bluuebunny/crossref_metadata_2025 huggingface dataset:
PERSPECTIVES IN PEDIATRIC PATHOLOGY. Edited by H. S. Rosenberg, M.D., and R. P. Bolande, M.D. Chicago, Year Book Medical Publishers; vol. I: 1973, $27.50, 406 pp; vol. II: 1975, $27.50, 318 pp
Authors: Ruckman Roger N.
Published: December 2021

Perspectives in Pediatric Pathology is a new periodical designed to fill the void "between individual studies published in a monthly journal and the necessarily concise and frequently dated material in the texts." Its content, edited by a distinguished board of pediatric pathologists, is aimed at a broad audience of pediatricians, pediatric surgeons, radiologists, obstetricians, perinatologists, and pathologists. Each volume consists of nine or ten chapters, written by authorities in the field. Each review serves to synthesize and clarify the pathogenesis of recognized pediatric diseases and, in addition, helps define evolving knowledge. Volume I offers reviews in the areas of immunology and infectious disease (the phagocytic system, postsplenectomy sepsis, and intrauterine rubella), nephrology (hereditary disorders of the kidney, childhood nephritis), developmental defects (tracheobronchial anomalies, coarctation of the aorta), oncology (mesoblastic nephroma), and laboratory methods (electron microscopy). There is also a thorough review of the histiocytosis syndromes. The second volume includes material from the areas of perinatology (hyaline membrane disease, placental pathology), neurology (leukodystrophy), oncology (peripheral neuroectodermal tumors), immunology and infectious disease (DiGeorge's syndrome), and developmental defects (Hirschsprung's disease). In addition, the unique problems of sudden infant death syndrome and cystic fibrosis are discussed.

Each of the chapters provides helpful photographs of gross and microscopic material. Clinicopathologic correlations are made effectively and major points are summarized at the end of most of the articles. The reviews and their excellent bibliographies provide a balanced emphasis on laboratory investigation and clinical studies. Where applicable, the importance of tissue sampling to patient management is also discussed.
Infantile Lobar Hyperinflation: Expectant Treatment
Authors: Shannon Daniel C. , Todres I. David , Moylan Fergus M. B.
Published: December 2021

Arterial blood gases and regional lung function, measured with a 133xenon technique, were used to evaluate the physiological defects and follow the natural history of 16 infants with lobar hyperinflation ("emphysema"). Hypoxemia was due to V/Q inequality at rest. Worsening of hypoxemia (mean PaO2 Δ -26 mm Hg) with crying was due to shunting as a consequence of cessation of ventilation in the involved lobe. Surgery was necessary in three patients. Two deaths were caused by bronchopulmonary dysplasia after respiratory distress syndrome (RDS). In 12 of 14 infants, lung function was normal between the ages of 5 days and 1 year.
CHANGING
Authors: Milio N.
Published: December 2021

It is a paradox that health professionals, in their efforts to improve people's health-related practices, seem to expect more of the ordinary consumer than they do of themselves. Almost all patient and consumer health education assumes, explicitly, that if people know what is most healthful, they will do it.

Perhaps the most obvious test of this assumption is to look at health professionals themselves. If knowing what is health-generating were directly related to doing, then surely we in the health field would be among the most robust in the nation, slim, agile, nonsmoking, temperate eaters of complementary protein, low fat and cholesterol, low-sucrose, and nonrefined carbohydrate foods, avoiders of drugging levels of alcohol and other artificial moodchangers, evenly paced in our daily patterns. This picture is obviously nonexistent. Nor do we expect it to exist. Most will recognize that it is not much more likely for a physician earning $85,000 a year to change his life pattern than for a $6,000-a-year hospital aide to do so. However, the potential for lifestyle change, the array of options available to these two individuals, may differ considerably.
Vertigo in Children: Differential Diagnosis and Treatment
Authors: Eviatar Lydia , Eviatar Abraham
Published: December 2021

A study of vertigo in 50 children showed that a careful neurological examination should be performed for all patients. A detailed family and personal history to find possible episodes of loss of consciousness or seizures should be obtained; 13 children with vertiginous seizures had a positive family history for seizures and 5 had febrile seizures in infancy. Electroencephalograms should be obtained in all instances of vertigo occurrence.
Physician uncertainty, specialty ideology, and a second opinion prior to tonsillectomy
Authors: Wennberg John E.
Published: December 2021

For half a century, the tonsil has been the target of a large-scale, uncontrolled surgical experiment-tonsillectomy. In the fourth and fifth decades of this century, well over 50% of children appear to have undergone the procedure; since World War II, opinion has swung away from mass use and by 1973 about 25% of children appear to have been affected.

Pediatricians have been the weathermen in the change of clinical climate, pressing for reduction in use of tonsillectomy in their journal articles. Among a sample of California physicians, the offspring of pediatricians underwent fewer tonsillectomies than the children of other types of physicians.
Varicella Vendetta: Plotkin's Plug
Authors: Plotkin Stanley A.
Published: December 2021

In the January 1977 issue there were two articles by Asano et al. concerning a Japanese live vaccine against varicella. Preceding the articles was a commentary by Philip Brunell denouncing the studies described. Although my friend Dr. Brunell and I have already presented opposing views on this subject in a previous issue of Pediatrics, I think fairness requires that your readers hear the other side once again.

Somewhere Montaigne wrote that the three stages of scientists' reactions to a new fact are first that it's not true, second that it's true but not important, and third that it's important but obvious.
Lack of Effect of TRH in Minimal Brain Dysfunction
Authors: O'Tuama L. A. , Swisher C. N. , Reichler R. J. , Routh D. K.
Published: December 2021

Tiwary et al. (56:119, July 1975) have observed a beneficial effect of thyrotropin-releasing hormone (TRH) on the behavior of two children with hyperkinetic impulse disorder. Unfortunately, we have failed to observe such benefit in a study of comparable design and involving a much larger number of patients. We likewise performed a double-blind crossover study with a placebo (intravenous [IV] TRH, 7 µg/kg, versus IV isotonic saline; both injections were given in a volume of approximately 2 ml).
Rights of Children in Pediatric Settings: A Survey of Attitudes
Authors: Suran Bernard G. , Lavigne John V.
Published: December 2021

This study compares the attitudes of parents and health care professionals toward the bill of rights for children in pediatric settings of the National Association of Children's Hospitals and Related Institutions (NACHRI) and a locally developed ombudsman committee bill of rights. Parents (N = 64), attending physicians (N = 33), resident physicians (N = 17), nurses (N = 27), nonmedical professionals (N = 35), administrators (N = 18), and clerical workers (N = 17) were surveyed. Each person rated statements derived from the bills from "strongly agree" to "strongly disagree." Analyses of variance indicated a high level of agreement overall for both bills by all groups; however, the local bill was significantly preferred. There were significant differences in agreement between the groups for the local bill and the two bills combined (an overall measure of attitudes about children's rights in pediatric settings). Attending physicians tended to agree significantly less than other groups. On the 32 individual items, attending or resident physicians were significantly lower in agreement than most other groups on 11 items, and nurses were lowest on one other. Disagreement was strongest on items concerning abortion or contraception, the child's right to privacy, the right to consent to care, and the right to have an immediate response from the physician in understandable language.
Cost-effective clinical decision making
Authors: Neuhauser Duncan
Published: December 2021

Are pediatric preoperative chest x-ray examinations worth doing? Sane et al. (p. 669) conclude that they are "medically and economically justified and essential." To answer this question requires at least the following information. What is the cost of the examination (dollars, radiation exposure, cost of further testing and perhaps inappropriate therapy resulting therefrom, and possible prolongation of hospital stay)? What is the benefit? What percent of patients have unsuspected findings; of these, the percent with modified treatment; and of these, what percent benefited therefrom? What was the cost per unit of benefit received? Is there some other use of these scarce resources that would have yielded greater benefits?
Suggests a Better Name
Authors: Bloch Harry
Published: December 2021

In the history of medicine, symptom-based disease-naming led, frequently, to diversion, delay, and confusion in the understanding, prophylaxis, and treatment of an affliction. This has been evident in the so-called child abuse syndrome, the etiology of which lies in psychosocioeconomic stress suffered by parents, factors almost totally suppressed and obliterated by the use of a symptom diagnosis. Child beating is but one of its manifestations, and, perhaps, least important in the larger picture of health and related problems of infants, children, and adolescents reared under such parental stress situations.
Dr. Arnaud Replies
Authors: Arnaud Sara B.
Published: December 2021

Drs. Giangiacomo and Gleason are quite correct in their criticism that the number of patients with vitamin D deficiency rickets is too small for statistical comparison of the concentration of serum 25-hydroxyvitamin D (25-OH-D) in mild, moderate, and severe rickets. For this reason, we did not attempt this type of statistical comparison (Student's t test). The statistical analysis which supports our conclusion is the calculation of the regression between senim 25-OH-D, ng/ml and the stage of the disease, designated by arbitrary numbers 1, 2, and 3 for mild, moderate, and severe.
Growth Is Only Part of It
Authors: Korczyn Amos D. , Laor Nathanel , Nemet Pinchas
Published: December 2021

We thank Dr. Romano for his remarks. Our conclusion that the ocular postganglionic sympathetic nerve releases less norepinephrine in infants (not newborns) was based on analysis of the pharmacologic responses to drugs. Although the growth of the anterior segment may partially account for the increase in pupillary diameter at rest in infancy, we could find no published work in which the size of the iris was compared in various ages. Thus, the relative contributions of the physical growth and of autonomic maturation remain to be established.
The Committee Replies
Authors: Miller Robert W.
Published: December 2021

Dr. Yerushalmy, a colorful and combative man, was so widely known and respected by American pediatricians (for his statistical contributions concerning prenatal influences on child health) that they elected him to membership in the American Pediatric Society, a rare honor for a scientist who was not a physician. Dr. Burch's clarifying quotation from a letter to a Senator from Kentucky sets the record straight regarding Dr. Yerushalmy's interpretation of his and other data on the relation between low birth weight and smoking during pregnancy.
Deception in Research
Authors: Solnit Albert J.
Published: December 2021

In regard to the article by Drabman and Thomas, "Does Watching Violence on Television Cause Apathy?" (Pediatrics 57:329, March 1976), there are serious ethical and scientific questions to be confronted by such studies. Notwithstanding Feinbloom's excellent commentary (Pediatrics 57:301, March 1976) and his rationalization for the ethically doubtful aspects of the research, I wonder how the editors guide themselves in making decisions about such research. The researchers utilized deception of the children as part of their method.
What About Movie Violence?
Authors: Schmitt Barton D.
Published: December 2021

Dr. Feinbloom (Pediatrics 57:301, March 1976) reminded us of the correlation between television violence and some children's selection of aggressive behavior or others' apathy to such behavior. His concerns are well documented. When compared to movie violence, however, television violence is a welterweight. For the last ten years movie violence has quickly gone to the outer limits in portraying any act of violence ever described. In any community at any time, one can easily find movies that cover dismemberment, maiming, torture, brutal murder, rape, sadism, profound terror, and the slaughtering of masses.
Letter to the Editor
Authors: H. R. J.
Published: December 2021

Both reviewers of the original manuscript and I were equally concerned with the deception used in the study referred to by Dr. Solnit, and I communicated this concern to the authors. In a revised manuscript they pointed out the safeguards taken, including informed consent of the parents, approval of the University Ethics Committee, the reassurances given to the children at the end of the experiment, and their observations that the children responded to the reassurances very promptly.
The Costs of a Blood Culture
Authors: Feinberg Arthur N.
Published: December 2021

As a pediatric practitioner, I approach every article on bacteremia in the outpatient setting with high hopes that this presentation will solve all my problems in this area.

In the welter of data presented by McCarthy et al. (Pediatrics 57:861, June 1976), I was most dismayed by the cost of proper identification of organisms. The figure of $6.40 per blood culture presumably refers to the cost to the hospital for bottles bought in large volume.
Questions About Hyperkinesis Study
Authors: Axelrod Penny , Haller Jerome S.
Published: December 2021

We are concerned with the findings and implications of the article by Huessy and Cohen (Pediatrics 57:4, January 1976).

The authors designated students in their study as "hyperkinetic" based on a questionnaire completed by teachers. It assessed the "social maturity, neuromuscular development, academic performance, and general attitude and behavior." They validate their use of this questionnaire by citing its high correlation (.77) with a research instrument used by Conners.1 Conners finds, however, that his rating instrument measures primarily aggressive, disturbing behavior and is only "somewhat correlated with another factor which measures hyperactivity."
Cigarette Smoking and the Fetus and Child
Authors: Dunn Henry G. , McBurney Annetta K.
Published: December 2021

The authoritative statement on the "Effects of Cigarette-Smoking on the Fetus and Child" (Pediatrics 57:411, March 1976) is an excellent summary but necessarily brief. With respect to the later growth and development of the children, the statement quotes only one study, which demonstrated no long-term effects of maternal smoking on physical growth and intellectual development through the first seven years of life. We believe that such effects may indeed be demonstrable though slight.

In the quoted study, Hardy and Mellits1 established 88 pairs of children of matched smoking and nonsmoking mothers.
The Smog Syndrome
Authors: Grossman A. M.
Published: December 2021

The fine article by Driscoll et al. on chest pain in children (Pediatrics 57:648, May 1976) failed to mention one of the most common causes of chest pain seen especially in southern California.

The "smog syndrome" consists of conjunctivitis, rhinitis, retrosternal pain, and cough. Most of the patients examined have only the pain on inspiration, and about 50% complain of both inspiratory and expiratory pain on days the ozone level in the atmosphere is 0.35 ppm and the temperature is above 32.2 C (90 F) while the relative humidity is below 40% and the wind current is less than 9.6 km/hr (6 mph).
Propranolol and Exercise Test for Growth Hormone Assays
Authors: Pombo Manuel , Martinon Jose M. , Tato Fernando , PeÑa Jose
Published: December 2021

According to the data of Maclaren et al. (Pediatrics 56:804, November 1975) and Shanis and Moshang (Pediatrics 57:712, May 1976), propranolol and exercise appear to be an effective screening test in estimating growth hormone (GH) function. Stimulated by these discoveries, we examined by this method the modifications of serum GH levels in 19 shortstature children, 5 to 15 years old. After an overnight fast, oral propranolol (20 mg to children less than 20 kg, and 40 mg to the remainder) was given.
Questions on Ambulatory Bacteremia
Authors: O'Shea John S.
Published: December 2021

Although it has long been appreciated that hospitalized children found with bacteremia fairly frequently have life-threatening infections,1 there has been a recent fascinating but perplexing emphasis on bacteremia in ambulatory children. Febrile children brought to pediatric outpatient areas of some large New England hospitals appear to have a small but definite incidence of bacteremia especially if they are infants with leukocytosis.2-4 Some of these children still have bacteremia when cultured a second time several days after the first visit, and occasionally life-threatening or even fatal infections develop.

See table in the PDF file
Dr. Tronick et al. Reply
Authors: Tronick Ed , Als Heidelise , Brazelton T. Berry
Published: December 2021

Dr. Fanaroff et al. have raised a reasonable question about our study. It certainly is possible that we may have screened out infants whose low Apgar score and CNS depressions at birth could be attributed to the effects of maternal obstetric medication. It would be informative now to have an accounting of the number of infants excluded and the reasons for their exclusion. The ratio of the number of babies not chosen because of low Apgar scores as well as for other postnatal complications to the number of babies selected would indeed clarify this point.
Dr. Jacobs Replies
Authors: Jacobs Alvin H.
Published: December 2021

Drs. Gorman and Snead bring up a purely semantic question: "What is the Sturge-Weber syndrome?" According to McKusick,1 Sturge-Weber syndrome, sometimes called the fourth phacomatosis, is characterized by nevus flammeus of the face and angioma of the meninges. Warkany2 states that it "consists of a facial port wine nevus, convulsions and other neurological manifestations." In fact, the latter author, in discussing reported cases, rules out as Sturge-Weber syndrome a case with the CNS changes but no skin involvement.
Prenatal Hair Growth
Authors: Baum David
Published: December 2021

I read with interest the article by Saadat et al. entitled "Measurements of Hair in Normal Newborns" (Pediatrics 57:960, June 1976). May I, through the courtesy of your columns, draw the authors' attention to the study which we published in 1974 entitled "Neonatal Hair as a Record of Intrauterine Nutrition."1 In this study, using the scanning electron microscope, we measured scalp hair diameters serially from the hair root to the tip.

We studied three groups of infants, a well-grown group of term infants; a group of very-small-for-dates term infants; and a group of preterm infants.
Dr. Gordis Replies
Authors: Gordis Leon
Published: December 2021

Dr. Merenstein is correct that questionnaire answers have limited validity, but for that matter, so do all methods of data collection. The critical issue is to recognize the limitations in any method used and to be sure that any inferences derived in using a method of data collection are, in fact, appropriate. Despite the limitations of questionnaires, they have proven invaluable in innumerable studies both of disease etiology and of attitudes of patients and health care providers.
A Useful Idea
Authors: Schaar Frances Elizabeth
Published: December 2021

Comment has been made regarding the transition needed in shifting career for the pediatrician.

Office practice without night or weekend responsibility would be desirable. Perhaps less emphasis on counseling and more on providing a placement service would be of help.

Many institutions and clinics seem fearful of utilizing the contribution of those 65 or even 60 who are in excellent health.
Suggests More Tests for Chest Pain Diagnosis
Authors: Elmore Michael F. , Lehman Glen A.
Published: December 2021

Driscoll et al. (Pediatrics 57:648, May 1976) reported a series of 43 patients with chest pain evaluated by history and physical examination, psychiatric interview, screening laboratory studies, ECG, and chest x-ray film. No organic cause was identified in 45% of patients, and various psychiatric aspects of the pain were discussed.

The history obtained from pediatric patients is often suboptimal, and specific pain characteristics and associations cannot be defined. We therefore propose that more vigorous diagnostic work-ups are necessary before chest pain can be classed as "idiopathic."
The History of Research on RLF
Authors: White Colin
Published: December 2021

The Committee on Fetus and Newborn has given a thorough account of the history of research on the etiology of retrolental fibroplasia (RLF) (Pediatrics 57(suppl), April 1976), but there are characteristics of this research program as a whole, and of the report, which are worthy of further comment.

1. Anyone who followed the work of Patz and his colleagues should have recognized by the end of 1953 that overuse of oxygen was the chief etiological factor in the disease.
Dry Myringotomies and Impedance Testing
Authors: Gordon A. G.
Published: December 2021

Paradise et al. make no mention of the important but largely ignored clinical problem of the dry myringotomy, as occurred in a third of the ears they tested (Pediatrics 58:198, August 1976). Most of these bilaterally dry taps would be avoided if immediate preoperative reassessments were routinely performed to exclude those whose effusions had spontaneously cleared since being scheduled for operation. Anesthesia is not hazardless, so there is surely a serious ethical problem when this retesting is not done, unless a therapeutic or diagnostic grommet is inserted regardless.
In Reply: A Different Position on Postural Drainage
Authors: Kosloske Ann M.
Published: December 2021

Dr. Kravath is absolutely correct in pointing out our error. The affected lobes are placed in a nondependent (or antidependent) position during the treatment. We employ positioning of the patient as outlined in the Guide to Diagnosis and Management of Cystic Fibrosis.1

Probably Dr. Kravath's thoughts on antimatter were inspired by the 12 children in our series from whom the foreign body was not retrieved yet who recovered. Was the foreign body annihilated? Could be.
DES Effect on Males
Authors: Rosenfield Robert L. , Gill William B. , Bibbo Marluce
Published: December 2021

We have found defects in the urogenital tract of males exposed to diethylstilbestrol (DES) in utero, but the anomalies are different than those expected from the data of Henderson and co-workers (Pediatrics 58:505, October 1976). They reported an increased incidence of suspected urethral stenosis in boys exposed to DES. Their conclusion was drawn from the response of 225 DES-exposed males to a questionnaire.

We have thoroughly examined 163 DES-exposed males and found a significantly increased incidence of oligospermia, hypotrophic testes, low ejaculate volumes, epididymal cysts, and microphallus.1
Initialosis: A New Disease of Medical Journals
Authors: Anderson Robert H.
Published: December 2021

It appears that we are rapidly approaching an epidemic of a disease that I shall call "initialosis" among the medical authors of our leading medical journals. It all began several years ago (harmlessly enough) when the initials EEG and EKG were used instead of the words themselves. This progressed to the use of RDS and ASD and PDA, which again was no cause for alarm to the average physician reader. Now this disease has become so severe that it is not possible to read a medical article without first consulting the table at the beginning of the article which explains all the strange and esoteric initials used.
Mumps and Hypoglycorrhachia
Authors: Oetgen William J. , Bass James W.
Published: December 2021

The review by Silver and Todd (Pediatrics 58:67, July 1976) clearly enumerates several clinical conditions which are associated with abnormally low concentrations of glucose in the CSF. Mumps meningoencephalitis is mentioned, and studies by Wilfert1 and Azini et al.2 are cited as documentation of the occurrence of hypoglycorrhachia in this disease. In these two articles the incidence of hypoglycorrhachia is given as 28% and 10%, respectively. Since these incidences seem exceptionally high in our clinical experience, we have undertaken a retrospective study to determine the incidence of hypoglycorrhachia in a large series of patients with mumps meningoencephalitis.
COMMENTS ON A DOCTOR'S EDUCATION
Authors: Kennedy Donald
Published: December 2021

We need all the help we can get from disinterested parties, since the dominant form of medical education in the U.S. is not, as you might think, medical schools . . . but the pharmaceutical companies, which spend $4,000 per year per doctor on direct persuasion on behalf of particular drug therapies. The total is more than the entire Federal budget for medical education; and even there the news isn't so good.
Acetaminophen: Report of an Unusual Poisoning
Authors: Aren Jay M. , Rourk Malcolm H. , Sibrack Corry D.
Published: December 2021

This is a report of an unusual acetaminophen poisoning in a 3-year-old girl who, three days after the ingestion of an estimated thirty-five 325-mg tablets of acetaminophen, had the highest levels of hepatic enzymes ever recorded at Duke Hospital. Although she was only moderately ill with an enlarged liver, she was discharged from the hospital on the seventh day in good condition. The liver enzyme levels returned to normal when last assessed, 50 days after ingestion. The importance of determining acetaminophen Plasma concentration at different times to evaluate more precisely the plasma half-life is discussed, along with the current suggested therapy now being recommended for acetaminophen poisoning.
THOMAS WILLIS ON THE TREATMENT OF CHILDHOOD EPILEPSY (1667)
Authors: C. T. E.
Published: December 2021

Although Thomas Willis (1621-1675) was not specially devoted to diseases of children, his writings occasionally contained items relating to this subject that were sufficiently important to be quoted by subsequent writers on pediatrics. This is how Willis viewed the preventive and therapeutic management of epilepsy.

A Man in this Neighborhood, had all his Children dead of Convulsions, within three months after they were born. At length, to prevent the same Fate in a Son of his that was new-born, he thought proper to try the Power of Medicine. I was called to him a few days after the Birth, and ordered an Issue in the first Place to be made in his Neck, and that two Ounces of Blood should be drawn next Day at the Neck, by the Application of Leeches. I advised besides, that for three Days before each Change of the Moon, and again before the Full, about five Grains of the following Powder should be given him Morning and Evening in a Spoonful of the Julap.

Take prepared Human Skull, the Root of Male-Peony, of each one Drachm. Pearls in Powder, half a Drachm. Mix them all together, and make a very fine Powder.

Take of Black Cherry-Water, three Ounces. The Antepileptick Water of Langius, and Ounce. Syrup of the Flowers of Male-Peony, six Drachms.

I likewise ordered the Nurse to take a Draught of Whey, in which the Roots and Seeds of Male-Peony, and the Leaves of Lilly of the Valley had been boiled, twice every Day at the same Hours.
COMMUNICATION
Authors:   Student
Published: December 2021

Here is . . . part of a message a Houston high school principal recently sent to the parent of a pupil:

"Our school's cross-graded multi-ethnic, individualized learning program is designed to enhance the concept of an open-ended learning program with emphasis on a continuum of multi-ethnic, academically enriched learning using the identified intellectually gifted child as the agent or director of his own learning.

"Major emphasis is on cross-graded, multi-ethnic learning with the main objective being to learn respect for the uniqueness of a person."

The parent wrote back.

"I have a college degree, speak two foreign languages and four Indian dialects, have been to a number of county fairs and three goat ropings, but I haven't th Submitted by Studente faintest idea as to what the hell you are talking about. Do you?"
SOCIAL PEDIATRICS: ASPECT OR ATTITUDE?
Authors: Miller Fred J. W. , H. R. J.
Published: December 2021

Definition constrains, paradoxically it does not necessarily clarify, and I have never found a definition which suffices to explain "social pediatrics." Indeed, in attempting to show what social pediatrics is, how it is provided, and how it is taught, I would rather call it an attitude toward the study of pediatrics. . . . For, rather than being an aspect or segment of a subject, it is a way of thinking and an approach to a discipline, an approach which can be acquired and used by anyone working with children, either as a clinical pediatrician in the community or hospital, as a specialist in preventive medicine, as a research worker or as a policy maker, organizer of medical care or administrator . . . . Social pediatrics, in short, is the study and care of the child in his "eco system."
INTRAVENOUS CANNULATION-PLASTIC CATHETERS OR SCALP VEIN NEEDLES
Authors: Goldmann Donald A. , H. R. J.
Published: December 2021

Although there are no adequate studies comparing the incidence of complications with plastic catheters versus scalp vein needles, a review of the available literature does permit certain general observations. The use of plastic catheters is accompanied by a high rate of phlebitis, catheter colonization and sepsis. In most studies the rate of these complications increased with the length of time catheters were left in place; when catheters were left in longer than 48 hours, the associated septicemia rate ranged between 2% and 5%. In contrast, only one case of cannula-related septicemia was noted among 535 patients receiving intravenous therapy via scalp vein needles in 4 studies. Moreover, rates of phlebitis and cannula colonization are lower with scalp vein needles than with plastic catheters. Suppurative thrombophlebitis has recently been reported in association with IV therapy via scalp vein needles. In other words, serious infections may be rare, but they do occur, particularly in immunosuppressed patients. The factors responsible for the relative safety of scalp vein needles are unknown; it has been suggested that needles are safer because they tend to infiltrate quickly, forcing changes at frequent intervals. The small teflon catheters now available may be less irritating than previously marketed plastic catheters.

Present information strongly suggests that scalp vein needles should be used for intravenous therapy whenever possible. If the cannula is to be used only for the periodic administration of medications such as antibiotics, a heparin lock is preferred to a "keep open" infusion since intravenous fluid supports the growth of bacteria and thus increases the risk of intravenous-related sepsis. Plastic catheters should be used when a child's life may depend on the reliability of the intravenous cannula as a route for the rapid administration of medications. Both scalp vein needles and plastic catheters should be changed every 48-72 hours.
A NOVEL IRISH CURE FOR WHOOPING COUGH AND CHICKEN POX (1898)
Authors: C. T. E.
Published: December 2021

No disease has had as many supposed cures as whooping cough. The following Irish cure is surely a novel one. I have not been able to discover whether or not it proved effective.

There are many curious customs and superstitions existing even in this enlightened age, and among the most peculiar are some practised by the peasants of Ireland for the cure of various complaints. In certain districts of that country whooping-cough is treated in quite a unique manner. A few months ago much amusement was caused by a case which came before the Coroner's Court in Belfast, in which whooping-cough was treated in a child by passing the sufferer three times under a donkey. Mr. W. R. Le Fann, in his amusing book on Irish life, relates several other instances of a like nature, and draws attention to the fact that nearly all the most popular remedies are for the relief of whooping-cough or chicken-pox. Some donkeys are believed to be possessed of curative virtues in a much higher degree than are others. A man living in County Cork owned an animal which could boast of more than a local reputation. This man used to lead his donkey through the streets of the City of Cork, crying out: "Will any one come under my ass for the chin-cough?" [A name given to whooping-cough in the rural parts of Ireland.] In County Down the charms in vogue were more various. Two kinds of food obtained from two first cousins who are married, and soup made from the tails of mice is there regarded as a panacea for chicken-pox.
AN EARLY CASE REPORT OF INFANTILE DEHYDRATION IN COLONIAL AMERICA (1663)
Authors: Pynchon John
Published: December 2021

In colonial America the outstanding members of the governing class who were acknowledged as physicians were the two John Winthrops, father and son. John Winthrop, Jr. (1606-1676), Governor of Connecticut, far surpassed his father in the extent of his medical activities. His medical advice was sought, usually by letter, by hundreds of people. Typical of the letters he received is the one below, sent to him by John Pynchon concerning his daughter's illness. I believe this is the first case report of dehydration in American medical literature and, to my knowledge, has never been published.

Much Honored Sir-

We are bold to crave your advice concerning our young daughter about or neere one yeare & three quarters old. God having pleased to visit her with Illness. She hath not bin welt these 3 or 4 days, but especially yesterday morning was taken with a greate looseness & vomiting which doth continue much & exceedingly weakens her. Shee is very restless & unquiet & sleepes litle & is exceding dry craving for drink: how the Lord may deale with her & us we know not, but desire in the use of meanes to submit to his good pleasure: desiring your helpfullness in what you conceive needfull. I comend you & your affaires to the guidance of God & humbly take leave to subscribe.
Periorbital and Orbital Cellulitis in Children
Authors: Gellady Andrew M. , Shulman Stanford T. , Ayoub Elia M.
Published: December 2021

The clinical and laboratory data on 87 cases of orbital and periorbital cellulitis were reviewed. Two distinct clinical presentations were encountered. One group of 45 patients had no history of trauma on apparent focus of infection. Blood cultures on these patients were positive in 34%. Haemophilus influenzae accounted for 82% of the positive blood cultures. This group of patients shares common features with children who have facial cellulitis due to H. influenzae type b. The second group consisted of 42 patients with adjacent soft tissue focus of infection. There was only one positive blood culture in this group. Staphylococcus aureus and/or group A β-hemolytic Streptococcus were isolated from conjunctival or wound exudate in the majority of these patients. Thirteen patients with orbital cellulitis were encountered among the 87 cases. These patients were older and had a high incidence of demonstrable sinus disease when compared with the overall group. The pathophysiology of orbital and periorbital cellulitis is reviewed and an approach to the management of these disorders is formulated.
THE REVEREND COTTON MATHER'S DESCRIPTION OF MEASLES (1713)
Authors: C. T. E.
Published: December 2021

It may surprise the contemporary physician that Cotton Mather (1663-1728) may well be "the first significant figure in American medicine."1 During the most widespread and most alarming of the colonial epidemics of measles that began in the late summer of 1713, Mather published a short letter on the medical aspects of the disease, which, although written for the benefit of the poor, happens to be a classic of American pediatrics and compares favorably with any description of measles written on the continent.2 Mather wrote3:

The Measles are a Distemper which in Europe ordinarily proves a light Malady; but in these parts of America it proves a very heavy Calamity; A Malady Grievous to most, Mortal to many, and leaving pernicious Relicks behind it in All. Because the Sickness is now spreading in all Parts; and its Malignity increases, as the Winter advances, and Good Physicians are not every where at Hand, for the Relief of the Sick, and a very nice Management of the Case is very requisite: You are now addressed with a short Letter of Advice concerning it . . .

The Usual Symptoms of an Arrest from the Measles are, an Head-ake; on Troubles in the Eyes; a Dry Cough; an Oppression on the Breast or Stomach; or a pain there, and in the Back and Limbs; and sometimes a Faintness, with Sickness, perhaps Vomiting, on Griping and Purging; A Thirst, with a constant Fever, which is mild at first, but grows high enough before it has done . . .
DR. ZABDIEL BOYLSTON DESCRIBES THE MELANCHOLY SIGHT OF MR. DORR'S FAMILY FOLLOWING SMALLPOX INOCULATION DURING THE EPIDEMIC OF 1721 IN BOSTON
Authors: C. T. E.
Published: December 2021

Zabdiel Boylston's (1680-1766) role in attempting to stem the severe epidemic of smallpox of 1721-1722 in Boston by introducing inoculation is well known. But less well known is how inoculation affected many of those who underwent this procedure. Boylston's vivid description of the postinoculation woes of one Boston family follows.

[November 29, 1721]

I inoculated Mr. Edward Dorr's other three children, one of 9, and one of 7 years, and the other about 18 months old, his Servant Man 20, and Indian Girl about 17 Years old [Mr. Dorr 35, and three of his children, one 11, one 5, and one three Years old had previously been inoculated on November 24, 1721]. Mr. Dorr would have had these five inoculated when he and the three Children were, but I refus'd to do it then. But for the Convenience of nursing and having one Nurse only for them all, they were put into one Chamber, and for better Stowage, two or three in one Bed, (the End of the Chamber being partition'd off for a private Lodging, in which was laid the Indian Girl) and by the time the first three were broken out a Day or two, the other five began their Sickness. Here was a melancholy Sight indeed! I had often three or four, but never nine in a Room together; the poor Children, with their Sickness and the Winter's Cold, prov'd froward, one crying, another coughing; one wanted Drink, another to do its Needs; one to get up, another to go to Bed, and so on; so that together with opening and shutting the Doors, the gigling [sic] of the Warming-pan, Fire-shovel and Tongs, there was scarce a Minute in the 24 Hours that all was still and quiet.
Who Should Have a CAT Scan?
Authors: Fisher Julian H.
Published: December 2021

While the utility and ease of diagnosis by computerized axial tomography (CAT) continue to be demonstrated in new situations, as in the evaluation of chronic seizure disorders by Bachman et al. (Pediatrics 58:828, December 1976), the logistics and availability of this now invaluable tool are such in many centers that there must be priorities set for its use.

Thus, the CAT might more profitably be used in the evaluation of patients whose patterns of chronic seizure disorders have changed, with the thought that the yield in terms of treatable pathology might be higher than the 2% reported by Bachman et al. in static seizure disorders.
Dr. Freeman Replies
Authors: Freeman John M.
Published: December 2021

The authors would concur with Dr. Fisher that the CAT should be utilized primarily in patients with persistent focal seizure disorders, or those that are associated with progressive neurologic dysfunction. As the study showed, even in patients with chronic seizure disorders, the incidence of abnormalities which alter management is very low. The demonstration of abnormalities explaining the etiology of the seizures was high (30%), but management was not altered on the basis of these findings.
The Diet Wasn't Controlled
Authors: Miller James S.
Published: December 2021

While the article of Conners et al. (Pediatrics 58:154, August 1976) is not the worst you have published, it is surely in active competition. The fundamental point relates to the diets. In what real sense is the second diet a "control" so as to permit the appellation "double blind"?

I list in the Table the principal foods to he omitted in each diet. Dr. Conners et al. do not tell us what their 15 children did eat, before or during the diets.
Drs. Levine and Liden Reply
Authors: Levine M. D. , Liden Craig B.
Published: December 2021

In response to the letter from Dr. Miller, we feel we should make a few points about our commentary, "Food for Inefficient Thought."

Your correspondent somehow implies that we were not hard enough on the study of Conners et al. with respect to food additives. This is clearly a very charged issue at the moment, and it seems important to take a very sober and fair look at the factors involved. The study should really be regarded as the first of a series of organized and disciplined approaches to the problem.
Cost Analysis of the Child Protection Team
Authors: Kempe C. Henry , Schmitt Barton D.
Published: December 2021

The suggestion is often made that hospital-based child protection teams are expensive, should be funded from outside sources, and somehow are not really the responsibility of a pediatric service. On the contrary, we feel that hospital-based child protection teams are properly funded along with all other medical care through the usual sources. In order to place the cost of a typical workup of an abused child in perspective, we have compared it to the cost of the evaluation and initial treatment of children with diabetes mellitus and leukemia.
Who Delivers Higher Quality Care?
Authors: Sparling David
Published: December 2021

Access by all children to high-quality medical care must be the goal of all pediatricians. There are many reasons why all of this care cannot in the foreseeable future be given by pediatricians. These include factors of geography, economics, family education, and comfort, and episodic versus continuity medical care, as well as aggregate manpower figures.

Dr. Hoekelman's presentation (Pediatrics 59:315, March 1977) addresses the issue, but his argument is poorly served by the undocumented statement that "there are no data to show that pediatricians do a better job in delivering primary care to children than do family practitioners."
Child Abuse Can Be Prevented
Authors: Rako Jules
Published: December 2021

The article by Elmer (Pediatrics 59:273, February 1977) brings up some alarming findings. Children of low-income families, abused and nonabused controls, all had severe developmental lags. Drs. Cupoli and Newberger in thier commentary (Pediatrics 59:311, February 1977), are optimistic about these abused children because they see strength in the fact that the abused children had no greater developmental lag than the controls.

I would like to be as optimistic as these workers in the field of child abuse, but as a practicing pediatrician I must confess that many of our low-income children are being denied access to pediatric care and must rely on fragmental health care, usually during crisis situations.
Dr. Travis et al. Reply
Authors: Travis Kenneth W. , Todres I. David , Shannon Daniel C.
Published: December 2021

While florid pulmonary edema can follow direct instillation of hydrochloric acid into the lungs,1,2 we have not encountered such dramatic pulmonary edema in cases of aspiration pneumonitis in children. Nor has it exhibited such even bilateral distribution. Furthermore, pulmonary edema from a chemical injury of such severity is not likely to regress as rapidly as did the pulmonary lesions of cases 1 and 2.

We concluded, therefore, that mechanisms other than aspiration of gastric contents were operable.
Prolonged Apnea in Infant Monkeys Resulting From Stimulation of Superior Laryngeal Nerve
Authors: Sutton Dwight , Taylor Eugene M. , Lindeman Roger C.
Published: December 2021

We measured characteristics of apnea resulting from electrical stimulation of the superior laryngeal nerve (SLN) in 28 anesthetized infant monkeys ranging from a gestational age of 141 days to 49 days postterm and in four adult monkeys. Progressive reduction in ventilation accompanied weak suprathreshold SLN stimulation. Poststimulus apnea followed stronger stimulation. Apnea duration was directly proportional to stimulus duration, provided that stimulus intensity was at least 1.5 x threshold. Poststimulus apnea periods were briefer in older infants and did not occur in adults. Pao2 measurements in four animals showed that lower values were associated with the longer poststimulus apnea episodes. Upper airway resistance measurements obtained from a subglottal cannula revealed that glottal closure was transiently associated with the onset of SLN stimulation, but the degree of closure diminished during the course of stimulation and was not present during the subsequent period of apnea. The parameters of SLN stimulation determine specific changes in cardiovascular functions independently of their respiratory effects. The results suggest that a brief afferent input from the SLN may have prolonged effects on respiratory regulation in infants. These persisting effects may be an important consideration in sudden infant death syndrome mechanisms.
PRODUCTION AND DEPLETION
Authors: Leonard John
Published: December 2021

According to Marvin Harris, a Columbia University Anthropologist . . . we have been going downhill since the Stone Age. Paleolithic man (and woman) got along fine on a combination of animal protein and infanticide, working just three or four hours a day. When at the end of the Pleistocene Epoch, the "megafauna" disappeared, not even an infanticide rate as high as 50 per cent could maintain an adequate diet for all the available people.

And so we turned from animal to plant protein; from a "mode of production" that was primarily hunting to one primarily agricultural; from roving bands to settled villages, then cities and states. Agriculture is more "labor efficient" than hunting. But the trouble with efficiency we're told is that as it intensifies production it also speeds up depletion of resources. Producing and reproducing we overpopulate our space and use up its capacity to sustain us. Then we go off to war with neighboring villages, and back to infanticide at home, while waiting for a new mode of production to suggest itself, which mode will in its turn, intensify and deplete.
Vitamin E and Neonatal Hemolysis
Authors: Gross Steven J. , Landaw Stephen A. , Oski Frank A.
Published: December 2021

An error was made in the article "Vitamin E and Neonatal Hemolysis" by Gross et al. (Pediatrics 59[suppl]:995, June 1977). In "Materials and Methods" on page 995, it states that infants received tocopherol acetate. The infants actually received the free alcohol form of tocopherol.
Torsion of Normal Uterine Adnexa in Childhood: Case Report
Authors: Ward Michael J. A. , Frazier Thomas G.
Published: December 2021

A case of torsion of a normal right ovary and tube in an 8-year-old child is presented. True infarction of the adnexa can be prevented only by considering this diagnosis early in the course of right lower quadrant pain. It is recommended that a routine exploration of the pelvis be carried out in any patient explored for acute appendicitis in whom that diagnosis cannot be made at the operating table.