bluuebunny/crossref_metadata_2025 huggingface dataset:
INTRODUCTION
Authors: SUCHYTA ROGER
Published: December 2021

Dear Colleague:

The American Academy of Pediatrics Department of Committees and Sections are pleased to present this supplement to PEDIATRICS. This is the fourth supplement devoted entirely to abstracts of presentations given at the Academy's Annual Meeting. It contains a vast array of subspecialty information in a structured abstract format, which will be indexed in the journal and be retrievable through all of the document delivery systems that feature PEDIATRICS. It will also be available on the yearly CD ROM update of PEDIATRICS. In addition this publication will serve as a guide and timetable for the Academy's Section programs which will be offered at the AAP 1999 Annual Meeting to be held October 9-13 in Washington, DC. Please remember to bring this, your complimentary copy, to the meeting! A limited number of additional copies for your personal use or distribution to colleagues will be available at the meeting.

Sections are arranged alphabetically. A Section's educational schedule appears first, followed by the complete text of the abstracts. Abstracts are identified by a number that appears in the left column of the schedule; this same number will identify the expanded text. Abstracts are numbered consecutively within each Section. Please note that the Section on Allergy has elected to print their schedule only.

A great deal of time and effort has been volunteered by the Academy Section members to develop these programs and to write and coordinate the abstracts for this special supplement.

In particular, we would like to acknowledge the contributions of of Kathleen Ozmeral (editor); Larry Mahoney, MD (Cardiology); Andrew Spooner, MD (Computers and Other Technologies); Niranjan Kissoon, MD (Critical Care); Daniel Isaacman, MD (Emergency Medicine), Flaura Winston, MD (Injury and Poison Prevention); Robert Cady, MD (Orthopaedics); Bruce Maddem, MD (Otolaryngology); William Engle, MD (Perinatal Pediatrics); Max Langham, MD (Surgery); Thomas Abramo, MD (Transport Medicine); and Craig Peters, MD (Urology).

I believe that we have planned a full schedule of informative and educational Section activities at the Annual Meeting and hope that this abstract compendium/program guide will be useful to all attendees. As always, Section programs are open to all registrants, and you should feel free to move from one section meeting to another as topics of interest to you are presented throughout each day.

Our sponsor for this project, Pasteur Merieux Connaught, concurs with the Academy that the continuing education of our members and allied health colleagues is of paramount importance. We appreciate the company's support in helping to bring this project to AAP members and PEDIATRICS subscribers. The abstracts will also be available on computer disk at the Annual Meeting at the Pasteur Merieux Connaught exhibit booth (Booth #809).

We look forward to seeing you in Washington DC.
Impact of an Encounter-Based Prompting System on Resident Vaccine Administration Performance and Immunization Knowledge
Authors: Shaw Judith S. , Samuels Ronald C. , Larusso Elizabeth M. , Bernstein Henry H.
Published: December 2021

Objectives.

To evaluate an encounter-based immunization prompting system on resident performance in administering vaccines and knowledge of immunization guidelines.

Design/Methods.

Prospective randomized, controlled trial. Subjects were first- and second-year pediatric residents in a hospital-based continuity clinic. The intervention group received manual prompts of immunizations due. Postclinic chart review compared immunizations due with those administered. Acceptable and unacceptable reasons for not administering vaccines were assigned. Resident knowledge was measured by a 70-item examination.

Results.

The intervention group had significantly less missed opportunities/vaccine administration errors (11.4% vs 21.6%). The most common reason for unacceptable errors in the intervention group: vaccine was given too early; in the control group: vaccine was postponed to next visit. Pre- and postintervention knowledge scores were similar: intervention group (75.5% vs 80.7%, control group; 76.5% vs 81.3%).

Conclusion.

An immunization prompting system in a hospital-based pediatric resident continuity clinic reduced missed opportunities/vaccine administration errors without significantly impacting resident knowledge of immunization guidelines.immunization schedule, vaccination, immunization, prompting systems, resident education.
GALACTOCELE IN A MALE INFANT
Authors: BESSMAN SAMUEL P. , LUCAS JOHN C.
Published: December 2021

A case of a galactocele in a 17 month old male is reported with identification of the sugar contained in it as lactose.

A hypothesis for the formation of the infantile form of galactocele is presented.
ALYMPHOCYTOSIS
Authors: DONOHUE W. L.
Published: December 2021

This study describes an unusual fatal disease in a child, which was characterized by fever, hepatomegaly, splenomegaly and a leucopenia in which the striking feature was a lymphocytopenia.

Postmortem examination revealed a widespread "idiopathic" atrophy and necrosis of the lymphoid tissue. An associated finding was an extensive monilia infection of the oesophagus.
THE PEDIATRICIAN AND THE PUBLIC
Authors: PETERSON OSLER L.
Published: December 2021

Dr. Osler Peterson, the author of this communication, is a native of Minnesota, who as a staff member of the Rockefeller Foundation has been their representative in Great Britain. After two years of observation he wrote A Study of the National Health Service of Great Britain to provide reading material for visitors who came to learn about the Service. This study was first produced in mimeographed form, but the demand was so great that it is now being issued as a book. The mimeographed edition received high praise in a Lancet editorial as an impartial, critical and fair review of the National Health Service; it is the best exposition of this subject which this editor has read.
SHOE-FITTING FLUOROSCOPES
Authors: WHEATLEY GEORGE M.
Published: December 2021

THE dangers of radiation have been recognized for many years. Even experienced physicians use x-ray equipment with extreme care and only when benefits from diagnosis and treatment can be expected to outweigh possible harm.

It is not surprising, therefore, that roentgenologists and public health departments have become increasingly disturbed over the use of x-ray shoe-fitting machines in retail shoe stores. The New York State Department of Health and the New York City Department of Health have recently altered the Sanitary Code in order to regulate the use of fluoroscopes in shoe stores.
THE PEDIATRICIAN AND THE SPECIES: SOME IMPLICATIONS OF OUR ACHIEVEMENTS
Authors: Zuelzer Wolf W.
Published: December 2021

I am deeply grateful to Dean Smart, Professor Court, Dr. Walker, and the other members of the Department of Child Health for the honor of this invitation,* but I cannot help wondering whether I would have had the courage to accept it if I had known beforehand what the Jacobson Lecture entails. It is one thing to address a gathering of professional colleagues on some innocuous subject of a strictly technical nature, but an altogether different thing to face members of every faculty of this University with a talk supposed to be of general interest. The physician is rarely called upon to leave the comfortable regions of shop talk for the wide open spaces of public debate, nor, broadly speaking, is he eager to venture into such dangerous territory where he might be blown about by the winds of controversy.

PROFESSIONAL INSULARITY

The reasons for this reticence are not hard to find. For one thing, we don't like being contradicted, least of all by laymen. Regrettably, the aura of mystery which from time immemorial has served us as a protective cloak has been dispelled by an enlightened public, and our social prestige has suffered somewhat from the levelling forces of the democratic age. Still, the doctor remains the arbiter of life and death and as such speaks with the voice of authority. His experience at the bedside and in his office conditions him to expect acquiescence, and he is prone to transfer this expectation from his patients to the public at large and to be surprised and hurt when it is disappointed.
PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM: REPORT OF 50 CASES
Authors: Shams Ali , Fowler R. S. , Trusler G. A. , Keith J. D. , Mustard W. T.
Published: December 2021

Fifty cases of pulmonary atresia with intact ventricular septum were reviewed. The patients were divided into two groups depending on the size of the right ventricle. Clinical, roentgenographic, and electrocardiographic findings in each group are discussed. The most reliable method for determining the size of the right ventricle is selective angiography with injection of dye into the right ventricle.

Up until 1967, with or without having surgery, patients of both groups died. Since then emergency cardiac catheterization and balloon septostomy followed by operative creation of a Potts' anastomosis and ligation of patent ductus arteriosus has improved results in patients with a small right ventricle.
DIETARY PAMPERING OF ENGLISH CHILDREN IN 1754 AND THE PHYSICIAN'S MALEVOLENT ROLE IN CHILD HEALTH, ACCORDING TO THE HONORABLE MRS. SEYMOUR
Authors: C. T. E.
Published: December 2021

Mothers in the past were no less interested in books about child care than are today's mothers. Any collector of books of this genre will soon find his bookshelves completely filled with eighteenth and nineteenth century items.

The most striking characteristic of these earlier predecessors of Doctors Spock and Gesell was their emphasis on the connection between daily tactics and moral strategy; practical advice was never given without constant doses of moral lessons as the excerpt below will prove:

In England there is one general Method of spoiling Children; it is by foolish Indulgencies. The Observation is a very common one; but those who make it do not know half its Force: It is not only that by these Indulgencies we make them peevish and tyranical (sic); though this were enough: we lay the Foundation of Ill Health, and bad Habits; and by that single Fault of pampering them in their Diet, we entail upon them Diseases, and we rob them of that Chearfulness (sic) of Disposition which is so amiable and so agreeable; for it depends, as already said, on Health.

If we look into the Generality of Families in which there are Children we shall find them eating ten Times a-day, and drinking all Day long. At their regular meals they eat what is improper. There are some few, who, to avoid this, run into the contrary Extreme, while the rest feed them immoderately, they starve them. One sees the first of these Faults universal; the other is met withal among some few Families of Quality.
Letterer-Siwe's Disease (Acute Disseminated Histiocytosis X): A Case Complicated by Disseminated Intravascular Coagulation and Responding to Heparin Therapy
Authors: Mauger David C.
Published: December 2021

Hemorrhagic skin lesions and thrombocytopenia are common manifestations of Letterer-Siwe disease.1-9 Both have been considered to be indicative of a grave prognosis.7,8

The case reported here satisfies the clinical criteria of Abt and Denenholz1 and the pathological criteria of Oberman.5 She presented with a hemorrhagic skin rash, thrombocytopenia, and a clotting profile indicative of intravascular coagulation. These abnormalities appeared to respond quickly to heparin and she is currently surviving some 8 months later, further improvement having been achieved by the administration of prednisone and cyclophosphamide.

Disseminated intravascular coagulation is now known to be a feature of many diseases, but it has not previously been described in this disorder and may well contribute to the poor prognosis which has been associated with the onset of hemorrhagic manifestations.
Psychosocial Problems in Treatment of Cystic Fibrosis
Authors: Cohen Philip A.
Published: December 2021

I read with interest the report of Shwachman, et al. (46:335) in the September issue of Pediatrics.

Today most of our institutions are teaching the concept of treating the entire patient– especially those who are suffering from chronic diseases such as cystic fibrosis. This is evidenced by the establishment of comprehensive care clinics into our teaching programs. To my dismay, nowhere in their article did I find reference to the myriad of psychosocial problems which the CF patients and families experience.
Stool Pattern of the Newborn— Effect of Bilirubin?
Authors: Lawson Wilbur C.
Published: December 2021

The traditional description of the stool pattern of the newborn during the first 2 weeks includes characteristics of looseness, frequency, and relation to feeding time. Some have termed this the period of transitional stools, and some have ascribed the condition to the bowel clearing of meconium and conditioning to the digestive process. This causation has always seemed of dubious nature to me.

Other elements of observation that enter into this bowel pattern might include: (1) A larger number of babies with physiological hyperbilirubinemia seem to be breast-fed babies.
ADRENAL GLAND STRUCTURE AND THE DEVELOPMENT OF HYALINE MEMBRANE DISEASE
Authors: Naeye Richard L. , Harcke Howard T. , Blanc William A.
Published: December 2021

Adrenal cortical function may influence the development of hyaline membrane disease. Corticosteroid administration to animal fetuses reportedly accelerates some parameters of lung maturation. Analysis of 387 consecutive autopsies on human neonates demonstrated that adrenal glands were 19% lighter in infants with hyaline membrane disease than in those without the disorder owing to a greater number of adrenal cortical cells in the latter infants. A positive correlation was found between the presence of infection arising before birth and the absence of hyaline membrane disease, the infected infants having larger adrenal glands.

It was found that anencephalic neonates who had little or no adrenal fetal cortical zone and half sized adult zones had 45% the mass of osmiophilic granules in pulmonary type II alveolar cells as did nonanencephalic control infants. The osmiophilic granules are reportedly the anatomic representation of surfactant.
CARBOXYHEMOGLOBIN LEVELS AS AN INDEX OF HEMOLYSIS
Authors: Engel Rolf R. , Rodkey F. Lee , Krill Carl E.
Published: December 2021

Carbon monoxide (CO) and bilirubin are formed in equimolar amounts during the catabolism of heme. In demonstrating increased endogenous CO formation from accelerated hemolysis it is important to separate out the effect of variable exogenous CO exposure. The carboxyhemoglobin level in 229 normal children ranged from 0.6 to 3.9% saturation, with a mean of 1.30% (S.D. = 0.47%). Forty children with hemolytic diseases had from 0.8 to 4.0% of their circulating hemoglobin saturated with CO with a mean of 1.95% (S.D. = 0.88%). The sixfold range observed in normal children is largely due to variable ambient CO exposure, since 574 comparisons between nonsmoking adults who were breathing the same gas mixture for over 18 hours, always gave carboxyhemoglobin values which differed by less than 0.35% saturation. By comparing the blood CO content of a suspect hemolytic patient with a normal sibling or another control individual who has been exposed to the same exogenous CO level for several hours, it is possible to obtain a qualitative index of increased endogenous CO formation. Thirty-seven children with known hemolytic disease always had carboxyhemoglobin levels which were higher than their matched environmental controls.
Wilson-Mikity Syndrome in a Full-Term Male Twin
Authors: Keidel Werner N. , Feingold Lawrence M.
Published: December 2021

In 1960 Wilson and Mikity1 reported a syndrome of chronic respiratory distress in premature infants. Signs of hyperpnea, intercostal retractions, and cyanosis develop insidiously during the first several weeks of life. Episodes of apnea and rales on auscultation can occur. Respiratory distress persists for the first month or two and slowly subsides in the infants who survive. The chest radiographs show progressive distinctive changes.2 During the acute phase, the radiographs show a diffuse streaky infiltrate, multiple small cyst-like foci, and often hyperaeration. The intermediate stage is characterized by coarse streaks radiating from the hilus, primarily to the upper lobes, with basilar clearing.
Progressive Increase in Cerebrospinal Fluid Measles Antibody Levels in Subacute Sclerosing Panencephalitis
Authors: Horta-Barbosa Luiz , Krebs Helen , Ley Anita , Chen Ta-Chuan , Gilkeson Mary R. , Sever John L.
Published: December 2021

The extraordinary elevation of serum and cerebrospinal fluid measles antibody titers in specimens from patients with subacute sclerosing panencephalitis (SSPE) has been reported by several investigators.1 However, in spite of these serological findings, very little data are available on serial antibody determinations throughout the progression of the illness. Legg,2 in 1967, conducted serological tests with serum samples of 22 patients and found no significant rise in antibody titers with development of the disease, but he reported a sharp decrease in titer for one patient showing spontaneous remission. One year later, Connolly and co-workers,3 in a 10-month follow-up of three patients, reported a sixteen-fold increase in measles antibody in one of the individuals.
BOOK OF ACCIDENTS
Authors: Cone Thomas E.
Published: December 2021

The modern urban child in this country rarely gets close enough to live horses to be kicked by them as was the little girl in this lesson. But times change; anyone who reads books about child rearing written in the last century will discover that the horse, not the automobile, caused many childhood accidents.1
Jingoism in Medicine: Education in Foreign Medical Schools
Authors: Schauf Virginia
Published: December 2021

As a pediatric resident in constant contact with many capable and dedicated foreign physicians, I was disturbed by the condescending tone of Dr. Wedgwood's article on "The Education of Foreign Medical School Graduates" (Pediatrics, 46:760).

Pediatrics is world-wide in distribution and read by many foreign house officers in the U.S.A. I think many fine physicians will be justly concerned at being labelled as "poorly trained physicians" who are "not desireable as house officers."

Foreign physicians provide essential medical care to the people of our country in their capacity as house officers, private practitioners, comprehensive clinic staff, and as teachers and researchers in medical schools.
Letters to the Editor
Authors: Wedgwood Ralph J.
Published: December 2021

Nothing devastates an author more than to find something he wrote–he hoped carefully–has been misunderstood, particularly when he has offended. I hope that you and several friends who have written, as well as other readers, will accept my apologies. I did not intend to defame or condescend. I wished to publicize my concern for the inappropriate conditions under which many foreign graduates find themselves in graduate medical education, in the hope that something might be done to change the system.
Letters to the Editor
Authors: Neumann H. H.
Published: December 2021

In cultural and anthropological matters, outsiders have some advantages; habits peculiar to one culture may appear as "just normal and natural" to one living close to it.

As an example, and without straying from the topic, the Otomi Indians in Mexico who have magnificent teeth, described their own diet as entirely soft. Yet observation showed that they chew toasted haba beans of a hardness that makes it almost impossible for others to chew them. They also crack open nuts-a staple-with their teeth.
RUNAWAY CHILDREN, OR DROMOMANIA—A 1913 VIEW
Authors: C. T. E.
Published: December 2021

Young People's problems are not too different from one generation to the next. We hear a great deal today about young people who run away from home. But even in 1913, Dr. Leonard Guthrie, of London's Paddington Green Children's Hospital, considered the issue of runaway children important enough to warrant publication of the following in one of the best pediatric textbooks ever published in English.

Dromomania may be a high-sounding name for playing "truant" but different causes of vagrancy should be recognized. Imaginative and romantic children will sometimes roam in search of adventure. Some, like St. Theresa, seek martyrdom; and some, like Maggie Tulliver, run away to be gypsyqueens because they do not reign at home. Some not only wander abroad at every opportunity, but account for doing so by inventing stories of ill usage and privation, in which they may appear to believe. Others seem to obey a nomadic instinct to stay out and sleep out whenever they get the chance. . . .

The ordinary truant is easily detected as a rule by his general demeanor, and by the manner in which he has occupied his time of unenforced leisure. A short and sharp shrift awaits him in accordance with his deserts. But truancy is not abnormal, whereas there is a distinctly morbid or neurotic element in all the other forms of vagrancy or dromomania. It is only the highly neurotic and sensitive schoolboy who runs away to escape punishment or persecution. A single escapade may result from mere thoughtlessness or from habits of morbid introspection and selfish disregard for the feelings of others.
Catheterization of the Pulmonary Artery in Transposition of the Great Arteries: A New Technique
Authors: Pickering Douglas , McDonald P. , Kidd B. S. L.
Published: December 2021

The publication of a paper describing a method for catheterisation of the pulmonary artery in transposition of the great arteries1 prompts the preliminary report of a technique which we have devised and used successfully in transposition of the great arteries with subpulmonic stenosis.

Following the study of the outflow tract of the left ventricle in transposition of the great arteries, a 0.045 I.D. Formocath B.D. catheter* was made out of Hanafee tubing with a curve as illustrated in Figure 1A. It is used as follows: a No. 6 Lehman catheter is passed to the left ventricle. A 220 cm guide wire is inserted through this with the nonflexible end foremost, into the apex of the left ventricle.
Hyperthyroidism in a 3-month-old Baby
Authors: Leszynsky Hannah E. , Gross-Kieselstein Eva , Abrahamov Abraham
Published: December 2021

A case of acute and severe thyrotoxicosis (without goiter and exophthalmos) in a 3-month-old male infant is reported. The case is unusual because of (1) the extreme rarity of the condition below the age of 6 months, and (2) the presence of features characteristic of the neonatal variety (gross cardiac insufficiency, hepatoslpenomegaly out of proportion to the heart.) LATS (long-acting thyroid stimulator) assay was positive in the patient and negative in his mother who was euthyroid. Prolonged antithyroid therapy was required to maintain the remission induced by iodine. It is postulated that in the present case an antecedent infection acting upon a (hereditarily transmitted?) liability of the thyroid cell toward disordered function, was the direct cause.
THE INTERRELATIONSHIP BETWEEN THE PATIENT, HIS FAMILY, THE REFERRING PHYSICIAN, AND THE PEDIATRIC ALLERGIST
Authors: Heimlich Ernest M. , Ellis Elliot F. , Frick Oscar , Ghory Joseph E. , Lecks Harold I. , Strem Edward L. , Halpern Salmon
Published: December 2021

The statement "The Interrelationship Between the Patient, His Family, the Referring Physician and the Pediatric Allergist," which appeared in the March issue of the Journal, was prepared by the Committee on Communications and approved by the Section Committee of the Section on Allergy of the American Academy of Pediatrics. The names of the members of the Committee on Communications of the Section Committee were inadvertently omitted from the statement: Salmon R. Halpern, M.D., Ph.D., Chairman Jerome Glaser, M.D. Victor C. Vaughan, III, M.D.
ADOLESCENT CYSTINOSIS: COMPARISONS WITH INFANTILE AND ADULT FORMS
Authors: Goldman H. , Scriver C. R. , Aaron K. , Delvin E. , Canlas Z.
Published: December 2021

Two adolescent siblings with a new form of cystinosis are distinctive because of their present age (15 and 14 years), their mild nephropathy, and the absence of retinopathy and pigmentary changes. The intracellular concentration of free cystine in their fibroblasts and leukocytes is 3 to 6 µmoles/gm protein, which is lower than in fatal infantile cystinosis and slightly higher than in the benign adult trait. The cystine is localized predominantly in the "granular" fraction. Both parents of the adolescent cystinotic siblings have excessive cystine retention in fibroblasts and leukocytes in the range which is typical of infantile cystinotic heterozygotes but cystine storage is not directly proportional to gene dosage. Dithiothreitol reduces the cystine content of "adolescent" fibroblasts, as it does in "infantile" cells. The three cystinotic traits indicate that several mutant alleles, at one or more gene loci, affect one or more gene products which control the steady-state of cystine metabolism in the cell. Clinical prognosis is apparently influenced to some extent by the severity of cystine retention.
Report of a Case of Annular Pancreas of the Newborn in Two Consecutive Siblings
Authors: Montgomery R. C. , Poindexter M. H. , Hall G. H. , Leigh John E.
Published: December 2021

Annular pancreas presenting as high intestinal obstruction in the newborn has been reported on numerous occasions.14 The purpose of this paper is to report the occurrence of annular pancreas causing duodenal obstruction in the newborn in two consecutive siblings.

Case Reports

Case 1, D.B., a male, was born August 31, 1966. The mother was gravida III, para II. Her expected date of confinement was September 12, 1966. The pregnancy had been uneventful except that she had minimal polyhydramnios. The mother had been on no medications during her pregnancy except a prenatal vitamin and iron. On August 31, 1966 the mother underwent an elective cesarean section because of previous cesarean sections which were performed for cephalo-pelvic disproportion.
Intra-uterine Diagnosis of Fetal Sex
Authors: Greensher A. , Gersh R. , Peakman D. , Robinson A.
Published: December 2021

The ability to examine amniotic fluid obtained by amniocentesis during the second trimester of pregnancy is a significant new advance in the practice of clinical genetics.1 We here report a rapid and accurate method for determining fetal sex, which should be useful when the pregnant woman is a carrier of a serious sex-linked disease such as muscular dystrophy or hemophilia. The method makes use of the selective concentration of fluorescent stains by the Y chromosome in interphase cells.2,3 Recently two observers have reported their preliminary observations on amniotic fluid cells using fluorescent techniques.4,5
Wanted: Reports of Lithium Babies
Authors: Weinstein Morton R. , Goldfield Michael D. , Woody James N.
Published: December 2021

Woody, London, and Wilbanks recently described an instance of lithium toxicity in a newborn.1 This infant had been the subject of an earlier article by Wilbanks, et al.2 While we strongly endorse the cautions both articles recommend in giving lithium to pregnant women,3 we believe that some of the conclusions the reader might draw from these reports could be misleading, and that certain additional facts should be called to the attention of your readers without delay.
STUDIES OF THE SUDDEN INFANT DEATH SYNDROME IN KING COUNTY, WASHINGTON
Authors: Ray C. George , Hebestreit Nancy M.
Published: December 2021

A group of 119 unselected cases of the sudden infant death syndrome (SIDS) were studied for evidence of viremia. None of 20 cases studied by standard culture methods yielded virus in the blood, and only 4 of 119 had detectable levels of serum interferon.

Coupled with previous studies, the data further suggest that viral infection, if it participates in the ultimate mechanism in SIDS, does not act by means of overwhelming viremia but rather may act locally, possibly in the respiratory tract.
NOAH WEBSTER INFORMS SCHOOL CHILDREN ABOUT THE ACUTE AND CHRONIC DISEASES OF THE UNITED STATES
Authors: C. T. E.
Published: December 2021

Noah Webster's (1758-1843) talents were eclectic. Not only was he a superb lexicographer, a prolific writer of schoolbooks, but also a surprisingly keen epidemiologist.

School children of the 1830's who read his History of the United States learned the following about acute and chronic diseases:

Diseases of the United States. The ordinary diseases of the United States are the same as those which invade mankind in all similar climates. The usual epidemics are hooping cough (sic), measles, influenza, scarlet fever, with some milder eruptive diseases. These diseases are periodical, though the periods are not exactly uniform. The autumnal diseases are chiefly dysentery and bilious fevers of all grades, from slight intermittents to the malignant fever, which is denominated pestilence. The dysentery appears, in scattered cases every year; but in some autumns becomes epidemic with great mortality. It however never invades large cities with such general mortality, as it does particular parts of the country. The malignant bilious fever occurs occasionally, but chiefly in large towns on the sea coast, or on rivers, or near lakes and stagnant water.

Chronic Diseases. In the northern region of the United States, and especially on the sea shore, the consumption is the most general and fatal chronic complaint; carrying off in some places, a fifth of the inhabitants. In the middle region it is prevalent, but in a less degree; and in the southern, is still less destructive. Rheumatic complaints, gout, and hypochondriac affections are common. In the country west of the mountains, between the Ohio and the lakes, the goiter, or swelling upon the throat, is very prevalent among the whites, but not among the natives.1
INCREASED LEAD ABSORPTION: TOXICOLOGICAL CONSIDERATIONS
Authors: Chisolm J. Julian
Published: December 2021

If physicians are to deal effectively with the biologic effects of ubiquitous chemical agents such as lead, a working knowledge of the pertinent time-dose-response relationships is essential. Lead is currently considered a nonessential trace element and is detectable in minute amounts in food and water and in the blood, tissues, and excreta of virtually all healthy persons. Apparently, the biologic effects of the usual daily intake from uncontaminated food and water (approximately 0.2 to 0.3 mg lead/day in adults) is negligible, so that this small "dose" of lead has no known adverse effect on the health of people, but as the chronic "dose" of lead increases, adverse responses of increasing severity become evident.
THE CRITICALLY ILL CHILD: DIAGNOSIS AND MANAGEMENT OF HEAD INJURY
Authors: DeVivo Darryl C. , Dodge Philip R.
Published: December 2021

In the article, "The Critically Ill Child: Diagnosis and Management of Head Injury," by D. C. DeVivo and P. R. Dodge (Pediatrics, 48: 129, 1971), the word evaluation (pp. 135, left column, line 22) should be changed to elevation.
AN EXPLANATION FOR THE VIVACITY AND TALENT OF IRISH YOUTH, ACCORDING TO SIR JOHN SINCLAIR
Authors: C. T. E.
Published: December 2021

Scotsmen, such as the scholarly Sir John Sinclair (1754-1835), have long sought an explanation for the vivacity and talent of Irish youth. As Sinclair mentions below, Irish peasant youths "displayed a degree of shrewdness exceeding what is generally met with from youth of a more exalted walk of life in England."

Sinclair, a barrister (Lincoln's Inn), President of the Board of Agriculture of Scotland, and an avid observer of children's growth and development, thought that the vegetable diet of the poor children in Ireland played an important part in making Irish youth (and adults, too) so lively and intelligent. He wrote:

There cannot be a doubt that the diet of the Irish is highly favorable to vivacity and talent. It is stated in the Code of Health that vegetable food has a happy influence on the mind, and tends to preserve a delicacy of feeling, a liveliness of imagination, and an acuteness of judgment, seldom enjoyed by those who live principally upon animal food. The latter is better calculated for those who labor with the body; but the celebrated Franklin ascertained that a vegetable diet promoted clearness of ideas and quickness of thought, and that a transition from vegetable to animal food produces injurious effects. A friend states that he has more than once selected from his tenant's children a boy remarkable for that smartness of intelligence so common in the Irish youth, while in the capacity of errand boys on the farm, or helpers in the stables, and before they became pampered with better food than their parent's cabin afforded. The lads were at first lively and intelligent, and displayed a degree of shrewdness exceeding what is generally met with from youth of a more exalted walk of life in England. But he invariably found that in proportion as these boys were better fed, they relaxed in activity, became dull and stupid; and he is confident that the change in disposition sprang from the effect of change in diet, and was not owing to corruption of mind from their intercourse with the other servants. In fact they lose all that vivacity of manner so inherent in the Irish boys, whether born in the vast bog of Allan, or in the dry and rocky counties of Mayo and Galway. He is therefore inclined to think that the character of the people does not depend so much upon climate or soil, as upon food, for no part of the globe can differ more than these parts of that kingdom.1
A Case of Thoracic Outlet Syndrome Occurring in Infancy
Authors: Workum P. , Purvis R. J. , Thomas G. W.
Published: December 2021

A case of the thoracic outlet syndrome occurring in a female infant is described in order to draw attention to its possible occurrence. Relief of symptoms was obtained after excision of a cervical rib.
Corticosteroids in Croup: Is There a Reply from the Ivory Tower?
Authors: Coffin Lewis A.
Published: December 2021

In reply to the letter1 concerning the use of corticosteroids in croup, I would like to state unequivocably that I am strongly in favor of their use and feel certain that they contribute a great deal to the reduction of morbidity and the necessity for tracheostomy or endotracheal intubation in laryngo-tracheal bronchitis.

I have been using corticosteroids in this problem for the past 10 years. I practiced for almost 6 years with two other pediatricians who use corticosteroids with croup.
The Taking of Temperatures (Continued)
Authors: Coffin Lewis A.
Published: December 2021

Joining the controversy which is currently "raging" in your publication,1 I agree with Dr. Sarshik when he states that most pediatricians do not take temperatures on a nonsick child routinely in the office and that it is better not done. Any pediatrician who has gone to an emergency room where this is done compulsively and repeatedly learns to discourage the nurse from poking the old thermometer in the obvious spot because he ends up with a child who is screaming and difficult to handle and has rapidly learned nothing that he could not have found out with his hands.
Autism: Symptomatic and Idiopathic—and Mental Retardation
Authors: Valente Mario
Published: December 2021

Ever since Leo Kanner first described autism some 30 years ago, psychiatrists and psychologists, as well as pediatricians, have been fascinated and, at times, obsessed with this concept. They have expended reams of paper in a futile attempt at explaining it. Even now, some psychiatrists still subscribe to the "refrigerated parent" theory, long since abandoned by Leo Kanner himself. The great majority, however, have either begun to realize that this is an organic process, or like Dr. Easson, have adopted a middle-of-the-road approach.
Physiology of the Perinatal Period: Functional and Biochemical Development in Mammals, edited by Uwe Stave. New York: Appleton-Century-Crofts, 1970, 1088 pp., 2 Volumes, $59.50 per set
Authors: Smith Clement A.
Published: December 2021

When William Windle published his Physiology of the Fetus, in 1940, he referred to Preyer's Specielle Physiologie des Embryo, published 65 years before that, as "long the only source of summarized knowledge concerning the activities of embryos and fetuses of many species." Dr. Windle then noted how "within the last decade of two" or some 40 years after Preyer, "interest has revived and a new school of developmental physiology has come into being . . . (though) . . . few biologists are aware of all that has been accomplished."
PHENOBARBITONE ENHANCEMENT OF BROMSULPHALEIN CLEARANCE IN NEONATAL HYPERBILIRUBINEMIA
Authors: Yeung C. Y. , Yu Victor Y. H.
Published: December 2021

Forty jaundiced Chinese newborn infants were randomly assigned to treatment and control groups. Twenty infants in the former group were given phenobarbitone 5 mg 8-hourly; those in the control group received no drug. BSP tests were performed in all infants on admission and repeated 24 hours afterwards. The percentage disappearance of the dye at designated intervals up to 135 minutes of each test before and after drug therapy was compared with that of the controls. Rate constants for the hepatic uptake phase (K1) and the biliary excretory phase (K2) in BSP removal were calculated from the plasma dye disappearance graph.

Following phenobarbitone therapy, a significant increase in BSP clearance was observed, with increases in K1 and K2 values, suggesting the corresponding enhanced hepatic uptake and excretion of the dye.

These results are consistent with the hypothesis that several mechanisms together are responsible for the phenobarbitone effect on the impaired liver function of newborn infants. It is suggested that the observed reduction of serum bilirubin levels with phenobarbitone therapy results both from enhanced uptake and from increased excretion of bilirubin by the liver.
WHAT PARENTS IN 1857 READ ABOUT CHILDREN'S SLEEP
Authors: C. T. E.
Published: December 2021

"To sleep like a child" implies that tranquil unbroken sleep which parents almost always expect from their children. But sleep disorders are so common in children that almost everyone who has written about their health from Hippocrates to Spock has included a discussion of sleep in their writings.

Attitudes toward sleep, like everything else, change with time. Perhaps no period was more dogmatic about a child's sleep than the mid 1850's in this country. The article below is a good example of what parents of that period read in a popular health journal:

Many a bright and beautiful child is destroyed or made idiotic for life by their nurses, in one of two ways.

By the administration of laudanum, paregoric, opium, or other form of anodyne.

By teaching self-abuse, in order that the exhaustion it produces should promote sleep.

Medical books abound in cases of this lamentable character. How to guard against them with most efficacy, is worthy of inquiry.

All children, under five years of age, will be made the better, healthier, happier, and more good natured, by an undisturbed sleep on one or two hours in the forenoon.

Children, under eighteen months, may require two day naps in summer time.

If a child is regularly put to sleep at the same time, for only three or four days in succession, the habit will so rapidly grow upon it, that with the aid of quiet, and a little darkening of the room, it will, if well, fall to sleep within a few minutes of the time, for weeks and months in succession–such is Nature's love for system and regularity.
Ampicillinuria and Ampicillin Crystalluria
Authors: Potter Joseph L. , Weinberg Arthur G. , West Raymond
Published: December 2021

Four patients with ampicillinuria and ampicillin crystalluria have been reported. The presence of ampicillin leads to false positive spots for leucine/isoleucine, phenylalanine, and β-amino isobutyric acid in paper chromatograms of the urinary amino acids, and to a false-positive spot for phenylalanine in paper electrophoretograms. Crystalluria, due to ampicillin, is also described. Its significance remains to be determined.
Is England Always Behind the USA?
Authors: MacKeith Ronald
Published: December 2021

I would answer Dr. Cone's note (Pediatrics, 47:769, 1971) by telling him that at least one English reader thinks the National Health Service (1948) brought medical care to all children, with every part of the country having specialist pediatricians available for seeing children referred by their general practitioners and a universal preventive service for infants, preschool, and school children, without division into indigent and nonindigent, and that England is not now always behind the U.S.A. in all aspects of child care.
Violence Against Children: Physical Child Abuse in the United States, by David G. Gil. Cambridge, Massachusetts: Harvard University Press, 1970, 204 pp., $6.50
Authors: Newberger Eli H.
Published: December 2021

In this monograph, a professor of social policy at Brandeis University tries to develop a macroscopic view of child abuse. He offers the results of two investigations, the poll of attitudes and opinions about child abuse which the National Opinion Research Center performed in 1965, and a compendium of data from the reported cases of 1967 and 1968. There are also a critical review of the literature on the subject and some recommendations for its control.
CYSTIC FIBROSIS—A PROBLEM OF PERMEABILITY?
Authors: Goldbloom Richard G.
Published: December 2021

The elaboration of a new concept of the pathogenesis of a familiar but idiopathic disease is always exciting, one way or another. Sometimes, as in the penicillin story, the scientific brotherhood marvels at how the obvious could have escaped it so long. Alternatively, if the new concept is not instantly palatable to all interested parties, the community may be split into adherents and doubters, with strong views on either side. The heat generated by such fission can be an important catalyst of scientific progress: the doubters are upset sufficiently to inspire them to try to disprove the validity of the proposal, while the believers hasten to prove and extend the new concept. This dual process invariably generates new knowledge.
MEASUREMENT OF BLOOD PRESSURE IN INFANTS AND CHILDREN BY THE DOPPLER ULTRASONIC TECHNIQUE
Authors: Hernandez Antonio , Goldring David , Hartmann Alexis F. , Crawford Charles , Reed Gerald N.
Published: December 2021

Simultaneous determination of arterial pressures by the Doppler ultrasonic technique and intra-arterial measurements were done on 13 children during cardiac catheterization at the St. Louis Children's Hospital. Their ages ranged from 4 weeks to 14 years. Sixty-nine paired determinations were obtained. There was good correlation between the two methods for systolic pressures ranging from 70 to 150 mm Hg (correlation coefficient 0.945) as well as for the diastolic pressures which ranged from 36 to 73 mm Hg (correlation coefficient 0.754).

The instrumentation is not elaborate; the method is simple and can be used by a physician, nurse, or nurse's aide for routine blood pressure determination in infants and children.
DID HENOCH DESCRIBE KOPLIK'S SPOTS BEFORE KOPLIK?
Authors: C. T. E.
Published: December 2021

Koplik (1858-1927) is usually given credit for being the first (1896) to note and report the labial and buccal mucosal spots which are an important early sign of measles.1

But Henoch (1820-1910), a pioneer in German pediatrics, and for many years the Director of the Department of Children's Diseases in the Royal Charité Hospital, Berlin, also described the clinical findings in the mouth during the prodromal stage of measles as follows:

In most cases, after the second day, you observe a rash on the hard and soft palate, especially in children who are strong and plethoric. The rash is either diffuse, with dark spots over it; or less commonly, the mucous membrane as a whole is still pale and presents more or less punctiform and stellate red patches. The former of these almost always precedes the eruption of measles.2

I found this observation in the fourth edition of Henoch's splendid textbook, published in 1889; quite likely the same description would also be found in the first edition, published in 1881.

Koplik's description of: "Small irregular spots of bright red color, in the center of each red spot is seen a minute bluish-white speck . . . on the buccal and labial mucous membrane . . ." is more vivid than Henoch's.

But didn't Henoch describe the prodromal enanthem of measles before Koplik?
MRS. SARAH GAMP ON MATERNAL IMPRESSIONS AND BIRTHMARKS
Authors: C. T. E.
Published: December 2021

Even today one still meets women who believe that congellital malformations, moles, and skin blemishes can be caused by maternal over- excitement or frights during pregnancy. That Charles Dickens was aware of this absurd belief is evident from the comments below of Sarah Gamp, the untidy and disruptable old nurse in his novel Martin Chuzzlewit, published in 1843-1844.

"I knows a lady, which her name, I'll not deceive you, Mrs. Chuzzlewit is ‘arris, her husband's brother bein’ six foot three, and marked with a mad bull in Wellington boots upon his left arm, on account of his precious mother havin' been worrited by one into a shoemaker's shop, when in a situation which blessed is the man as has his quiver full of sech...."1
MORE COMMON RADIONUCLIDE EXAMINATIONS IN CHILDREN: INDICATIONS FOR USE WITH A DISCUSSION OF RADIATION DOSE RECEIVED
Authors: Tefft Melvin
Published: December 2021

In summary, we have reviewed briefly the pediatric uses of the more common radionuclide examination, and have noted the dose absorbed as related to both the age of the patient in µCi on mCi administered. In general the relatively low doses involved and the ease of the examination makes the radionuclide scan useful as a general survey examination in many conditions. In other circumstances, when justified by the clinical situation, it may prove of great benefit in differential diagnosis or in planning therapy and evaluating its results. To some degree, we have attempted to indicate to the clinician, in certain specific instances, when these examinations are most useful.
"Acne Vaccinatum"—A Complication of Smallpox Vaccination
Authors: Schmitt Barton S. , Marks Melvin I.
Published: December 2021

Although most textbook and committee recommendations on immunizations mention eczema and other more acute dermatitides as contra-indications to vaccination, no specific reference could be found regarding the significance of acne vulgaris.1,2 We have recently observed a serious complication of primary smallpox vaccination in a patient with acne vulgaris.

Case Report

Ten days after receiving a primary smallpox vaccination, a 16-year-old male was seen for a 2 x 2 x 2 cm tender node in his left axilla. He was afebrile and had a primary pustular vaccination reaction of the skin over the left deltoid muscle as well as left axillary lymphadenopathy.
Cardiac Tamponade Resulting from a Swallowed Safety Pin
Authors: Norman M. G. , Cass Elie
Published: December 2021

Cardiac tamponade occurring after swallowing a safety pin is a rare complication of foreign body in the esophagus. This case is reported to warn pediatricians of this danger.

A 1-year-old child was found apparently lifeless in her crib at home. She was rushed to hospital where she was pronounced dead on arrival in the Emergency Department. The coroner ordered an autopsy.

Significant findings were confined to the esophagus, heart, and pericardium. A 1'' long safety pin was found 2 cm proximal to the esophageo-gastric junction. The pin was open, with the sharp point and keeper pointing cephalad. The point had punctured the esophagus and adjacent pericardium.