bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Screening for Phenylketonuria: II. Age Dependence of Initial Phenylalanine in Infants With PKU
Authors: Holtzman Neil A. , Mellits E. David , Kallman Clayton H.
Published: December 2021

The relationships between initial and follow-up blood phenylalanine concentration and between initial concentration and age were examined in infants with elevated screening tests. Data were provided by health departments and phenylketonuria (PKU) clinics. Among infants who attained levels of 20 mg/100 ml or more the following was observed: (1) one-fourth had only minimal elevations (to less than 10 mg/100 ml) on the initial screening test; (2) of those with minimal elevations 66% were screened on or before the third day of life; (3) most of those whose initial elevations were more than minimally elevated and most of those with minimal elevations who were screened early had follow-up phenylalanines of 30 mg/100 ml or more. In contrast, those with minimal initial elevations who were screened late were more likely to have follow-up phenylalanines between 20 and 30 mg/100 ml. They may represent a different form of PKU. The findings suggest that as long as most infants in the United States continue to be screened on or before 4 days of age, some infants with PKU will be missed.
Developmental Screening of Preschool Children: A Critical Review of Inventories Used in Health and Educational Programs
Authors: Thorpe Helene S. , Werner Emmy E.
Published: December 2021

Five developmental screening inventories, currently popular in health and educational programs, are compared on relevant technical and practical criteria. All five have limitations because their norms are based on small samples of children who are often not representative of the children later screened. Until carefully conducted longitudinal studies of normal children of different racial, socioeconomic, and educational backgrounds are available, these inventories cannot be used for prediction of future potential. However, when administered by a properly trained person, each of these procedures can be used as a narrative description—if not a numerical score—a profile for planning the health and education of the preschool child.
Propionicacidemia (Ketotic Hyperglycinemia): Dietary Treatment Resulting in Normal Growth and Development
Authors: Brandt Ira K. , Hsia Y. Edward , Clement David H. , Provence Sally A.
Published: December 2021

A number of metabolic disorders are now known to bring about a syndrome of recurrent ketoacidosis, vomiting, lethargy, stupor, and hypotonia, to present in the newborn period and to result in neurological impairment or death, if not properly controlled. The subject has been discussed by O'Brien and the number of disorders, primarily those involving a block in the metabolism of amino acids, continues to increase.

See image in the PDF file

The principles involved in diagnosis and management of these disorders are well exemplified in the present report. At the earliest suspicion that such a disorder exists, one should discontinue protein feeding, obtain blood and urine specimens for metabolic screening, and restore and temporarily maintain a normal metabolic milieu by the administration of water, glucose and balanced electrolytes. Should a specific metabolic block be ascertained, appropriate management, usually lifelong and dietary, may then be instituted with high expectations as to being able to control if not entirely prevent the usually unfavorable consequences. While the sporadic case may not be ascertained before some permanent damage is done, in situations in which the genetic predisposition has been defined the potential for normalcy is present. That this potential has been achieved in this patient is in greatest measure due to the cooperation and understanding of the parents, since the burden of management was primarily theirs.
Letter to the Editor
Authors: David Simeon
Published: December 2021

In the past few years, there have been several reports implicating sickle cell trait as a probable factor in unexpected death occurring both in military recruits undergoing severe physical stress and in children during anesthesia. The authors of the latter article, McGarry and Duncan, concluded that, "It would be appropriate to advocate screening Negro citizens for the presence of the S hemoglobin at some time during their life, preferably early in childhood. The results of these tests should be known if anesthesia is to be administered."
Management of Idiopathic Hyperbilirubinemia in Term Infants: Community Practices
Authors: Lewak Norman
Published: December 2021

The management of idiopathic hyperbilirubinemia in term infants in a pediatric community was surveyed. Babies admitted to a pediatric medical center had significantly less days of high bilirubin since the introduction of phototherapy. Five percent of babies in three community hospitals received phototherapy. The number of babies in whom jaundice was noted, the investigation of the jaundice, and the use of phototherapy varied greatly in the community hospitals. Physicians need to evaluate their own strategies in dealing with idiopathic hyperbilirubinemia.
"Aseptic Meningoencephalopathy" or "Neurotoxicity" in Leukemia?
Authors: Szalay Glenn C.
Published: December 2021

The "aseptic meningoencephalopathy" following CNS prophylaxis in childhood lymphoblastic leukemia reported by McIntosh and Aspnes would seem to be explained by the findings of Bleyer et al. They found markedly elevated CSF levels of methotrexate in five patients manifesting "neurotoxicity" following intrathecal injection in the dose range normally used for this form of therapy. Speculation regarding "geographical differences in virus infection or other factors" will now need to center on the reason(s) for the marked elevation (up to 100 times) of CSF methotrexate levels in these patients.
Immunology in Clinical Medicine, ed. 2, by J. L. Turk, M.D., D.Sc. (Lond.), M.R.C.P., M.R.C. Path. New York: Appleton-Century-Crofts, 1972, 259 pp., $9.75
Authors: Quie Paul G.
Published: December 2021

This second edition (1972) of Dr. Turk's book "Immunology in Clinical Medicine," first published in 1969, is a welcome guide for clinicians in the tangled pathways of immunologic information. As in the first edition, Dr. Turk has provided his readers with concepts of immunology underlying disease processes. The author is ever mindful that his reader is concerned with patients, and the information about immunologic concepts is intended to provide helpful understanding of the pathophysiology of immunologic diseases.
Black Monday's Children: A Study of the Effects of School Desegregation Self-Concepts of Southern Children, by Gloria J. Powell, M.D. New York: Appleton-Century-Crofts, 1973, 334 pp., $16.50
Authors: Coles Robert
Published: December 2021

This book lends itself to a diversity of interpretations—not because it is full of contradictions or inconsistencies, but because the author, a black-child psychiatrist, has chosen to approach children primarily through the medium of psychological testing rather than direct and sustained clinical observation. There are advantages to her approach, too: a relatively large number of boys and girls can be worked with, and at least something of what goes on in their minds obtained.
Renal Disease in Childhood, ed. 2, by John A. James, M.B. (Edin.), M.R.C.P., D.C.H. St. Louis: The C. V. Mosby Company, 1972, 377 pp., $23.50
Authors: Worthen Howard G.
Published: December 2021

This is the second edition of Dr. James' compact text dealing with pediatric nephrology. The short interval between the first and second editions attests both to the rapid rate of change in this field and to the success of the first edition.

The format of the second edition remains the same as that of the first. Introductory chapters on anatomy and physiology of the kidney, signs and symptoms of renal disease and diagnostic procedures in infants and children are followed by chapters dealing with the various diseases and disorders encountered in pediatric nephrology.
ABO Haemolytic Disease of the Newborn, by E. R. Gold, M.D. and N. R. Butler, M.D., F.R.C.P., D.C.H. Baltimore: The Williams & Wilkins Company, 1972, 212 pp., $15.75
Authors: Lucey Jerold F.
Published: December 2021

This is a compact, up-to-date (1972), thorough, source book. It contains more information on ABO incompatibility than most physicians need or may want to know. Approximately one third of the book's 212 pages are devoted to clinical aspects of the problem. The other two thirds is concerned with serology, laboratory techniques, and the history of hemolytic disease. The book is clearly written and would be particularly appropriate for house staff, research fellows, and consulting physicians who want a concise, accurate, authoritative reference.
Sickle Cell Hemoglobin: Molecule to Man by Makio Murayama, Ph.D., and Robert M. Nalbandian, M.D. Boston: Little, Brown and Company, 1973, 198 pp., $16.50
Authors: Nathan David C.
Published: December 2021

This book represents a second volume by Murayama and Nalbandian devoted to their concepts of urea and its purported relationship to the sickling phenomenon. The book seems to have been written and published in vacuo. Despite reasonable criticisms of the authors' concepts following publication of their previous work, neither the authors nor the publishers appear to have sought prepublication review by experts. As a result the book is as replete with error as its predecessor and thereby offers little but further confusion to the field.
Harry Bakwin—Some early memories
Authors: Gairdner Douglas
Published: December 2021

In the 1930s Charles Hendee Smith was Professor of Pediatrics at Bellevue Hospital. He must have possessed a streak of Anglophilism, for he went out of his way to welcome men from overseas to his Department and a succession of young men from England and Scotland thus came to work there. Ronnie MacKeith was the first; he was followed by Louis Findlay, through whom I came to know of this opening. My own arrival in 1939 at the Bellevue coincided with the start of the war, which however was in that curiously quiescent phase of the "phoney war" which lasted from the lightening defeat of Poland until the fighting in Western Europe started up in earnest in April 1940 when I returned to England.
Hemodialysis and renal transplantation in children: The role of the pediatric nephrology team
Authors: Grushkin Carl , Lewy John E. , Cole Barbara , Holland Nancy , Lewy Peter , Potter Donald
Published: December 2021

Dialysis and transplantation are now acceptable modes of therapy for infants and children with end-stage renal disease. This necessitates a consideration of the appropriate role of the pediatric nephrology team in the care of these children. The passage of Federal legislation amending the Social Security Act to cover the extensive costs of dialysis and transplantation and the likelihood of the establishment of regional centers for adults and children further emphasizes the need to establish guidelines for personnel and facilities caring for infants, children and adolescents.

Initially, we must assess the goals of dialysis and transplantation in children. The most desirable and obvious goal is to return renal function to normal through transplantation whenever possible.
Double-Blind Study of the Effectiveness of a Broad Spectrum Antibiotic in Status Asthmaticus
Authors: Shapiro Gail G. , Eggleston Peyton A. , Pierson William E. , Ray C. George , Bierman C. Warren
Published: December 2021

Forty-four children and adolescents with status asthmaticus and without signs of bacterial infection, such as otitis media, purulent pharyngitis or lobular pulmonary infiltrate and fever were treated identically except that one group received hetacillin, whose active form is ampicillin, and one group received placebo in a prerandomized double-blind fashion.

The groups were similar in terms of age, size and severity of asthma. Hospital course, complications and duration of hospitalization were similar for the two groups. The incidence of viral and mycoplasma infection was 20%. History, physical examination and chest x-ray were poor predictors of those with nonbacterial infection. There was no culture evidence that bacterial disease had been missed.

It appears that the use of broad spectrum antibiotics such as hetacillin or ampicillin in children and adolescents with status asthmaticus and without clinical evidence of bacterial disease is of no benefit. The need for close observation of these patients is stressed.
Sequelae of Early Steroid Administration to the Newborn Infant
Authors: Fitzhardinge Pamela M. , Eisen Abraham , Lejtenyi Christine , Metrakos Katherine , Ramsay Maria
Published: December 2021

Twelve infants received hydrocortisone intravenously in the first 24 hours of life as therapy for RDS. They were paired with 12 similar infants who received a lactose placebo. Comparison follow-up studies were done on the two groups for one year and showed no difference in rate of growth or in ultimate size at 1 year of age. Steroid therapy was not associated with an increased rate of infection. Tests for immune competence were normal at one year in both groups. Infants who received the steroid tended to have a slightly increased incidence of gross neurological and electroencephalographic abnormalities. The developmental quotient was normal in both groups although subtests showed a significant lowering of the gross motor development in the study group.
Contentment Defined for American Children in 1787
Authors: C. T. E.
Published: December 2021

In 1787 a Philadelphia printer published a book for school children entitled "Miscellanies in Prose and Verse for the Improvement of Young Persons of Both Sexes." Benjamin Franklin expressed his approval of this book in these words: "A book containing so many well chosed sentiments and excellent instructions, put into the hands of our children cannot but be highly useful to the rising generation." The following is a lesson from this book:

Forget not that thy station on earth is appointed by the wisdom of the eternal; who knoweth thy heart, who seeth the vanity of all thy wishes, and who in mercy often denieth thy requests; yet for all reasonable desires, for all honest endeavours, his benevolence hath appointed, in the nature of things, a probability of success. The uneasiness thou feelest, the misfortunes thou bewailest, behold the root from whence they spring, even thine own folly, thine own pride, thine own distempered fancy; murmur not therefore at the dispensations of God, but correct thine own heart; neither say within thyself, if I had wealth or power, or leisure, I should be happy; for know, they all of them bring of their several possessors their peculiar inconveniencies.

The poor man seeth not the vexations and anxieties of the rich; he feeleth not the difficulties and perplexities of power, neither the wearisomeness of leisure, and therefore it is that he repineth at his own lot. But envy not the appearance of happiness in any man, for thou knowest not his griefs.
Dermatophilus congolensis Chronic Nodular Disease in Man
Authors: Albrecht R. , Horowitz S. , Gilbert E. , Hong R. , Richard J. , Connor D. H.
Published: December 2021

Dermatophilus congolensis is a common infectious agent among animals. However, infectivity in man has only rarely been observed. We report the association of D. congolensis with a chronic nodular disease in an 8-year-old boy. The time of exposure to the organism was unknown but may have occurred in utero. Testing of the immunologic system reveals a deficiency of B-lymphocytes bearing Fc receptors as well as impairment of lymphokine production. It is possible that an immunologic deficiency has permitted a chronic infestation with D. congolensis in a manner similar to that described for some cases of chronic mucocutaneous candidiasis.
Thyroid Storm in an 11-Year-Old Boy Managed by Propranolol
Authors: Galaburda Margaret , Rosman N. Paul , Haddow James E.
Published: December 2021

An 11-year-old boy with an 18-month history of incompletely treated thyrotoxicosis was hospitalized because of progressive weakness. During his first hospital day he suddenly decompensated, with signs of acute thyroid storm. He responded dramatically to intravenously and then orally administered propranolol which controlled his hyperthyroid symptomatology until propylthiouracil could take effect. This is the first reported description of the use of propranolol in the treatment of thyroid storm in childhood thyrotoxicosis.
Hemophilus influenzae Meningitis
Authors: Bennett John V. , McCormick Joseph B. , Feldman Roger A.
Published: December 2021

In a recently published article, "Bacterial Meningitis: A Symposium" (Pediatrics, 52:586, 1973), it was stated "The Center for Disease Control estimates that, in the United States, there are 29,000 cases of H. influenzae (meningitis) each year. . ." This number was released in October 1970 at a meeting at NIAID, and was an extrapolation made from cases that occurred in eight community hospitals in the United States in the four-month period from January to April 1970; this represented one of the few data sources available at that time by which the incidence of the disease could be estimated.
Simple Rule for Converting Body Weight to Body Surface
Authors: Harvey Norman A.
Published: December 2021

The body surface area (BSA) in square meters is commonly used to determine daily body water and electrolyte needs. Most pediatric fluid and electrolyte problems are calculated in patients under 70 lb in body weight (1.004 sq m).

To arrive at the proper decimal fraction of the BSA for infants and small children one needs a slide rule, nomogram or pocket calculator, all of which have a way of never being handy when needed. The standard formula (see below) may be used but this is a bother.
Letter to the Editor
Authors: McIntosh Sue , Aspnes Gregg T.
Published: December 2021

It is becoming increasingly apparent, as Dr. Muriel and others have observed, that transient encephalopathy often occurs in leukemic children during the second month following prophylactic irradiation. We have found in retrospect that this "reactive syndrome" occurs to a variable degree in at least 30 percent of patients, some of whom are well again after only a few days of mild somnolence and malaise.

We agree that these types of delayed encephalopathy are different in many ways from acute effects of intrathecal methotrexate.
DR. JOHN BROWN ON THE EVILS OF WHISKY FOR THE NURSING MOTHER
Authors: C. T. E.
Published: December 2021

In his delightful volumes of essays, Horae Subsecivae (i.e., "leisure hours"), Dr. John Brown (1810-1882), a Scottish physician, included a touching chapter on "Children and How to Guide Them." His warning below about the evils of whisky for the nursing mother must have made many of them teetotalers.

A baby for nine months after it is born, should have almost nothing but its mother's milk. This is God's food, and it is the best and the cheapest too. If the baby be healthy it should be weaned or spained at nine or ten months; and this should be done gradually, giving the baby a little gruel, or new milk, and water and sugar, or thin bread-berry, once a day for some time, so as gradually to wean it. This makes it easier for mother as well as baby. No child should get meat or hard things till it gets teeth to chew them, and no baby should ever get a drop of whisky, or any strong drink, unless by the doctor's orders. Whisky to the soft, tender stomach of an infant is like vitriol to ours; it is a burning poison to its dear little body, as it may be a burning poison and a curse to its never-dying soul. As you vlaue your children's health of body, and the salvation of their souls, never give them a drop of whisky; and let mothers, above all others, beware of drinking when nursing. The whisky passes from their stomachs into their milk, and poisons their own child.
Battered Child Syndrome: Review of 130 Patients With Controls
Authors: Lauer Brian , Broeck Elsa Ten , Grossman Moses
Published: December 2021

The medical and social service records of the 130 battered children under 10 years of age admitted to San Francisco General Hospital during a six-year period, July 1, 1965, to June 30, 1971, were reviewed. Only children with physical injuries were included. A control group was selected from concurrent admissions. The findings showed a steadily rising number of admissions for child abuse. Many of the children suffered from emotional, physical and medical neglect as well as intentional trauma and 44% had been abused previously. Six children died. Sixty-three percent of the battered children were less than 2 years old. Their parents were significantly younger than parents of controls and also much more transient. White children rather than nonwhite children were battered more often than expected when compared to the ethnic distribution of the control group.
Use of Serum Amylase Isoenzymes in Evaluation of Pancreatic Function
Authors: Taussig Lynn M. , Wolf Robert O. , Woods Robert E. , Deckelbaum Richard J.
Published: December 2021

Amylase isoenzyme patterns were evaluated in serum, urine, and duodenal fluid from 19 patients with cystic fibrosis (CF) and normal subjects. Two thirds of the CF patients with absent pancreatic enzymes lacked a serum pancreatic isoamylase band, while the remainder had a markedly diminished pancreatic band when compared to the salivary isoamylase. In normal sera the pancreatic band is equal to or greater than the salivary band. In all patients with absent enzymes the diagnosis of abnormal pancreatic function could have been made by evaluation of serum isoamylase patterns thereby avoiding duodenal intubation or collection of 72-hour stools for proteolytic enzyme activities. The patients with normal pancreatic enzyme activities had normal serum zymograms. No CF patient had a low total serum amylase concentration. Total duodenal fluid amylase levels may be misleading in the evaluation of pancreatic function since the amylase may be of salivary origin.

The advantages of this isoamylase method include (1) simplicity and noninvasiveness, requiring only a small blood sample; (2) specificity for pancreatic function; and (3) independence of pancreatic enzyme medication.
AN ACCOUNT OF A MONSTROUS CHILD BY DR. JOHN BURTON, PHYSICIAN AT YORK
Authors: C. T. E.
Published: December 2021

The case history below, published in 1747, demonstrates two things. First, that children could sumvive in spite of serious congenital anomalies; and second, that physicians' claims were not always accepted at face value.

—Wright, Spouse to a Ship Carpenter living at Kirkthorp near Wakefield in Yorkshire, bore a Child that had no Parts of Generation proper either to Male or Female, there not being the least Appearance of such Organs at the Place where we should expect to find those Parts; the child in every other Part was made as is common, except about half Way betwixt the Navel and Os pubic there was a circular Orifice of about an Inch Diameter, in which was a spongious Substance resembling the end of the Glans Penis excoriated; it did not project in the least from the Body, neither was it covered, but was quite bare, and very sore and tender. Through the several and almost innumerable Pores or Orifices of this spongious Body the Urine ouzed (sic) continually, and sometimes Blood, and at other times a reddish-coloured Serum. The Child lived to the Age of five Years or thereabouts, and died of the small Pox in November last. To the Truth of this I can bring many certificates, as well as living witnesses, if it was thought necessary.1
Objection to New Size of Pediatrics
Authors: Barton Leslie H. , Snowe Robert J.
Published: December 2021

Recent international and national events have forced upon us a consciousness of the finite stores of natural resources such as wood and its by-product, paper. Thus we were greatly disturbed at the increased size of the January issue of Pediatrics. The enlarged margins and increased spacing neither contribute to the ease of reading nor to the conservation of paper. It is rather paradoxical that Drs. Lucey and Haggerty commented on the "shortages and rising costs [of paper]"1 in the same issue.
Mucocutaneous lymph node syndrome (MLNS): A disease widespread in Japan which demands our attention
Authors: Fetterman George H. , Hashida Yoshie
Published: December 2021

In 1967 Kawasaki of Tokyo1 described 50 cases of a seemingly self-limited disease syndrome of infants and young children, which he designated as mucocutaneous lymph node syndrome (MLNS). The patients ranged in age from 2 months to 9 years, more than half being under 2 years of age. The cases had come to Kawasaki's attention over a six-year period from 1961 through 1966. The condition was somewhat reminiscent of the Stevens-Johnson syndrome, but was less awesome since all patients recovered. Some resemblance of MLNS to scarlet fever was also noted, but the author was confident that MLNS was different from and could be differentiated from both scarlet fever and the Stevens-Johnson syndrome.
Systemic Plant Poisoning in Children
Authors: Lampe Kenneth F.
Published: December 2021

There is probably no area in clinical toxicology more steeped in folklore, misunderstood, or mismanaged than plant and mushroom poisoning. Although there are thousands of species of plants capable of producing moderate to severe and possibly fatal poisoning, relatively few cases of serious intoxication occur in the United States and these are associated with a limited number of plants. The majdrity of the victims of plant poisoning are children under 6, but recently older age groups of children have become more vulnerable due to the increased popularity of camping, natural food cultism, and the search by some for naturally occurring hallucmnogens.

Because of incomplete reporting and limited means for physicians to obtain plant identifications, it is very difficult to prepare meaningful statistics on serious or fatal poisonings by plants containing systemically active toxins. For the United States it may be estimated that approximately half of these cases involve mushrooms. The remaining are distributed among a variety of species with different pharmacological properties.

One of the most perplexing problems facing those concerned with Poison Control Information Centers is the call from the panicky mother that her child has or may have swallowed a red berry growing on a bushy little plant with funny looking green leaves in the backyard. Equally frustrating is the parent who appears in the pediatrician's office with a wilted plant specimen announcing that this is growing all over the neighborhood, is it poisonous? Plant identification is becoming even more difficult with the increasing number of ornamentals and horticultural varieties introduced throughout the country.
Outpatient Intravenous Medications in the Management of Cystic Fibrosis
Authors: Rucker Ralph W. , Harrison Gunyon M.
Published: December 2021

The use of an indwelling intravenous infusion set for the home administration of potent antibiotics has been quite successful in the therapy of the chronic bronchopulmonary infection associated with cystic fibrosis. Gentamicin and colistimethate have been used extensively for sensitive strains of mucoid and nonmucoid Pseudomonas organisms. The convenience, patient acceptability, lack of complications, prevention of hospitalizations and effectiveness entitles this mode of therapy to a place of importance in the management of this complication of cystic fibrosis.
Impedance Audiometry Suggested
Authors: McCurdy John A.
Published: December 2021

The findings of Kaplan et al.1 with respect to impairment of verbal ability in Alaskan children with hearing loss greater than 25 dB ISO secondary to chronic suppurative otitis media warrant renewed attention to a similar otologic problem which constitutes a threat to the verbal development of a significant percentage of all children—hearing impairment secondary to chronic secretory otitis media.

Although the hearing loss in chronic secretory otitis media may fluctuate, a significant conductive impairment will persist as long as fluid remains in the middle ear.
Scrubbing and Hexachlorophene
Authors: Sonnenschein Harry
Published: December 2021

I enjoyed reading the excellent article by Ruby and Nelson1 on the influence of hexachlorophene scrubs in impetigo. The single weak spot in the study was the marriage of hexachlorophene to scrubbing with a stiff-bristled brush. A long time ago, even before the antibiotic era (revealing my age is indeed a heroic gesture on my part; I hope your readers appreciate my sacrifice), I recognized from clinical experience, without a double-blind study, that rubbing or scrubbing the lesions of impetigo is the most traumatic assault one can make upon them.
Congratulations on a Useful Article
Authors: Johnson George M.
Published: December 2021

Forman, Goldstein and Gonel are to be congratulated for their important, succinct paper, "Management of Juvenile Diabetes Mellitus: Usefulness of 24-Hour Fractional Quantitative Urine Glucose" (Pediatrics, 53:257, 1974).

For the past five years, on the recommendation of Dr. Donnell B. Etzwiler, we have followed approximately 60 juvenile diabetics using fractional quantitative 24-hour urine glucose values (obtained three or four times a year). As the authors point out, it is unfortunate and often detrimental to the juvenile diabetic that this simple inexpensive test has not gained wide clinical acceptance or even consideration by the physician caring for the juvenile diabetic.
The Whiplash Shaken Infant Syndrome: Manual Shaking by the Extremities With Whiplash-Induced Intracranial and Intraocular Bleedings, Linked With Residual Permanent Brain Damage and Mental Retardation
Authors: Caffey John
Published: December 2021

Our evidence, both direct and circumstantial, indicates that manual whiplash shaking of infants is a common primary type of trauma in the socalled battered infant syndrome. It appears to be the major cause in these infants who suffer from subdural hematomas and intraocular bleedings. The label "battered infant" is a misnomer in many cases which may interfere with early diagnosis and proper preventive treatment.

The essential elements in the infantile whiplash shaking syndrome present an extraordinary diagnostic contradiction. They include intracranial and intraocular hemorrhages, in the absence of signs of external trauma to the head or fractures of the calvaria, and are associated with traction lesions of the periosteums of the long bones in the absence of fractures and traumatic changes in the overlying skin of the extremities. Usually there is no history of trauma of any kind.

Habitual, prolonged, casual whiplash shakings may produce an insidious progressive clinical picture, the latent whiplash shaken infant syndrome, which is often inapparent to both parents and physicians. It usually first becomes evident at school age when minor idiopathic cerebral motor defects are first detected along with mild idiopathic mental retardation. Permanent impairments of vision and hearing may also be identified at this time for the first time when the children are 5 to 6 years of age. The actual number of such cases is incalculable from current evidence but it appears to be substantial.

This concept of the whiplash shaken infant syndrome warrants careful diagnostic consideration in all infants with unexplained convulsions, hyperirritability, bulging fontanel, paralyses, and forceful vomiting singly or in combination. The routine careful examination of the ocular fundi of all infants should provide a superior screening method for early and massive detection of pathogenic whiplash shakings along with radiographic examination of the long bones for confirmation in appropriate cases.

Current evidence, though manifestly incomplete and largely circumstantial, warrants a nationwide educational campaign on the potential pathogenicity of habitual, manual, casual whiplash shaking of infants, and on all other habits, practices and procedures in which the heads of infants are habitually jerked and jolted (whiplashed).

The proposed nationwide educational campaign against the shaking, slapping, jerking, and jolting of infants' heads is summarized in the following stanza:

Guard well your baby's precious head,

Shake, jerk and slap it never,

Lest you bruise his brain and twist his mind,

Or whiplash him dead, forever.
Questions for Bauer et al.
Authors: Stevenson Stuart Shelton
Published: December 2021

The recent article by Bauer et al., which associates prolonged rupture of membranes with a decreased incidence of respiratory distress syndrome, is intriguing.1 Stevenson and Laufe theorized, on the basis of guinea pig experiments,2-4 that "... the human disease occurred when aspirated amniotic fluid reacted with pulmonary exudate in the lungs and the resulting film of fibrin coated the alveoli and alveolar ducts in the form of a hyaline membrane."

The infants cited in Bauer's article obviously had less opportunity to aspirate amniotic fluid and their elevated corticosteroid levels might have mitigated the severity of their pulmonary exudates.
Letter to the Editor
Authors: Holtzman Ian R.
Published: December 2021

There is no question that attempts to explain and solidify the possible association between prolonged rupture of the membranes and hyaline membrane disease is of the utmost import in the management of the premature. Unfortunately, I believe the recent paper by Drs. Bauer, Stern, and Colle (Pediatrics, 53:7, 1974) raises more problems than it purports to answer.

The greatest difficulty I found in reading this paper was the lack of multiple ancillary data critical to interpreting the results.
Pediatric turf
Authors: Bergman Abraham B.
Published: December 2021

It seems like just yesterday that the pages between these green covers were filled with dire pronouncements about the child-health manpower shortage. The "pediatric numbers game" was worked to prove that since fewer kids' doctors were going to be around to see more kids, pediatricians couldn't possibly carry the whole load. I was among those calling for "others" to assume many of the tasks traditionally performed by pediatricians. Well, it's worked; the crisis cries were heeded. In the span of two short years, such profound changes have taken place in the manpower game, that general pediatricians in the United States may well be teetering on the threshold of a museum.
WHO INVENTED THE ICE CREAM SODA?
Authors: Dickson Paul
Published: December 2021

The generally acknowledged creator of the ice cream soda is Robert M. Green, who fathered it in October, 1874, at the semicentennial celebration of the Franklin Institute in Philadelphia, where he was a concessionaire selling soda fountain drinks from a three-foot-square dispenser. At the beginning of the exhibition he was serving a popular drink of the time which was mixture of sweet cream, syrup and carbonated water. During one of the early days of the celebration, however, he ran out of cream and began substituting vanilla ice cream. The customers gave their hearty approval to the new drink as evidenced by the fact that Green, who had been averaging $6 a day with the first drink, was taking in over $600 a day for ice cream sodas by the end of the exhibition. Green went on to make a fortune as a soda manufacturer, and when he died in 1920 his will called for a large monument to be erected over his grave with the inscription: ORIGINATOR OF THE ICE CREAM SODA.
Brain Scanning and Cerebral Radioisotope Angiography (CRA) in Children
Authors: Yalaz Kalbiye , Treves S.
Published: December 2021

The incidence of abnormal brain scans was high in children with symptoms of increased intracranial pressure, focal motor signs or meningitis. In patients with seizure disorders, headache (alone) and mental retardation, abnormal brain scan findings occurred in 1%, 2%, and 4% of the cases, respectively; thus the routine use of brain scanning as a screening procedure of the patients may be questionable. The true-positive rate of brain scans in this series was 83%. Cerebral radioisotope angiography (CRA) increased the true-positive rate by 3% when done selectively.

Cerebral radioisotope angiography was frequently abnormal in patients referred for early diagnosis of cerebrovascular accidents, when the brain scan was most frequently normal.

The high yield and sensitivity of brain scanning for diagnosis of brain abscess was confirmed in this study. The brain scan was found very useful in localizing brain abscess for surgical drainage and to assess the results of therapy.
FRANCIS GLISSON ON THE TREATMENT OF RICKETS
Authors: C. T. E.
Published: December 2021

Although Francis Glisson (1597-1677) was not the first to describe rickets, nevertheless, his treatise on rickets (1650) is generally regarded as the most important work which has yet appeared on the subject.1

A sample of Glisson's method of treating rickets follows:

To straighten the trunk of the body or to keep it straight, they use to make breast plates of whalebone put into two woollen cloths and sewed together, which they so fit to the bodies of the children that they may keep the back-bone upright, repress the sticking out of the bones, and defend the crookedness of them from a further compression. But you must be careful that they be not troublesome to the children that wear them, and therefore the best way is to fasten them to the spine of the back with a handsom [sic] string fitted to that use. The bearing them about in the nurses arms is almost agreeable to the same children, and under the same conditions; in like manner the rejoicing of the child whilst the nurse singeth, either as it sits in her lap, or is held up in her hands, as also the tossing of it up and down, and waving it to and fro. Also the drawing of the children backward and forward upon a bed or a table between the two nurses, the one holding it by the hand, the other by a foot. The two last notions seem to contribute somewhat to the erection of the crooked or bended backbone.
A Comparison of Pediatric Interviewing Skills Using Real and Simulated Mothers
Authors: Helfer Ray E. , Black Mary A. , Teitelbaum Howard
Published: December 2021

In order to allay concerns about using simulators as opposed to real mothers for teaching and evaluating interviewing skills, a study was designed to test for differences in students' approaches when interviewing simulated and real mothers. Three mothers were trained to give their own children's histories consistently and two mothers trained to simulate a history. Thirty third-year medical students conducted two interviews which were audiotaped. Students were told the nature of the study and whether the mother was real or simulated. One half of the time the mothers were presented as simulators and one half of the time the simulators were presented as mothers. The variable of order was controlled.

An objective checklist containing 70 to 80 bits of organic and personal data per case and an interaction analysis (with an average of 285 interactions per interview) were utilized to measure the content material gathered and the approach used by the students. The data were analyzed using an analysis of variance (ANOVA) technique. All but 1 of the 55 null hypotheses were accepted, i.e., no significant differences were found.

The Use of Simulation for Teaching and Evaluating Interviewing Skills Provides a Valid Experience.
BENJAMIN FRANKLIN ON BREAST-FEEDING AND WHY WOMEN OF PARIS CANNOT NURSE THEIR BABIES
Authors: C. T. E.
Published: December 2021

Benjamin Franklin lived at a time when men of education and genius in varying paths of life did not consider it strange or unusual to write about medical matters.

Many of Franklin's letters dealt with medical matters. The letter below written to a nonmedical friend is a good example of Franklin's interest in infant feeding.

Passy, May 23, 1785

. . . I return your Note of Children receiv'd in the Foundling Hospital at Paris, from 1741 to 1755, inclusive; and I have added the years preceding as far back as 1710, together with the general Christnings of the City, and the Years succeeding down to 1770. Those since that Period I have not been able to obtain. I have noted in the Margin the gradual Increase, viz. from every tenth Child so thrown upon the Public, till it comes to every third! Fifteen Years have passed since the last Account, and probably it may now amount to one-half. Is it right to encourage this monstrous Deficiency of natural Affection? A Surgeon I met with here excused the Women of Paris, by saying, seriously, that they could not give suck; "Car", dit il, "elles n'ont point de tetons." He assurr'd me it was a Fact, and bade me look at them, and observe how flat they were on the Breast; " they have nothing more there," said he, " than I have upon the Back of my hand." I have since thought that there might be some Truth in his Observation, and that, possibly, Nature, finding they made no use of Bubbies, has left off giving them any.
Neonatal Bromide Intoxication : Prenatal Ingestion of a Large Quantity of Bromides With Transplacental Accumulation in the Fetus
Authors: Pleasure Jeanette R. , Blackburn Michael G.
Published: December 2021

A 27-year-old woman who was 34 weeks pregnant was admitted in a semicomatose state. Five days later she gave birth to an infant who demonstrated significant CNS depression. Elevated blood levels confirmed bromide intoxication in both the mother and infant secondary to chronic maternal bromide ingestion (Nervine). Simultaneous determinations revealed a higher intitial serum bromide level in the infant compared to that of the mother in spite of a subsequent more rapid rate of disappearance in the neonate. It is suggested that the drug history obtained from the pregnant woman include nonprescription medications containing bromides. This possibility should also be included in the differential diagnosis in infants exhibiting evidence of CNS depression, particularly those born to mothers classified led as neurotic or psychotic.
Hemophilus influenzae Meningitis at the Children's Hospital Medical Center in Boston, 1958 to 1973
Authors: Peter Georges , Smith David H.
Published: December 2021

Three hundred ninety-seven children were admitted to the Children's Hospital Medical Center, Boston between 1958 and 1973 with H. influenzae meningitis. The annual rate of admission and the percent of all cases of bacterial meningitis were not changed from that of the preceding decade. The age incidence was strikingly similar to that reported from this hospital for 1920 to 1932.
Hemophilus Meningitis: Comparison of H. influenzae and H. parainfluenzae
Authors: Bachman David S.
Published: December 2021

Eleven cases of Hemophilus meningitis seen in the last year are reported. Three were H. parainfluenzae and eight were H. influenzae. The number of patients is small but probably indicates that there is little difference in the clinical or laboratory data in meningitis caused by these two organisms.

The children with H. parainfluenzae tended to be less anemic and had more normal admission spinal fluid sugars and proteins, but this was probably because these patients were older and had shorter prodromes. As more cases of H. parainfluenzae meningitis are noted, it seems likely that there will not be any difference in the clinical or laboratory data. Two of the three cases of H. parainfluenzae meningitis had the complication of ataxia secondary to severe bilateral vestibular deficits.

Finally, it should be noted that these two organisms will not be distinguished by routine bacteriological studies, and that differentiation must be carried out by an experienced laboratory.
Participation in Sports by Girls
Authors: Thornton Melvin L. , Eng Gloria D. , Kennell John H. , McLeod Robert N. , Shaffer Thomas E.
Published: December 2021

Until recently, girls and women have been deprived of their rightful share in physical recreation ion and sports by traditional concepts about a socially acceptable feminine image, misconceptions about the extent to which females may safely participate in strenuous activity, and, in fact, society's whole previous notion about woman's role and her basic needs and her physical capabilities.

Customary safeguards for protection of health and safety of males in sports and competitive athletics should apply to girls and women. Thus, competent medical care before, during, and after participation, rigorous conditioning, suitable high-quality equipment, good playing facilities, competent coaching, and capable officiating are necessary for the safety of all who engage in sports and competitive athletics.

To assist physicians who may be involved in making decisions regarding participation in sports by girls and young women, the Committee offers the following guidelines:

(1) There is no reason to separate prepubescent children by sex in sports, physical education, and recreational activities.

(2) Girls can compete against girls in any sports activity if matched for size, weight, skill, and physical maturation as long as the safeguards mentioned above are followed.

(3) Girls can attain high levels of physical fitness through strenuous conditioning activities to improve their physical fitness, agility, strength, appearance, endurance, and sense of psychic well-being. These have no unfavorable influence on menstruation, future pregnancy, and childbirth.

(4) Postpubescent girls should not participate against boys in heavy collision sports because of the grave risk of serious injury due to their lesser muscle mass per unit of body weight.
Question Regarding Pooled Data
Authors: Hook Ernest B.
Published: December 2021

The article by Leonard et al.1 on the early development of children with abnormalities of the sex chromosomes pooled data in a way that makes it very difficult to compare their results on particular genotypes with those of studies in progress by others. Data on 3 XXX, 1 XO, 4 XXY, and 3 XYY individuals are lumped together, although these are obviously quite different entities. The authors state that the "number of study children was too small to make a valid comparison between the children who had different chromosome constitutions."
Is Transcutaneous Po2, Reliable for Arterial Oxygen Monitoring in Newborn Infants?
Authors: Duc Gabriel , Bucher Hans U. , Micheli Jean L. , Johanson B. A.
Published: December 2021

The necessity of frequent Po2 controls in newborns exposed to high oxygen concentrations entails the use of indwelling arterial catheters. Any method of bypassing the complications of arterial catheters would be a great advantage for the newborn. Recently, electrodes were engineered allowing transcutaneous Po2 (tc Po2) measurements. tested two of them, the oxygen monitor 5300 Roche and the oxygen electrode of Huch et al. Good correlation between tc Po2, and Po2, has been reported in both in the newborn.
Breast-Feeding and Fluoride
Authors: Libo Hersh W.
Published: December 2021

The value of fluoride treatment in dental caries prevention was again well emphasized by Ripa1 and the Leskes2 in the August issue of Pediatrics. One problem not discussed and of great practical importance to patient and physician is the child living in an area with a fluoridated public water supply who neither drinks water nor ingests it via tap water used for cooking, mixed frozen juices, etc.

In our area and among our private patients, most infants are on preprepared formulas or on breast milk and take little or no tap water.
The use of cromolyn sodium in the treatment of asthma in children
Authors: Bierman C. Warren , Soyka Lester F.
Published: December 2021

In July, 1973, cromolyn sodium was approved for use in the United States by the F.D.A. for treatment of patients with severe perennial asthma. The companies marketing the drug immediately mounted an intense campaign of physician education about the pharmacology of the drug, its indications and its unusual method of administration. Physician response varied from enthusiastic use to refusal to prescribe because of the intense commercial promotion. More importantly many physicians apparently did not read the educational material because they used it inappropriately and when it did not relieve acute asthma they stopped using it entirely.

Cromolyn has been a controversial drug in the United States both before and after its release measure.