. Springfield, Illinois: Charles C Thomas, 1970, 103 pp., $5.75
Authors: Galdston Richard
Published: December 2021

The death of a child is absurd. It makes no sense-not from any point of view. The author of a book about the dying child undertakes a particularly difficult task. There is very little to be said about death other than that it terminates life. There is a great deal to be said about living. It is hard enough to learn what the child, particularly the small child thinks and feels about anything, least of all the prospect of his own death.
DR. RICHARD MEAD AND HIS REMEDY FOR THE BITE OF A MAD DOG
Authors: C. T. E.
Published: December 2021

Perhaps the best known English physician of the first half of the eighteenth century was Dr. Richard Mead (1673-1754). His regimen for the treatment of a patient bitten by a mad dog was widely used, not only in England but also in the United States. Dr. Mead's name was so revered that few physicians dared to question the efficacy of his regimen until Dr. James Mease (1771-1846) of Philadelphia who in 1792 wrote that Mead's management of rabid dog bites, cited below, was "totally useless."1

Take Ash coloured Ground Liverwort four drachms, Black Pepper two drachms, mix them together into a fine powder: This is to be divided into four doses, whereof one is to be taken in warm milk in a morning fasting, for four mornings successively; after this the person must be put into a cold bath, pond, or river, for thirty days together, early in the morning, and before breakfast: he is to remain in it with his head above water not longer than half a minute. The wound should be continually fomented with a pickle made with Vinegar and Salt, as warm as it can be borne.2
PERIPHERAL CIRCULATORY RESPONSE TO FEEDING IN THE NEWBORN INFANT
Authors: Yao Alice C. , Wallgren C. Göran , Sinha Sachchida N. , Lind John
Published: December 2021

In the article, "Peripheral Circulatory Response to Feeding in the Newborn Infant," Pediatrics, 47:378, February 1971, a typographical error occurs. Line 11 of the Summary on page 382 should read ". . . after the meal there was as a rule a superceding . . ."
FEVER AND BIOCHEMICAL THERMOGENESIS
Authors: Matsaniotis Nicholas , Pastelis Vasiliki , Agathopoulos Anthony , Constantsas Nicholas
Published: December 2021

Serum free fatty acid versus glycerol ratios were decreased in human newborn infants during pyrexia or cold injury, but remained practically unchanged in older infants and children. Decreased ratios in the newborn resulted exclusively from an increase in serum glycerol. In children a parallel increase in both serum glycerol and free fatty acids was observed in pyrexia. The results suggest that in pyrexia both newborn infants and older children behave as if they were cold, mobilizing the mechanisms of nonshivering and shivering thermogenesis respectively to adjust the temperature of their body at a relatively higher reference level.
Congenital Islet Cell Adenoma Causing Hypoglycemia in a Newborn
Authors: Buist Neil R. M. , Campbell John R. , Castro Albert , Brant Bolek
Published: December 2021

Hypoglycemia caused by an islet cell tumor of the pancreas has been reported in only a few newborn babies.1-7 This paper presents another case in whom the hypoglycemia was severe and resistant to all forms of medical therapy, including 7-chloro-3-methyl-2H-1,2,4-benzothiadiazine 1, 1-dioxide (Diazoxide). Hyperinsulinemia was not found but the plasma insulin/glucose ratio was inappropriately high while the patient was hypoglycemic. The hypoglycemia was cured by removal of the tumor at the age of 4 months. Insulin levels in the tumor and in the normal pancreatic tissue are also reported.

Methods

Glucose tolerance tests were performed using 2.5 gm/kg glucose given as a 25% solution by gavage over 5 minutes.
Letters to the Editor
Authors: Yankauer Alfred
Published: December 2021

The generalizations which Dr. Nichols has made (or inferred) by applying his (incorrect and incomplete) definitions to data from Galveston and Philadelphia are affected by an enormous sampling bias. How many other places in the United States which are not medical centers report the outcomes of pregnancy in the same way? Perhaps there is even more "under-reporting" (as Dr. Nichols defines it) in the U.S.A. as a whole than in the Netherlands as a whole in spite of certain differences in "official" reporting requirements (even though the difference Dr. Nichols specifies no longer holds)? Furthermore, the Galveston-Philadelphia data Dr. Nichols quotes are not those reported to the Vital Statistics Divisions of the cities of Philadelphia and Galveston.
Trivalent Oral Polio Vaccine: Disappointing Results
Authors: Ghosh Shanti
Published: December 2021

I was interested to read the paper on trivalent oral polio virus vaccine trials by Hardy and colleagues in your journal of March 1970,1 which reached here only recently. It prompts me to state the results we have achieved in the babies attending the Well Baby Clinic, who received three doses of trivalent oral polio vaccine at 4 to 6 weeks interval beginning at 3 to 6 months of age.2 Our results are disappointing and compare with the results achieved in some other tropical countries, particularly Nigeria.
Skinfold Thickness in Assessment of Nutrition
Authors: Gupte S. P.
Published: December 2021

May I support the opinion expressed by Dr. Keet, et al.1 concerning the value of skinfold measurement in the assessment of nutritional status.

Our own observations regarding detailed anthropometry on infants and children with advanced protein-calorie malnutrition are reported elsewhere.2,3 Triceps skinfold thickness in our cases of nutritional marasmus is consistently far below the 3rd percentile, the average being 3.2 ± 0.83 mm, which is about 40% of the Western standard. In kwashiorkor, on the other hand, it measures 6.5 ± 1.06 mm which is about 68.1% of the Western standard.
Letters to the Editor
Authors: Wehrle Paul F.
Published: December 2021

For the committee, Dr. Wehrle answered as follows:

The comments by Dr. Podolsky summarize very well the present concerns over health effects of air pollutants among children. We concede that direct "cause and effect" relationships are difficult to establish in children. The Theeye irritation of photochemical smog and exercise effects on treadmill performance using various inhalants can be conducted only among adults after gaining full informed consent.

The admonition to the pediatrician to be aware of possible adverse effects remains well advised.
EVALUATION OF IMPEDANCE CARDIAC OUTPUT IN CHILDREN
Authors: Lababidi Zuhdi , Ehmke D. A. , Durnin Robert E. , Leaverton Paul E. , Lauer Ronald M.
Published: December 2021

In 20 children without shunts or valvular insufficiency, duplicate dye dilution and impedance cardiac outputs (ICO) were carried out. The duplicate dye dilutions had a standard deviation 0.259 L/min/m2, while duplicate ICO had a standard deviation 0.192 L/min/m2 (F = 1.82, p < 0.05). Of 53 sequential estimates, cardiac outputs measured by both indicator dye dilution and ICO had a 5.5% mean difference.

In 21 subjects with left to right shunts, the ICO related well with pulmonary blood flow (r = 0.92) rather than systemic flow (r = 0.21). In 13 subjects with aortic insufficiency, sequential Fick and ICO had a 50% mean difference; the impedance measurement was found to be higher in every case.

These data indicate that the impedance cardiograph can provide a noninvasive measure of cardiac output when there are no shunts or valvular insufficiencies. In subjects with left to right shunts the impedance cardiograph provides a measure of the pulmonary blood flow. When aortic insufficiency exists the impedance cardiograph is distorted such that it is consistently higher than Fick cardiac output.
A STUDY OF A PEDIATRIC RESIDENCY TRAINING PROGRAM
Authors: Shah Chandrakant P. , Robinson Geoffrey C. , Kinnis Claire , Israels Sydney
Published: December 2021

This study was undertaken in order to determine the extent of the utilization of community settings in pediatric training programs and their value rating by pediatricians in Canada. Community settings were defined as any resident staff learning experience in the community other than at the teaching hospital, and they were divided into medical, social, and educational settings.

Response rate was 100% for the 31 programs surveyed and 73.2% for the 790 pediatricians surveyed. Utilization of community settings was minimal, with the exception of pediatricians' offices, community hospitals, and clinics for well child care and rehabilitation. However, most of the pediatricians favored additional exposure of resident staff to these community settings. While pediatric education should continue to teach the pathology of the sick child in hospitals, this study suggests that the Canadian pediatricians think that graduate teaching programs should also embrace other facets of the health care delivery system. This will enhance the utilization of community resources by the pediatricians.
Improved Separation of Centile Lines on Growth Charts
Authors: Wingerd John , Schoen Edgar J. , Solomon Irene L.
Published: December 2021

On infant growth curves drawn by the usual technique (Fig. 1, left), it is often difficult to distinguish among the centile lines. The lines for the first few months of life are so steep, and so close together, that a chart must be made inconveniently large to be readable. Plotting the logarithm of the height or weight against age improves distinction only slightly.

A more satisfactory graphic representation of growth data is suggested by the method of Rao.1 A modification of Rao's method, applicable to the longitudinal analysis of growth data, was recently described by one of us (J.W.).2
Reticulocyte Counts in Intra-uterine Growth Retardation
Authors: Lochridge Stanley , Pass Robert , Cassady George
Published: December 2021

Elevated erythropoietin levels,1-3 high hematocrits,4-6 and increased RBC volumes4,6,7 and counts5 have been reported in infants with intra-uterine growth retardation (IGR). These findings, compatible with prolonged in utero hypoxia, have led us to examine reticulocyte counts in these infants.

Materials and Methods

Heparinized blood samples were studied from a total of 145 neonates. Eighty-two of these samples were obtained from the umbilical vein at time of delivery. The remaining 63 were obtained within 24 hours of birth from capillary or venous blood, 37 of these within 12 hours, and 55 within 18 hours of birth.
Stool Pattern of the Newborn— Effect of Bilirubin?
Authors: Chopra D. R.
Published: December 2021

Your query to Dr. Lawson's letter1 prompts this reply.

In this part of the country I had the opportunity of seeing a large number of American Indian neonates with hyperbilirubinemia–who are not wholly breast fed, but show the typical pattern of stooling described by Dr. Lawson– whether you give phototherapy or not. In our analysis the hyperbilirubinemic infants were equally divided for breast feeding and bottle feeding. So I don't think breast feeding is a prime factor, but I do strongly feel that the decline in bilirubin level is often associated with frequent loose yellow stools.
PULMONARY MECHANICS IN ASTHMA AND CYSTIC FIBROSIS
Authors: Zapletal Alois , Motoyama Etsuro K. , Gibson Lewis E. , Bouhuys Arend
Published: December 2021

Maximum expiratory flow rates on flow-volume curves are often decreased below normal limits in children with asthma or cystic fibrosis who are clinically well and whose standard spirometric tests are within normal limits. In particular, maximum flow rates at small lung volumes (25% of vital capacity) are decreased. Maximum expiratory flow-volume (MEFV) curves provide a sensitive and quantitative assessment of small airway obstruction in these and other obstructive lung conditions.
POSITIVE TRANSPULMONARY AIRWAY PRESSURE
Authors: Oliver Thomas K.
Published: December 2021

There is now good evidence unpublished and published1,2 that neonatal intensive care is associated with increased survival. The major cause of neonatal mortality is the idiopathic respiratory distress syndrome (IRDS); hence the decrease in neonatal mortality can be ascribed, in part at least, to improvement in the management of infants with this syndrome. The arterial oxygen tension while breathing 100% oxygen has been shown to be the most valuable prognosticator for outcome in this disease;3,4 an oxygen tension less than 100 mm Hg (in 100% oxygen) during the first 24 hours is associated with a markedly increased mortality. Thus central in the management scheme is adequate oxygenation.
CYTOMEGALOVIRUS MONONUCLEOSIS IN A FIRST TRIMESTER PREGNANT FEMALE WITH TRANSMISSION TO THE FETUS
Authors: Davis Larry E. , Tweed Gerald V. , Stewart John A. , Bernstein Michael T. , Miller Gerald L. , Gravelle Clifton R. , Chin Tom D. Y.
Published: December 2021

An understanding of the pathogenesis of congenital cytomegalovirus (CMV) infections is hampered by the fact that the majority of adult infections are subclinical. This prevents documentation of the time of fetal infection. In the instance described, a 17-year-old pregnant female developed cytomegalovirus mononucleosis during her first trimester. CMV was recovered from her convalescent urine at 12 weeks' gestation and from amniotic fluid at 21 weeks' gestation. Following a therapeutic abortion at 22 weeks' gestation, CMV was recovered from multiple fetal organs. Cord serum contained 14 mg/100 ml IgM which is elevated for a 22-week fetus.

The IgM fraction of the cord serum contained specific CMV antibodies as demonstrated by indirect hemagglutination and indirect immunofluorescence techniques. This suggests that, under abnormal circumstances such as intra-uterine infections, fetuses may be capable of synthesizing detectable levels of specific IgM antibodies as early as 22 weeks' gestation.
COMPLEXITIES OF PARENTAL UNDERSTANDING OF PHENYLKETONURIA
Authors: Sibinga Maarten S. , Friedman C. Jack
Published: December 2021

Parental understanding of phenylketonuria (PKU),investigated through a questionnaire, was evaluated as to completeness and with respect to distortion. Only 19% of 79 parents gave adequately correct answers. The education of the parents was not related to their understanding. Neither the intellectual status of the child with PKU nor its behavioral reactions were found to be related to the individual parent's understanding of the illness. However, the better the understanding of a marital pair, the more intelligent the child was (p < .05) and the higher its behavioral score tended to be (p < .10). Mothers with more complete understanding tended to have brighter sons. Half of the total parent group displayed considerable tendencies to distort in their answers to the questionnaires, education again being unrelated to distortion. Fathers who were more prone to distort had children with lower IQ scores (p < .05) and poorer behavior ratings (p < .10).

We believe that effectiveness of communication with parents is, in part, related to the nature of parental thinking. This might be explored independenty, not where it pertains to the child's illness.
ISLET CELL ADENOMA IN THE NEWBORN: REPORT OF TWO PATIENTS
Authors: Robinson M. J. , Clarke A. Murray , Gold Hugo , Connelly J. F.
Published: December 2021

Islet cell adenoma is a rare cause of severe neonatal hypoglycemia. Two cases are reported and difficulties in diagnosis are outlined. In one infant, cure followed subtotal pancreatectomy at the age of 19 days.

It is suggested that severe hypoglycemia of obscure origin persisting beyond the age of 2 weeks in a newborn infant of normal birth weight and not responding to standard medical measures, justifies exploration of the pancreas. Even if an islet-cell tumor is not identified, subtotal pancreatectomy is indicated.
THE EVIL EFFECTS OF HIGHER EDUCATION FOR GIRLS— ACCORDING TO DR. S. WEIR MITCHELL
Authors: C. T. E.
Published: December 2021

During the latter half of the nineteenth century most physicians in this country were convinced that girls should not undergo the same rigorous scholastic programs as boys their age. The explanation usually given was that too much stimulation of the girl's brain would cause dire effects on the "female organs." The simplistic explanation went as follows: "The nutritive demands of the stimulated brain would jeopardize the nutritive needs of the girl's reproductive organs." This would cause not only disabling "female complaints" but bad health in general.

Dr. S. Weir Mitchell (1829-1914) vividly expressed the commonly-held view of the harmful effects of nineteenth century female education in these words:

"Worst of all, to my mind, most destructive in every way, is the American view of female education. The time taken for the more serious instruction of girls extends to the age of eighteen, and rarely over this. During these years, they are undergoing such organic development as renders them remarkably sensitive... To show more precisely how the growing girl is injured by the causes just mentioned (forced and continued study at the sexual epoch) would carry me upon subjects unfit for full discussion in these pages; but no thoughtful reader can be much at a loss as to my meaning... To-day the American woman is, to speak plainly, physically unfit for her duties as woman, and is, perhaps, of all civilized females, the least qualified to undertake those weightier tasks which tax so heavily the nervous system of man. She is not fairly up to what Nature asks for her as wife and mother.
ACUTE FOREIGN BODY LARYNGO-TRACHEAL OBSTRUCTION: A CAUSE FOR SUDDEN AND UNEXPECTED DEATH IN CHILDREN
Authors: Steichen Felicien M. , Fellini Andrew , Einhorn Arnold H.
Published: December 2021

Sudden unexpected death in three well children beyond crib age due to laryngo-tracheal obstruction by a foreign body is described. The clinical picture is characterized by a paucity of clues in, very often, the absence of reliable witnesses and of any preexisting causes for sudden death. Because of this and on suspicion only, immediate laryngoscopy and bronchoscopy are indicated in all children above crib age with sudden unexpected and unexplained death, after initial respiratory and cardiac resuscitation have taken place. It is hoped that mouth to mouth breathing by the nonprofessional bystander as well as expertise with respiratory resuscitation by ambulance crews, will deliver the occasional child suffering from potentionally fatal foreign body obstruction of the airways to the emergency department before irreversible anoxic cerebral damage has occurred. Children treated in this optimal fashion may thus be given an opportunity to survive.
BOOK OF ACCIDENTS
Authors: Cone Thomas E.
Published: December 2021

Most contemporary American children probably think the bull's function is to charge the matador in the bullring. But in rural America of the 1800's children often sustained serious–and at times fatal–injuries from an angered bull, as this illustration shows.1
Eponyms and Other Inane Titles for Diseases
Authors: Thelander H. E.
Published: December 2021

The list of forgotten Pediatric diseases in the April issue Pediatrics, prompted me to list the following from the abstracts of the papers presented at the recent American Pediatric Society Meeting.

In addition to these there appeared these inane titles to syndromes: "Cat-Eve," "Chinese Restaurant," and "Stale Fish." Should not all of these designations be relegated to oblivion? What is wrong with a name like "Trisomy 21" or "Hemihypertrophy?"
Postural Hypotension from Imipramine
Authors: Slovisd Thomas L. , Ott John E. , Wenzl James E.
Published: December 2021

It was of interest to read that postural hypotension occurred in a patient in a "therapeutic dose" of imipramine.1 This, however, is common in patients on any of the tricyclic antidepressants (amitriptyline, nontriptyline, and so forth) as these drugs decrease the cardiovascular reflexes, such as carotid reflex, Bezold-janisch reflex, and postural reflexes.2,3

I take issue with the statement that the patient was on "therapeutic dosages of this drug," as she exhibited many of the toxic manifestations of this class of compounds.
Danger of Plexiglass Oxygen Hood: Query and Clarification
Authors: Lee Sherwood B. , Indyk Leonard
Published: December 2021

In his recent paper,1 Dr. Indyk states that a dangerous situation in newborn thermoregulation arises with the use of plexiglass oxygen hoods in infants placed under radiant heat infant warmers. One might infer from the data that a decrease in a newborn's optimal core temperature is associated with the combined use of plexiglass hoods and infant warmers.

There is an inherent problem, however, in applying purely physical data, as the author has done, to a biological system, i.e., the newborn infant.
Indications for Tonsillectomy in Infectious Mononucleosis
Authors: Feroli Edward J. , Mella Gordon W. , Pedreira Frank A. , Storch Regis T. , Gutgesell Howard P.
Published: December 2021

We read with interest the recent report, "Acute Airway Obstruction in Infectious Mononucleosis."1 Dr. Gutgesell appropriately has called attention to a serious complication of a usually benign disease. He mentions brief, high-dose corticosteroid therapy, tracheotomy, nasotracheal intubation, and IPPB as potential modes of therapy. The following case report suggests an additional therapeutic modality in the management of these patients.

A 4-year-old girl was admitted to a community hospital in acute respiratory distress associated with suspected infectious mononucleosis.
Mental Illness in Childhood: A Study of Residential Treatment, by Dr. V. L. Kahan. Philadelphia: J. B. Lippincott Company, 1971, 219 pp., $10.00
Authors: Wore Henry H.
Published: December 2021

This delightfully written little book does not contribute very much new in 1971. Rather, it is a monograph describing the care of a small number of children in a highly specialized, English residential treatment home called West Stowell House. The principles upon which the house operates are similar to those described by Bettleheim and indeed many of the therapeutic techniques seem borrowed from him.

A real asset is the excellent description of the cases. The course of each child's stay in the hospital is laid out clearly and without apology.
Handbook of Clinical Dermatoglyphs, by Musallam S. Elbualy and Joan D. Schindeler. Coral Gables, Florida: University of Miami Press, 1971, 58 pp., $6.95
Authors: Cone Thomas E.
Published: December 2021

Until a few years ago a physician caught staring at the palms and finger prints of one of his patients would, at the least, have been considered decidedly odd by his peers and, at the worst, a practitioner of the ancient and still widely practiced system of divination known as cheiromancy or palmistry. All this has changed; now the long-forgotten and unappreciated observation of what the brilliant seventeenth century English physician-botanist, Nehemiah Grew (1641-1712) called the "innumberable little ridges of equal bigness of the finger skin patterns and of the palms" has acquired both scientific respectability and an appropriately hybrid name–dermatoglyphics–derived both from Latin and Greek.
THE REGULATION OF OXYGEN AFFINITY OF FETAL BLOOD
Authors: Orzalesi Marcello M. , Hay William W.
Published: December 2021

It has been previously shown that red cell 2,3-diphosphoglycerate (DPG) binds to reduced hemoglobin (Hb) decreasing its affinity for oxygen (O2 and that the in vitro effect of DPG on fetal Hb is less marked than on the adult Hb.

The present study on whole blood provides evidence that the in vivo effect of DPG on the O2 affinity of fetal Hb is approximately 40% of that of adult Hb. It also shows that the O2 affinity of fetal blood decreases during gestation and depends on the relative proportions of adult and fetal Hb and on the level of red cell DPG.
ON THE CHOICE OF A PHYSICIAN TO CARE FOR CHILDREN
Authors: C. T. E.
Published: December 2021

In 1836 Dr. J. Ackerley, who practiced medicine in New York City, published an excellent pamphlet fOr parents' use entitled "The Management of Children in Sickness and in Health." In it Dr. Ackerley offered parents this advice about choosing a physician for their children.

It is important above all things, in choosing a physician, that one should be selected, if time and opportunity permit, in whose skill and integrity we have entire confidence. It is certainly desirable to have gentleness and mildness of manner combined with skill if it can be obtained, particularly . in the treatment of children; but, although we should never countenance coarseness and vulgarity, by allowing it to pass for eccentricity, we should never reject a man because his personal appearance, his manner or his dress, does not exactly accord with any preconceived notions we may have as to perfection in these matters, for they are small matters–small indeed, when compared with the important nature of the business we have in hand for him. We ought to reflect, and never lose sight of the object for which his services are required; we ought never to forget that it is to have the sick made well; we ought to recollect that our child's life is at stake–the child so long wished for, and born in pain and travail–the child on whom we delight to gaze and dote–the child in whom we, perhaps, already perceive our very selves–is in danger of perishing. And can we leave this little suffering, helpless thing to the care of those in whom we have not the fullest confidence? No, we cannot.
RETURN TO THE LAND OF THE LIVING: AN APPROACH TO THE PROBLEM OF CHRONIC HEMODIALYSIS
Authors: Nordan Robert , Ostendorf Richard , Naughton John P.
Published: December 2021

An extremely withdrawn 15-year-old boy, on chronic hemodialysis and with a severe hearing loss, was involved in a team-directed rehabilitation program in order to reverse his increasing deterioration. Various professionals–teacher, nutritionist, speech therapist, psychologist, physical therapist, occupational therapist, social worker, medical student–all cooperated in a program of total involvement for the boy and his family. Within a few weeks the patient began to "return" from his state of withdrawal, and rather dramatic changes occurred in his medical, physical, and psychological condition.
PRESENT STATUS AND TREATMENT OF PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA
Authors: Linde Leonard M. , Turner Searle W. , Awa Shoichi
Published: December 2021

The therapeutic agents that have been described will successfully convert close to 100% of all episodes of PST in children. Digoxin is the most frequently used agent for treatment of acute PST and is highly effective and safe. Recently, cardioversion and beta-adrenergic blockade are being employed more frequently, both with specific indications. Newer electrical means and new agents such as Verapamil are effective but the former are not yet widely used and the latter not yet authorized for use in the United States. Prophylaxis of recurrent episodes is usually successful with digoxin, with the addition or substitution of propranolol in certain conditions.
The Use of L-Arginine and Sodium Bicarbonate in the Treatment of Malabsorption Due to Cystic Fibrosis
Authors: Kattwinkel John , Agus Saul G. , Taussig Lynn M. , di Sant'Agnese Paul A. , Laster Leonard
Published: December 2021

It has long been recognized that patients with cystic fibrosis have a malabsorption syndrome secondary to pancreatic insufficiency for which they generally are treated with the oral administration of pancreatic extracts from hog or beef origin. Recently Solomons, Cotton, and Dubois reported that the oral administration of L-arginine resulted in a reduction of steatorrhea and gain of body weight in cystic fibrosis patients, perhaps by acting as a mild detergent and thus reducing the viscosity of intestinal mucus and increasing the emulsification of dietary fats. In the treatment of pancreatic insufficiency not due to cystic fibrosis, other investigators have advocated the oral administration of sodium bicarbonate (NaHCO3) in an attempt to correct the deficiency of endogenous NaHCO3 secretion seen in such patients.
FABLES FOR THE INSTRUCTION OF YOUTH PUBLISHED IN BOSTON IN 1818
Authors: Cone Thomas E.
Published: December 2021

In the early years of the nineteenth century William Perry's The Only Sure Guide to the English Tongue, published by Isaiah Thomas, Jr., was the most widely used speller and reader in New England schools (Fig. 1). The two things in Perry's book that were said to have most impressed those who learned to spell and read from it were the frontispiece (Fig. 2) and the collection of fables.

The frontispiece shows a tree of learning growing in a schoolyard, and groups of boys playing in its shadow. A ladder reaches into the branches and several boys with open books in their hands are climbing up the ladder into branches of the tree.

The illustrated fables found toward the end of Perry's book were studied and memorized by almost all New England school children a century and a half ago. Perry's choice of fables, one of which will be published each month, will offer an excellent view of the kind of moral instruction our children were once taught.1
Phototherapy in Hemolytic Disease
Authors: Ente Gerald
Published: December 2021

I agree wholeheartedly with Dr. Lanzkowsky that "phototherapy should be used with extreme caution" and that it is the object of "indiscriminate use . . . bringing in its wake a number of potential hazards." However, I disagree that anemia after use in hemolytic disease is the fault of the therapy.

Just as a good carpenter does not blame his tools, a knowledgable physician does not abuse his tools, although he knows their hazards. Phototherapy is an adjunct in the treatment of pathological jaundice, and is considered to be therapeutic in physiologic jaundice by some, while unnecessary by others.
Letter to the Editor
Authors: Lanzkowsky Philip
Published: December 2021

I regret that Dr. Ente has misunderstood both the content and the intent of our paper. We never stated that anemia in hemolytic disease is the fault of phototherapy, but stated that it was the consequence of multiple factors such as transient erythroblastopenia, splenic sequestration, and continuous hemolysis, and was well recognized before the use of phototherapy. The intent of the paper was, not to blame the therapy, but to caution the physican about the need to do frequent bilirubin and hemoglobin estimations in hemolytic disease of the newborn, especially when the infant has had phototherapy and therefore may not require an exchange transfusion.
Light Plus Phenobarbital in the Reduction of Serum Bilirubin
Authors: Valdes Orestes S. , Maurer Harold M. , Shumway Clare N.
Published: December 2021

The study by Blackburn and associates, showing the lack of additive effect of phenobarbital when used in combination with phototherapy in lowering the serum bilirubin concentration in one identical twin in each of six sets, eliminates the possible interference of genetic background on bilirubin metabolism. As part of a larger study, we have previously presented and reported similar results in a controlled study of 75 low birth weight infants of a predominantly Negro population. Members of each of our therapy groups (phenobarbital, light, phenobarbital and light, no therapy) were comparable with respect to birth weights and initial serum bilirubin concentrations, and were kept in similar environments, although their genetic backgrounds were dissimilar.
"The Innate Constitutional Vigor of Black Youth"
Authors: Friedmann Theodore
Published: December 2021

The recent article (48: 979, 1971) by M. E. Wegman on "Annual Summary of Vital Statistics-1970," shows clearly that this country has not yet solved the medical and socioeconomic problems which contribute to our inordinately high infant mortality rate, especially among nonwhites. It is a bit puzzling, though, to read in such an article that one can clearly recognize "the innate constitutional vigor of black youtone has only to look at the sports pages daily."
Hypertension as a Cause of Facial Paralysis
Authors: Roskes Saul D.
Published: December 2021

The review paper by Drs. Manning and Adour on facial paralysis in childhood was illuminating in terms of differential diagnosis.

However, one very important consideration in the assessment of children who present with peripheral facial paralysis is the possibility that it may be the initial manifestation of severe hypertension in children. It is presumed that the paralysis is due to hemorrhage within the facial canal.

Because hypertension in childhood very frequently has an etiology which is surgically or medically remediable the index of suspicion for its presence must be maintained at a high level.
Toxoplasmosis, edited by Didier Hentsch, M.D. Bern, Stuttgart, Vienna: Hans Huber Publishers, 1971, 264 pp., no price given
Authors: Eichenwald Heinz F.
Published: December 2021

After a decade or so in which there was rellively little progress, a considerable expansion of information bearing on human toxoplasmosis occurred. Simplified serologic tests were introduced, basic epidemiologic data emerged which had previously eluded investigators and which suggested for the first time a logical source of human infection, the life cycle of the organism became clear and finally, and perhaps most importantly, the problem of asymptomatic infection during the newborn period was defined, along with its frequent and disasterous sequela of mental retardation.
LUNG EXPANSION IN THE PREMATURE RABBIT FETUS AFTER TRACHEAL DEPOSITION OF SURFACTANT
Authors: Enhörning Göran , Robertson Bengt
Published: December 2021

Concentrated "surfactant" was obtained by centrifugation of alveolar wash from adult rabbits for 1 hour at 4°C, 1,000xG, and deposited in the trachea of premature rabbit fetuses, killed at the gestational age of 28 days, i.e., 1 day before appreciable amounts of surface active phospholipids are naturally present in the pulmonary fluid. Pressure-volume tracings revealed a mature pattern in the surfactant-treated animals, with wide hysteresis. Significantly less air entered the lungs of control fetuses from the same litters, and the pressure-volume tracings from these animals showed a premature pattern, with minimal hysteresis.

The lungs of the fetuses were fixed in formalin under the endotracheal deflation pressure of 10 cm H20. Histological examination of the lungs revealed moderate or prominent air expansion of the parenchyma in surfactant-treated animals, whereas no or only slight air expansion characterized the controls.

Tracheal deposition of surfactant prior to the first breath thus seems to enhance the air expansion of the premature lung, and might possibly be applied as a method for prophylaxis against the idiopathic respiratory distress syndrome, which is related to deficiency of surface active phospholipids in the pulmonary fluid.
ROUSSEAU ADVISES PARENTS NOT TO REASON WITH CHILDREN
Authors: C. T. E.
Published: December 2021

In his pedagogical novel Emile, published in 1761, Rousseau (1712-1778) traced the principles of all modern education. According to Rousseau, education should do nothing but give the child an opportunity to develop its natural gifts unhampered and shield it from the corrupting influences of civilization. Rousseau had this to say about reasoning with children:

DO NOT REASON WITH CHILDREN

Of all the powers of the human mind, reason, which may be said to be composed of all the rest, unfolds itself last and with the greatest difficulty; yet is employed to bring forward the other faculties, thus making a tool of that which ought to form the main-spring of the machine. By talking to children in their infancy a language they do not understand, they are accustomed to be satisfied with mere words, to criticise all you say, to believe themselves as wise as their instructors, and to become disputatious and stubborn. Act reasonably, but do not reason with your pupil. Above all, do not try to reason him into what is disagreeable, because to bring in reason on all occasions and upon unpleasant subjects, will only disgust him, before he is of an age to understand it. If in answering a child's questions you employ any arguments he is incapable of understanding, he will perceive you are reasoning on your own ideas not on his, and will conclude what you say is good for your age, but not for his; he will therefore cease to have any confidence in you, and all is lost.
Mobitz Type II Atrioventricular Block in a Newborn
Authors: Kelly David T. , Rowe Richard D.
Published: December 2021

Patients with congenital complete heart block and no other cardiac lesion usually are asvmptomatic and have a normal axis and QRS pattern on the electrocardiogram. The site of the block is usually in the region of the AV node. Another less common type of congenital AV block has an abnormal QRS complex on the electrocardiogram. Death from Stokes-Adams attack has been recorded in infancy in this group. Mobitz Type II block is very rare in infancy but may precede complete heart block which requires ventricular pacing. The purpose of this report is to illustrate Mobitz Type II heart block in a newborn which progressed to complete block.
School Phobia? Or Allergic Tension-Fatigue
Authors: Crook William G.
Published: December 2021

Dr. Barton Schmitt's article on school phobia is logically organized and well written. However, there is one fault. The author obviously has never heard of the allergic tension-fatigue syndrome which, in my experience, is a common cause of (1) vague physical symptoms, (2) normal physical and laboratory findings, and (3) poor school attendance.

I won't make this a long and detailed letter for three reasons: First, I know space in the Letters to the Editor section of Pediatrics is limited. Second, the typical clinical picture of the child with systemic manifestations due to allergy was presented in detail in this journal some years ago.
Opening of the Season: Little League Baseball Pro and Con
Authors: Maller Harold M.
Published: December 2021

Drs. Torg et al. have thrown us a curve with their article in the February issue of Pediatrics on arm injuries in young baseball pitchers.

Having referred to "the effect of competitive pitching" in their title, they have proceeded to discuss a group of boys who, they would have us believe, played baseball "for the sake of recreation rather than competition." If one could imagine that such a group of boys had been found, then the authors have failed to investigate what they claim to have investigated.
Fluoride Availability in Fish Flour
Authors: Hadjimarkos D. M.
Published: December 2021

The recent statement by the Committee on Nutrition, American Academy of Pediatrics, that fluoride in fish flour is less than 50% available is incorrect. Recent balance studies in man demonstrated an 88% absorption of fluoride present in fish flour.

Fish flour contains 150 to 300 ppm fluoride. In studies conducted abroad, infants and children 2 to 5 years of age received daily between 10 to 30 gm of fish flour in their diets. Assuming a fluoride content of at least 150 ppm, the daily fluoride intake would be between 1.5 and 4.5 mg
The Real Cause of Lead Poisoning
Authors: Klein Robert
Published: December 2021

The report of the Committee on Environmental Hazards misdirects its emphasis and implicitly supports a myth that has inhibited efforts to eradicate childhood lead poisoning. The Committee agrees that childhood lead poisoning is preventable and then calls for government financial commitment as well as unspecified legislative action because it may be economically unfeasible for landlords to improve deteriorated buildings. The stress should not be on economic aid for landlords but on changing society so children's lives and brains are valued more than landlords' financial well being.
Consultations in Dermatology With Walter B. Shelly. Philadelphia/London/Toronto: W. B. Saunders Company, 1972, 289 pp., $11.00
Authors: Griesemer Robert D.
Published: December 2021

In this small volume are found brief accounts of the basic features of 50 clinical problems in dermatology and practical programs for their management. A case history is used to introduce each chapter. The author condenses his quarter century of experience in a famous medical center into very readable distillates, which contain the essence of clinical information about common and not-so-common entities. There are current bibliographies for each chapter with a short evaluation of each reference listed. The photographs are large, clear, and dramatic.