bluuebunny/crossref_metadata_2025 huggingface dataset:
Letters to the Editor
Authors: Klein Jerome O. , Haddow James E. , Young Lily M.
Published: December 2021

We do not have data to respond adequately to Dr. Nespole's concern for the 6-hour ampicillin dosage schedule in acute meningitis. However, it is of interest that, on the 6-hour schedule, ampicillin sterilized the spinal fluid of our patient although the hemophilus was not eradicated at the distal site and orbital cellulitis and bacteremia resulted.1

Dr. Pryles's remarks on the need for therapy tailored to the individual patient are appreciated and we thank him for reiterating these points as made in the discussion and summary of our paper.
Letters to the Editor
Authors: Geraci Robert P.
Published: December 2021

Thank you for the opportunity to reply to Dr. Mark's comments with respect to the use of rectal thiopental in children. I am in complete accord with his views and I regret that the case as reported apparently resulted in a misinterpretation of the role in which rectal thiopental was used. In point of fact, the child, J.B., had been sedated with intramuscular pentobarbital during his hours of observation prior to intubation. Line 16, page 144 might better have been written: "After additional sedation, this time with rectal thiopental . . . . " Only when it was decided to intubate the child was additional sedation required and thus immediately before intubation rectal thiopental was administered.
MANAGEMENT OF FEBRILE CONVULSIONS IN 1836
Authors: C. T. E.
Published: December 2021

One of the most popular early nineteenth century American pamphlets written to help parents care for their children in sickness and in health was that written by Dr. G. Ackerley of New York City. A good example of his style is the following quotation to help mothers manage their child's febrile convulsion:

Fits in children are always attended with danger, and not a moment should be lost in sending for assistance. In the mean time strip the child of its clothes and place its feet and legs in cold water. Should its head be very hot, and the fits continue, pour a stream of cold water on the back of the child's head, holding it over a pail while its feet are still in the warm bath. Never plunge a child wholly in to the hot bath in cases of fits or convulsions, neither give it anything hot or stimulating to stop them; rather let it alone with what is already done until medical aid arrive (sic), then [for the parent] to proceed one step in doubt, when that step may lead to utter destruction of the life of the child.1
THE USE OF ETHACRYNIC ACID IN INFANTS AND CHILDREN WITH CONGESTIVE HEART FAILURE
Authors: Sparrow Albert W. , Friedberg David Z. , Nadas Alexander S.
Published: December 2021

Administration of intravenous ethacrynic acid in doses of 1 mg/kg to 8 study patients and 14 "nonstudy" patients–all of whom had congestive heart failure–is reported. No significant changes in serum electrolytes are noted following administration of the drug. In nearly all cases, diureses and clinical improvement within a few hours after administration were noted. The authors suggest that intravenous ethacrynic acid replace mercurials in the treatment of acute congestive heart failure in infants and children.
Febrile Convulsions, by J. Gordon Millichap, M.D., M.R.C.P. New York: The Macmillan Company, 1968, 239 pp., $7.95
Authors: Byers Randolph K.
Published: December 2021

This rather modest-looking monograph deals not only with the large experiences of the author in relation to febrile seizures, but also presents an extensive review of the modern relevant literature (266 references in the bibliography).

The most useful point made in the book, it seems to me, is that febrile convulsions are just that: i.e., convulsions coinciding with fever, the result of illness not directly involving the brain or its meninges. Such a seizure may be an isolated occurrence in the life of the individual, or it may recur a few times with fever; it may be the first sign of idiopathic chronic epilepsy, or it may be evidence of more or less apparent cerebral injury of a static sort; or, it may be the presenting symptom heralding progressive cerebral disease.
FAMILY LIFE AND SEX EDUCATION
Authors:   Committee on School Health, Jennison M. Harry , Cone Thomas E. , Fischer Carl Castle , Hobart Harold M. , Hurd Arthur H. , Murdock C. George , Rogers Kenneth D. , Shultz Carl S. , Bustamante Werner ,   Committee on Infant and Preschool Child, Wakeman Edward T. , Adams William Curtis , Bates Talcott , Chenoweth Alice D. , Christy Raymond A. , Forsyth William B. , Lipow Herman W. , Miller Roland E. ,   Committee on Youth, Deisher Robert W. , Allen V. Robert , Bakwin Harry , Hammar S. L. , Hazard Sprague W. , Schroeder Albert J. , Shaffer Thomas E. , Welty John Allen , Wood Charles Louis
Published: December 2021

The American Academy of Pediatrics is deeply concerned with the increasing social health problems in today's society, particularly those that relate to the function of the family as a unit and to the behavior of its children and youth. Some of the signs of the serious social, moral, and ethical crisis facing us are: increasing illegitimacy, early marriage, dangerous drug use, rising incidence of venereal disease, family fragmentation manifested in divorce, and lack of restraint within the mass media in presenting sexually stimulating material to young and immature persons.

It is the Academy's conviction that all segments of the society of responsible adults, lay and professional, must mobilize now in support of personal and collective action to help children and adolescents grow to a healthy maturity as intellectually, socially, and sexually secure individuals. We join with other national organizations, such as the National Congress of Parents and Teachers, the American Medical Association, the National Education Association, and support the interfaith statement of the nation's major religions in officially supporting health education, including family life and sex education. We urge programs that will create a vigorous and healthy social climate in which family life can flourish and which foster mature sexual behavior in each individual. With this larger goal in mind, we propose and endorse the following general programs and actions.

1. Every concerned adult, lay or professional, must be encouraged to examine his own values and behaviors in order to develop an openness which permits a meaningful rapport with children and youth.
Guiding Your Child from Two to Five, by Molly Mason Jones. New York: Harcourt, Brace and World, Inc., 1967, 366 pp., $8.75
Authors: Kolodny Roselyn L.
Published: December 2021

Molly Mason Jones, Professor of Psychology at Scripps College, has written a child guidance book drawing upon her years of experience in nursery school education, child study, parent counseling, and her own home as a mother of two. With this background, she describes a logical and consistent approach to child rearing, such that parents and offspring live in a more harmonious and satisfying atmosphere. Her pervading theme is adequate (but subtle, from the child's viewpoint) guidance of the child with the important addition that "children themselves benefit when reasonable satisfactions for parents are woven into life.
Atlas of Strabismus, by Gunter K. von Noorden, M.D., and A. Edward Maumenee, M.D. St. Louis: The C. V. Mosby Company, 1967, 188 pp., $17.50
Authors: Costenbader Frank D.
Published: December 2021

The authors state that this book is designed primarily for the ophthalmologist-in-training, the practicing ophthalmologist who confronts diagnosis of complex muscle problems only casionally, and for the orthoptist. Neither the format nor the information contained would be helpful to the pediatrician, but the book is of significant interest to the pediatric ophthalmologist (of whom there are 25 or 30 in North America now).

The Atlas outlines and beautifully illustrates the procedures in muscle diagnosis, but with a less thorough approach to therapy.
THE PLATELETS IN CYANOTIC CONGENITAL HEART DISEASE
Authors: Gross Samuel , Keefer Vicki , Liebman Jerome
Published: December 2021

The mean platelet count in 102 children with congenital cyanotic heart disease was found to be 235,000/mm3 ± 1 S.D. of 85,000/mm3 as compared to 260,000 ± 70,000 in an age-matched group of normal children. In the cyanotic children, whose mean oxygen saturation was >80%, the mean platelet level was 315,000/mm3 as compared to 185,000/mm3 in the <60% oxygen saturation group. The platelet means were inversely related to the mean hemoglobins, such that the mean hemoglobin in the >80% oxygen saturation group was 13.2 gm/100 ml as compared to 17.2 in the <60% group. The age of the patient, and thus the duration of the disease, was also related to the platelet levels with significantly higher platelet counts in the children under 3 years of age. The mean age of the patients with platelet counts below 100,000/mm3 was 4.7 years as compared to a mean age of 2.8 years in the patients with platelet levels greater than 400,000/mm3. In addition, the older children had the highest hemoglobins and the lowest oxygen saturations. The inverse was true for the thrombocytotic individuals. The level of bound iron was not related to the platelet levels; nor were there any associated marrow or suspected capillary changes. It appears that the initial response to oxygen undersaturation is a platelet stimulation which subsequently results in underproduction as oxygen desaturation persists and worsens.
Indications of Operations in Craniostenosis
Authors: Freeman John M.
Published: December 2021

The review article by Drs. Shillito and Matson (Pediatrics, 41:829, 1968) provides an opportunity to assess the proper treatment of craniostenosis. The constant interest of these excellent neurosurgeons over many years should provide the minimal morbidity and mortality figures against which to weigh the benefits of surgery. Unfortunately, once again, the field is clouded by lumping all forms of craniostenosis as one entity. Few would be unwilling to accept a 14% morbidity and mortality faced with the patient in Figure 24 with closure of all sutures, but is it acceptable for the patient in Figure 19 with the minimal de formity of metopic stenosis?
In Reply: Gas Leak Syndrome
Authors: Coleman Allan B.
Published: December 2021

The warning about the "gas leak syndrome" is surely timely. The summertime is the season for checking the patency of flues and making certain that nesting birds have not obstructed chimney tops. Indeed, in some areas, bird and squirrel proof screens on chimneys are a necessity.

My own experience with each of two families is rather like that described by Moore and Finstone recently ("The Case of the Disappearing Headache," New Eng. J. Med., 278:1216, 1968), with recurrent symptoms which were worse at home and better away from home.
A SURVEY OF ALLIED HEALTH WORKER UTILIZATION IN PEDIATRIC PRACTICE IN MASSACHUSETTS AND IN THE UNITED STATES
Authors: Yankauer Alfred , Connelly John P. , Feldman Jacob J.
Published: December 2021

A questionnaire was mailed to all fellows of the American Academy of Pediatrics in the Commonwealth of Massachusetts and to a 2% random sample of fellows in all other states. The questionnaire inquired into their present utilization of allied health workers in office practice and their opinions on this subject. Ninety percent of the questionnaires were returned. In 70% of the returns the pediatricians were in solo, partnership, association, or group practice. Relative to the national sample, Massachusetts practitioners were more apt to engage in solo practice (regardless of age), spend more time in health supervision, employ more registered nurses and fewer "medical assistants," and delegate fewer specific tasks to allied health workers. For both sets of respondents, clerical and minor technical task delegation was more common than patient care task delegation. The degree of task delegation and the variety of allied health workers employed in a practice were greater in partnership, association, or group practices than in solo practice, but this did not account wholly for the differences between Massachusetts and national sample. A majority of both Massachusetts and national sample respondents expressed opinions favoring delegation to allied health workers of specific patient care tasks related to information seeking, information giving, and counselling, whether or not this was their current practice. In 80% of all respondents the feeling was that increased delegation in general would result in improved and/or more efficient child care. Teachers of pediatrics and hospital-based clinicians favored delegation more strongly than practitioners.
Letters to the Editor
Authors: Lauweryns J. M. , Claessens St. , Bourgeois N. , Boussauw L.
Published: December 2021

Dr. Lauweryns and coworkers commented as follows:

Concerning our report, "The Pulmonary Lymphatics in Neonatal Hyaline Membrane Disease" (Pediatrics, 41:917, 1968), Dr. Daniel Stowens has pointed to two portions which he considers to be in error.

Of lesser importance is his questioning of our statement of having reported for the first time this general increase in diameter of the pulmonary lymphatics in hyaline membrane disease (HMD). Dr. Stowens, and other authors, may be unaware of our (J.M.L.) reports, which we consider the original observations, (1) to the forty-ninth Annual meeting of the Association des Anatomistes, held in Madrid, September 6-10, 1964 (published in the Bulletin de l'Association des Anatomistes, 49e Reunion, 127: 1015) and subsequently (2)to the Fifteenth Annual "Journées d'Etudes du nouveau-né, du prémature et du nourrisson" in Paris, October 15-20, 1964 (published in the January issue of the Archives Françises de Pédiatric, 22:5, 1965).
Intradermal Injections of Influenza Vaccine
Authors: Greenblatt Jacob
Published: December 2021

Several colleagues and I have been administering 0.1 to 0.2 cc influenza vaccine intradermally into infants and children for a numher of years. This was based on a report on adults that intradermal injections give almost as high titers as subcutaneous.

The impression is that these injections were effective and without side effects. A systematic study should be done.
Pediatric Care for the Children of your Friends
Authors: Work Henry H.
Published: December 2021

In the article of Drs. Carey and Sibinga (Pediatrics, 42:106, 1968) comment is made on the second page that psychiatric literature in general offers little pertinent material about their topic. This, in a way, is true since it has become part-and-parcel of the accepted credo of psychiatric practice that one does not get involved with one's family or friends. Such an idea relates to much earlier work in the field of psychiatry when the concept of the importance of the transference and the emotional involvement with one's patient became clear.
Letters to the Editor
Authors: Carey William B. , Sibinga Maarten S.
Published: December 2021

Drs. Carey and Sibinga comment on these two letters as follows.

Are there any other opinions from correspondents?

We are grateful to Dr. Work for his supportive comments on the issue of whether pediatricians should provide medical care for their friends' children.

The mention of the trends in family therapy is not exactly pertinent to our central thesis. The relationship described is still basically professional, although the therapist can become quite involved with the family.
Another Pigment in the Urine
Authors: Britton Howard A. , Hilton Charles B.
Published: December 2021

This is apropos of the article by Dr. Thomas E. Cone, Jr., "Diagnosis and Treatment: Some Syndromes, Diseases, and Conditions Associated with Abnormal Coloration of the Urine or Diaper" (Pediatrics, 41:654. 1968).

Recently we have noted a blue-green discoloration of urine during the first 3 to 4 days of life from infants whose mothers had received intravenous methylene blue in conjunction with propitocain hydrochloride (Citanest registered) an anesthetic agent used for caudal anesthesia. Since this anesthetic agent is capable of producing methemoglobinemia, a number of obstetricians routinely administer 1 to 2 mg per kilogram of a 1% solution of methylene blue to the mother intravenously and this produces a blue-green color to the infant's urine.
SMALLPOX VACCINATION OF ECZEMA PATIENTS WITH A STRAIN OF ATTENUATED LIVE VACCINIA (CVI-78)
Authors: Kempe C. Henry , Fulginiti Vincent , Minamitani Mikio , Shinefield Henry
Published: December 2021

A group of 1,009 patients suffering from eczema or other skin disorders have received elective vaccination with the CVI-78 strain of vaccinia. The vaccine is attenuated by repeated passages through chick embryos; its infectivity titer is 8.4 (TCID50/ml). It is free of bacteria and known viruses, including avian leukosis virus. It was administered by one of two routes (multiple pressure or subcutaneously) with a minimal dose of 1,000 TCID50 and a maximal dose of 30,000 TCID50. Local and systemic reactions and temperature elevations in these eczematous patients were significantly less marked than those experienced with a standard strain of vaccinia in normal children. No virus dissemination or other complications occurred, except for two instances of mild erythema multiforme. Seroconversion was noted in all 387 patients tested to date. Multiple pressure revaccinations with a standard strain 1 to 6 months later resulted in marked modification of the vaccination reaction without systemic reactions. It would appear that the CVI-78 strain of vaccinia virus is effective and safe for elective primary vaccination of children suffering from eczema.
PROPER LOCALIZATION OF UMBILICAL ARTERIAL AND VENOUS CATHETERS BY LATERAL ROENTGENOGRAMS
Authors: Baker David H. , Berdon Walter E. , James L. Stanley
Published: December 2021

Widespread use of umbilical arterial and venous catheters to monitor the acid-base status of sick newborn infants has made proper placement of such catheters mandatory. Clinical assessment of their placement is poor. Radiographic localization is simple with anteroposterior and most important lateral films of the chest and abdomen. The venous and arterial course is totally different since the vein ascends anteriorly, while the artery descends to join the pelvic arteries before a posterior ascent into the aorta. The lateral film is optimal to identify inadvertent venous catheterization of a mesenteric vein or a wedged portal vein site. The lateral arterial view allows correction should the catheter slip into the ductus arteriosus and pulmonary arteries.

The arterial catheter placement is felt to be best situated either in the chest below the ductus or in the abdomen below the major arteries to avoid either irritation of their ostia or injection of highly alkaline agents into the kidneys or intestines.
IMMUNOFLUORESCENCE IN THE DIAGNOSIS OF ACUTE BACTERIAL MENINGITIS: A COOPERATIVE EVALUATION OF THE TECHNIQUE IN A CLINICAL LABORATORY SETTING
Authors: Fox Howard A. , Hagen Patricia A. , Turner Dorothy J. , Glasgow Lowell A. , Connor James D.
Published: December 2021

Previous workers have described the application of immunofluorescent techniques as a research tool for the identification of the organisms commonly causing acute bacterial meningitis. In this report the evaluation of the fluorescent anti-body (FA) technique in a clinical setting is described. Cerebrospinal fluid (CSF) specimens from 287 patients with acute bacterial meningitis were examined in the routine hospital laboratory by culture, Gram stain, and the FA test. Polyvalent FA reagents as well as group, pool, and type specific reagents for Neisseria meningitidis, Diplococous pneumoniae, and Hemophilus influenzae, respectively, were used in this study. There was no statistically significant difference in the overall number of positive identifications made with each of the three tests (culture, Cram stain, and FA). The FA test provided an immunologically specific identification within one hour of receipt of the CSF specimen and was an accurate method for testing CSF's from patients who had been partially treated with antimicrobial agents. The FA test also was useful in the examination of spinal fluids containing scant numbers of organisms. Examination of spinal fluid by the FA technique appears to be a valuable adjunct in the rapid, specific identification of the three bacterial species commonly causing acute bacterial meningitis.
BENIGN INTRACRANIAL HYPERTENSION ASSOCIATED WITH A DELAYED PENICILLIN REACTION
Authors: Schmitt Barton D. , Krivit William
Published: December 2021

A 9-year-old girl with an unusual, delayed penicillin reaction showed purpura, myalgia, arthralgia, and anemia following a benzathine-procaine penicillin G injection. Benign intracranial hypertension, not previously reported with penicillin reactions, was manifested by headache, papilledema, clonus, cerebral spinal fluid pressure of 410 mm of water, and a normal carotid arteriogram. All of the patient's symptoms cleared spontaneously within 5 weeks after their onset. The presumed pathophysiology of this association was cerebral angioedema and vasculitis. The patient is the seventh reported as experiencing a systemic reaction to penicilloyl-polylysine skin testing.
METABOLIC STUDIES IN TWO BOYS WITH CLASSICAL PROGERIA
Authors: Villee Dorothy B. , Nichols George , Talbot Nathan B.
Published: December 2021

Two boys with classical progeria have been studied by a variety of laboratories in the Boston area. Evidence for unresponsiveness to growth hormone, relative insulin resistance, and highly cross-linked collagen is presented. The data support the concept that progeria represents a form of mesenchymal dysplasia in which connective tissue cells are unresponsive to growth influences. It is hypothesized that this failure to grow may account for the "older" collagen which may in turn produce structural abnormalities in vessel walls predisposing to atherosclerosis.
DIAGNOSIS AND TREATMENT: CHILDREN WITH FEVERS
Authors: Cone Thomas E.
Published: December 2021

In the infant the temperature rises on the most trivial cause; it may be lumpy faeces in the intestine, it may be a slight coryza. I have seen cases where even some irritation of the skin seemed sufficient cause; as the child grows older, similarly but less often, constipation, some slight deviation from a customary diet, or even some unwonted excitement may be sufficient cause for a rise in temperature.1

Sir George Frederic Still

STILL'S explanation of some of the causes of fever in the infant and child may not be acceptable to the contemporary practitioner, but none would doubt that the clinical thermometer has been both an instrument of great diagnostic value, yet often a source of undue parental anxiety. Ever since Traube in 1850 first recommended routine daily recording of the temperature of ill children, the normal diurnal variations of body temperature in infants and children remain of clinical interest-and at times misunderstanding. Parents and some physicians forget that no one temperature reading can be given as normal for all children at all times.

BODY TEMPERATURE MEASUREMENT IN CLINICAL PRACTICE

The internal temperature of the body can best be determined by a rectal thermometer. But, even rectal temperature readings may not be a true record of the body's deep temperature because of variations in the technic of using the thermometer. When, under experimental conditions, the thermometer is inserted 14 cm, the reading will be 0.3 to 2.4°F(0.2 to 1.3°C) higher than when it is inserted between 2 and 6 cm, as is the custom in clinical practice.
BETA-HEMOLYTIC STREPTOCOCCAL SEPTICEMIAS IN CHILDHOOD LEUKEMIA
Authors: Dudding Burton , Humphrey G. Bennett , Nesbit Mark E.
Published: December 2021

During a 12-year period from 1955 to 1967, 13 episodes of beta-hemolytic streptococcal septicemia have occurred in 12 children with leukemia; 4 of these episodes occurred within 6 months prior to this report. Based on a review of septicemia in childhood leukemia from 1953 to 1963 at this same hospital, the frequency of septicemia caused by beta-hemolytic streptococci was 6.3%. An estimated frequency during the period covered by this report is between 5 and 10%, a percentage that is much higher than has been reported elsewhere.

Beta-hemolytic streptococcal septicemia occurred during all stages of the leukemic process, but only in four instances could the septicemia have been related to the child's death. Eleven children had acute lymphatic leukemia, and one had acute promyelocytic leukemia. Although the clinical and laboratory findings associated with septicemia were similar in most instances (spiking fever, anorexia, lethargy, severe leukopenia, anemia, and so forth), the source of the infection which led to the septicemia was obvious only in one child who had cellulitis and thrombophlebitis. Despite the lack of clinical findings commonly associated with beta-hemolytic streptococcal infections, 8 of 12 patients who had routine throat cultures taken at the onset of septicemia had positive cultures for beta-hemolytic streptococci. Further identification of the organisms suggested that the same organism found in the blood was also present in the throat of these individuals.

Grouping and typing of the beta-hemolytic streptococci isolated from these children revealed that nine of the septicemias were caused by a proven or presumptive group A streptococcus, whereas only four were caused by non-group A streptococci. The latter organisms may produce disease in man but their role in human disease is more often like that of other opportunistic pathogens. The greater number of group A streptococcal septicemias in these children may simply reflect the fact that this organism commonly produces upper respiratory disease in childhood. Nine of these leukemic children recovered from the septicemia. This finding plus the frequency with which beta-hemolytic streptococcal septicemias are reported in these patients should increase the awareness of physicians to this relatively easily diagnosed and treated infectious complication of childhood leukemia.
HEIGHTS OF 12-YEAR-OLD PUERTO RICAN BOYS IN NEW YORK CITY: ORIGINS OF DIFFERENCES
Authors: Abramowicz Mark
Published: December 2021

Heights of 12-year-old Puerto Rican boys attending New York City schools are influenced by place of birth and number of years residence in New York. As would be expected from other population studies, Puerto Rican boys born in New York are taller than boys born in Puerto Rico. However, in addition, boys who came to New York after the age of 6 years demonstrate a highly significant regression relationship between height at age 12 and years of residence in New York.
WHAT CHILDREN IN 1844 READ ABOUT THEIR LIFE EXPECTANCY IN A WIDELY USED SCHOOLBOOK OF THAT PERIOD
Authors: C. T. E.
Published: December 2021

In Mrs. Jane Taylor's popular, small, paperback schoolbook entitled, Physiology for Children, the length of life in the 1800's was given as follows:

Do most people live to be old? No, one half die before they are eight years old. Only one out of three lives to fourteen, and but one in four lives to see twenty-one.1
HIATAL HERNIA AND GASTROESOPHAGEAL REFLUX IN CHILDREN
Authors: McNamara J. Judson , Paulson Donald L. , Urschel Harold C.
Published: December 2021

Gastroesophageal reflux, usually with associated hiatal hernia, is recognized as a cause of disabling esophageal and respiratory complications in all age groups; but, until recently, it has been thought to be an unusual problem in infants and children. Respiratory complications, now appreciated with increased frequency in the adult population, may also occur in the pediatric age group.

Thirty patients under 20 years of age with gastroesophageal reflux are presented. Eighteen patients underwent surgical repair. Respiratory complications alone occurred in 3 patients, 2 had only esophageal complications, and 13 had both respiratory and esophageal complications or symptoms as indication for surgery. Symptoms and signs of both respiratory and esophageal complications are tabulated.

Results of medical and surgical therapy are summarized. Surgical patients all represented failure of at least 1 year of medical treatment. Fourteen patients were asymptomatic (excellent result) 6 months to 6 years after surgery. One was considered a good result, one was considered a fair result, and two were considered poor results or failures of surgical treatment.

Results of surgical treatment depends principally on appropriate patient selection. The diagnostic approach particularly in patients with respiratory complications of gastroesophageal reflux is outlined.

The data indicates that many severe recurrent respiratory problems of unexplained etiology in infants and children are due to gastroesophageal reflux and aspiration.
CHROMOSOME STUDIES IN PATIENTS WITH HYPOSPADIAS
Authors: Juberg Richard C. , Jewson Douglas V. , Taylor Mary Belle , Moore Vicki L.
Published: December 2021

Hypospadias in the male has frequently been regarded as a mild form of intersexuality. This concept is based only upon the observation that a male with hypospadias is morphologically more similar to a female than is a male without abnormality of the external genitalia. There has been no demonstration that the presence of feminine cells causes this deviant development. This investigation was designed to see if patients with hypospadias possessed evidence of intersexuality by having cells in their circulating blood which were not consistent with their phenotypic sex. The probability that such cells existed in patients with hypospadias was considered greater as the site of the urethral orifice progressed toward the perineum.

Among the 21 patients ascertained, location of the urethral meatus was glandular in 8 patients, penile in 6, at the penoscrotal junction in 2, scrotal in 2, and perineal in 3. Six patients also possessed abnormalities of the scrotum, testes, or kidneys, and 12 had congenital malformations of other systems.

Chromosomes obtained by leukocyte culture were studied in approximately 30 cells per patient. Neither chromosomal structural abnormalities nor mosaicism was demonstrated in any of the patients. Thus, there appears to be no genetic basis for the assumption that hypospadias in the male represents a form of intersexuality.
ECOLOGY OF WISCONSIN PEDIATRICIANS
Authors: Tenney Horace K. , Smith Nathan J.
Published: December 2021

The ecologic approach so useful in the study of multivariant phenomonae has been applied to a study of the physicians practicing pediatrics in Wisconsin. Ninety-five percent of the 139 physicians engaged in practice were interviewed personally by a professional survey worker inquiring about their education, training, practice, and attitudes. An overwhelming majority were satisfied with their professional work even though they worked an average of 60 hours per week and saw 150 patients, more than one half of whom were well babies, and even though they felt that their speciality as a whole was underpaid. Looking back on their training, many thought that it should have been more appropriate to the type of patient they would be seeing.
Letters to the Editor
Authors: Baum David , Dillard David H. , Mohri Hitoshi , Crawford Edward W.
Published: December 2021

Thank you for the opportunity to comment on Dr. Wolfson letter.

Apparently, Dr. Wolfson misread portions of our article and one of its more important references. For example, we did not conclude that lowered temperature impairs hepatic function because of an increase in the ratio of plasma glycerol to FFA and a failure to metabolize infused glucose with deep hypothermia. We suggested on page 103 of our article that (1) the disparate relationship between plasma glycerol and FFA and (2) the parallel courses of plasma glycerol and lactate levels found in our hypothermic patients might be the result of impaired liver function, but not necessarily indicative of it.
Foetal and Neonatal Physiology: A Comparative Study of the Changes at Birth, by Geoffrey S. Dawes, D.M. Chicago: Year Book Medical Publishers, Inc., 1968, 247 pp., $11.00
Authors: Smith Clement A.
Published: December 2021

In the review of Foetal and Neonatal Physiology: A Comparative Study of the Changes at Birth, by Geoffrey S. Dawes (Pediatrics 43:312, 1969), reference was made to Barcroft's Researches on Perinatal Life. The correct title is Researches on Prenatal Life.
SIGNIFICANCE OF SPLIT PRODUCTS OF FIBRIN IN SERUM OF THE NEWBORN
Authors: Nathan David G. , Lubin Bertram H.
Published: December 2021

The paper of Stiehm and Clatanoff,1 in this issue of Pediatrics, examines in a clear and highly productive fashion an extremely important problem in the management of critically ill patients and in the pathophysiology of coagulation. Hemorrhage in infection is a well established phenomenon; and, in the newborn with so-called purpura fulminans, it may be as disastrous as the now nearly forgotten Waterhouse-Friderichsen syndrome. The infusion of suspended particles of the size of bacteria, or of soluble endotoxin, into experimental animals may also be associated with profound bleeding, and this has recently been ascribed to thrombocytopenia which may result from reticuloendothelial sequestration of particle-induced platelet clumps.
ANATOMIC FACTORS CAUSING RESPIRATORY DISTRESS IN ACYANOTIC CONGENITAL CARDIAC DISEASE
Authors: Stanger Paul , Lucas Russell V. , Edwards Jesse E.
Published: December 2021

Respiratory symptoms in acyanotic congenital cardiac disease may result from several factors, including cardiac failure and bronchial obstruction. Significant bronchial compression by hypertensive pulmonary arteries and, in some cases, the left atrium, also may occur. Sites of predilection are the left main bronchus and the left upper and right middle bronchi. The latter two sites correlate with distribution of lobar emphysema in acyanotic congenital cardiac disease.
SPLIT PRODUCTS OF FIBRIN IN THE SERUM OF NEWBORNS
Authors: Stiehm E. Richard , Clatanoff Dallas V.
Published: December 2021

Levels of split products of fibrin (SPF), as measured by an immunologic tube precipitin method, were studied in cord and maternal sera obtained shortly after delivery. One hundred thirty-seven of 208 (65%) of vaginally delivered, term newborns, 28 of 48 (58%) of cesarean section delivered newborns, and 9 of 13 (69%) of low birth weight infants had SPF in their cord serum. Serial studies in 14 infants indicate that SPF disappeared from the serum within 24 hours with a half-life of 3 to 6 hours. The presence of SPF in the serum of newborn infants after 24 hours (found in 7 of 11 sick infants in this study) suggests a pathologic condition associated with fibrin breakdown such as sepsis, respiratory distress, or internal bleeding.

Cord serum SPF levels were not correlated with levels of other coagulation factors, nor with clinical features such as length of labor. Since SPF in cord serum are not increased in traumatic delivery, we conclude that their origin is the continuous lysis of clots within the placenta.

SPF were also present in 23 of 77 (30%) maternal sera obtained immediately after delivery. There was no correlation between maternal and cord serum SPF levels and their pattern differed on immunoelectrophoresis. Maternal SPF levels appear during labor and disapppear shortly after delivery.
An Index of Infant Health Supervision
Authors: Barron Bruce A. , Mindlin Rowland L.
Published: December 2021

The health supervision of infants under 1 year of age comprises a major segment of pediatric practice. Nevertheless, many infants receive only sporadic or episodic care. In this paper a numerical index is presented with which organized programs or private practitioners can rate the infant health supervision they actually provide. It may be used to (1) evaluate the patterns of preventive care of individual patients within a given program or practice, (2) identify meaningful subsets of infants within a given program or practice with respect to their health supervision, and (3)contrast the experience of one program or practice with another.
Tablets Versus Suspensions of Anticonvulsants
Authors: Lagos J. C.
Published: December 2021

In the past 2 months we have seen five young children with signs and symptoms of dilantin intoxication manifested in the form of ataxia, nystagmus, and drowsiness. The intoxication in all cases was iatrogenic and resulted from the use of the suspension form of the drug. In one case it was due to a mistake on the part of the mother (teaspoons were given instead of milliliters). After reduction of the dosage of dilantin on its withdrawal and replacement by another anticonvulsant, all signs and symptoms disappeared in 24-78 hours.
LEUKEMIC INFILTRATION OF THE TESTES DURING BONE MARROW REMISSION
Authors: Finklestein Jerry Z. , Dyment Paul G. , Hammond G. Denman
Published: December 2021

The clinical courses of four boys with acute lymphocytic leukemia who developed leukemic infiltration of their testes while in bone marrow remission are described. Clinically, they had only unilateral involvement; however, histologically, bilateral disease was present in the three patients who underwent biopsy of the contralateral organ. The development of testicular leukemia did not herald immediate bone marrow relapse. Management is discussed which includes surgery and radiotherapy.
Care of the Well Baby: Medical Management of the Child from Birth to Two Years of Age, ed. 2, by Kenneth S. Shepard, M.D. Philadelphia: J. B. Lippincott Co., 1968, 368 pp., $12.50
Authors: Hughes James R.
Published: December 2021

The principal value of this compact book is its description of one man's practice of well baby office pediatrics in the 1960's. The major textbooks of pediatrics fail to convey such a succinct definition of the practicing pediatrician's role. Such a brief "how to" book, of course, necessarily omits the "why to" which must underlie rational medical practice. As the author emphasizes, however, "We do not say that this is the way but, rather, that this is a way of approaching the month to month problems of mothers and their babies."
A DUTIFUL DAUGHTER MAKES THE BEST WIFE
Authors: C. T. E.
Published: December 2021

Once upon a time young girls were told by their elders that to be a good wife it was all important to have behaved in a tender and respectful manner toward their parents. The quotation below, which was written by David Fordyce a little more than a century ago, is a good example of the type of teaching given to young ladies in those days.

When a young woman behaves to her parents in a manner particularly tender and respectful, I mean from principle as well as nature, there is nothing good and gentle that may not be expected from her in whatever condition she is placed. Of this I am so thoroughly persuaded, that, were I to advise any friend of mine as to his choice of a wife, I know not whether my first counsel would not be, "Look out for one distinguished by her attention and sweetness to her parents." The fund of worth and affection, indicated by such a behaviour, joined to the habit of duty and consideration thereby contracted, being transferred to the married state, will not fail to render her a mild and obliging companion.1
CARE OF THE CRITICALLY ILL CHILD: ACUTE ADRENAL INSUFFICIENCY
Authors: Bongiovanni Alfred M.
Published: December 2021

Although critical illness may occur in the course of chronic adrenal insufficiency (Addison's disease ), the causes of acute adrenal insufficiency in childhood are generally different. These include aplasia or hypoplasia of the adrenal gland in infancy, adrenal hemorrhage (usually in the newborn ), fulminating infections (rarely ), discontinuation of steroid therapy, and unilateral adrenalectorny for a tumor causing Gushing's syndrome. In addition, there are certain salt-losing syndromes associated with a relatively low aldosterone secretion, occurring either as primary diseases or in conjunction with classical, congenital, virilizing adrenocortical hyperplasia. There is actually little proof that fulminating infections, per se, cause acute adrenal insufficiency, whereas a body of evidence suggests ample adrenocortical response most of the time. This applies to the secretion of the corticoids as well as aldosterone. Thus, empirical use of steroids to treat serious infection is not sanctioned here.

The keys to therapy of adrenocortical failure include fluid and electrolyte replacement as well as appropriate steroid hormone replacement. Approxim ately 100 to 120 ml of isotonic saline solution per kilogram of body weight should be administered intravenously to children weighing up to 20 kg within the first 24 hours, and 75 ml per kilogram should be administered when the weight is above 20 kg. These recommendations are based on the special situation applicable to the dehydration of adrenal failure where extracellular fluid loss pnedominates. When shock is especially severe, 5 ml of plasma per kilogram may be substituted volume for volume as part of the mitial replacement fluid.
The Body Lymphatics in Neonatal Hyaline Membrane Disease
Authors: Lauweryns J. M. , Deleersnyder M. , Boussauw L.
Published: December 2021

In analyzing the significance of the recently reported increase in diameter of the pulmonary lymphatics in neonatal hyaline membrane disease (HMD), it seems pertinent to examine by identical morphometrical methods and in the same infants the occurrence versus the absence of this same phenomenon in some other body organs. Were this lymphangiectasis—as claimed by Stowens—of a very generalized distribution throughout the body, one would indeed have to consider the significance of its occurrence in the lungs in a more general way, i.e., as not only restricted to a more exclusive pulmonary origin (such as a disturbed alveolocapillary wall permeability, a delayed removal of fetal lung liquid, or higher surface tension characteristics).
DRUG ABUSE IN ADOLESCENCE
Authors: Deisher Robert W. , Schroeder Albert J. , Allen V. Robert , Bakwin Harry , Eisner Victor , Garell Dale C. , Hammar S. L. , Hazard Sprague W. , Shaffer Thomas E. , Welty John Allen , Wood Charles Louis , Keck Charles , Blaine Graham
Published: December 2021

The pediatrician can be useful to the young person with a drug problem if he: (1) is aware of the different motivations for drug abuse by adolescents and how to approach them, (2) recognizes the need for confidentiality, (3) provides factual information in a non-authoritarian manner and listens and counsels as indicated, and (4) manipulates the environment-to relieve school and family pressures and to help youngsters find better challenges.

Drug abuse in children and adolescents is a major source of concern to parents, educators, law enforcement agencies, and physicians. For the pediatrician as well as the others, a challenge exists to find more appropriate ways of help for young people who turn to drug abuse for the answer that is not there.
CARDIAC CATHETERIZATION IN THE NEWBORN: EXPERIENCE WITH 100 CASES
Authors: Varghese P. J. , Celermajer J. , Izukawa T. , Haller J. Alex , Rowe R. D.
Published: December 2021

One quarter to one third of all children born alive with congenital heart disease are dead by the end of the first month of life. To decrease the overall mortality of congenital heart disease, early diagnosis and management in this age group are important. One hundred infants under 1 month of age underwent cardiac catheterization during a 4½-year period (1964-1968). The indications for the investigation were congestive cardiac failure alone in 45%, cyanosis alone in 23%, and a combination of heart failure and cyanosis in 30%. A diagnostic classification of the cases is presented and the major groups are briefly outlined.

The total mortality was 57%. Fifty-three patients underwent cardiac surgery and 22 (42%) survived. Nineteen patients died within 24 hours of cardiac catheterization without operation. The high mortality after surgery and cardiac catheterization in this age group is emphasized, and the factors involved are discussed.
HEREDITARY ELLIPTOCYTOSIS: AN UNUSUAL PRESENTATION OF HEMOLYSIS IN THE NEWBORN ASSOCIATED WITH TRANSIENT MORPHOLOGIC ABNORMALITIES
Authors: Austin Robert F. , Desforges Jane F.
Published: December 2021

Three cases of hereditary elliptocytosis in siblings are presented with hemolysis and hyperbilirubinemia in the newborn period requiring exchange transfusion. In two infants, transient morphologic changes of the red cell were noted shortly after birth. The clinical course of the third infant is suggestive of a similar course of events.

Attention is drawn to the presenting morphologic picture, which was not diagnostic of elliptocytosis but more closely resembled pyknocytosis.
INFANT DEVELOPMENT IN THE ZINACANTECO INDIANS OF SOUTHERN MEXICO
Authors: Brazelton T. B. , Robey John S. , Collier George A.
Published: December 2021

Neonatal observations and monthly tests of development administered to southern Mexican Indian infants in the first 9 months were coupled with observations in their homes. The behavior of the neonates was strikingly different from Caucasian infants in North America. The mothering practices seemed to reinforce their quiet alertness. Despite little opportunity to practice or "learn" motor and cognitive tasks, the infants' development paralleled that of babies in the United States, but it was delayed by 1 month. The importance of understanding genetic and innate characteristics, as well as environmental influences, in accounting for differences in development among individuals and cultures is emphasized by this paper.
Neonatal Hyperbilirubinemia
Authors: Aase Jon M.
Published: December 2021

I read with interest the obervations of Dr. Milby and his co-workers (Pediatrics 43:601, 1969) regarding seasonal variations in neonatal hyperbilirubinemia. The differences between the two hospitals in the yearly fluctuation of the bilirubin levels is intriguing and raises a question about possible etiology which might bear consideration.

Several recent reports have emphasized the effect of light on the degradation of bilirubin. Is there a possibility tha the two hospital nurseries differed in the amount of light to which the infants were exposed?
Pediatrics, edited by Henry L. Barnett, M.D., with the collaboration of Alfred H. Einhorn, M.D. New York: Appleton-Century Crofts, 1968, 1847 pp., $24.50
Authors: Jolly Hugh
Published: December 2021

Although this is the fourteenth edition of this textbook, it should be clearly understood that it is an almost entirely new book; the editor, in his preface, refers to it as a "first" edition. Dr. Henry Barnett has been assisted by a large team of distinguished pediatricians, and he has accepted the challenge of increasing specialization within the framework of pediatrics by appointing 18 assistant editors. Each of these editors has been responsible for the choice of his own team of contributors.
NURSERY ROUTINES AND STAPHYLOCOCCAL COLONIZATION OF THE NEWBORN
Authors: Williams Christopher P. S. , Oliver Thomas K.
Published: December 2021

Staphylococcal colonization was studied in a newborn nursery for 6½ years. Culture of the nares of each infant at the time of discharge was found to be a simple, effective monitor. The average rate of 4.1% demonstrates that a low rate can he maintained for an extended period of time. Hexachlorophene bathing of infants and handwashing by personnel between the handling of infants appear to be the critical elements of staphylococcal control. Neither the modification of infant bathing to the extent of deferring the initial bath until the attainment of thermal homeostasis, nor of handwashing to the extent of eliminating brushes resulted in increased colonization. It was also possible to eliminate certain traditional elements of nursery routine-the wearing of caps, masks, hair nets, and gowning except when handling an infant outside an incubator-and to allow medical students and parents fret access to the nurseries, all without an increase in colonization. Elaborate nursery precautions are not only expensive but may also discourage physicians from giving optimal care to ill infants; judicious changes in nursery technique may be made, as long as there is careful surveillance of bacterial colonization and infection.