bluuebunny/crossref_metadata_2025 huggingface dataset:
Head Circumference Growth in North American Negro Children
Authors: Nellhaus Gerhard
Published: December 2021

The growth of maximal occipito-frontal head circumference in North American Negro children, as reported recently by Verghese, et al.,1 deviates significantly in early life from the patterns calculated by me on the basis of reports from the world literature since 1948.2 This variance (Fig. 1 and 2), in which the means (x) ± 2 SD (·) of the head circumferences of the Negro children are plotted on the international and interracial graphs published in Pediatrics,1 warrants additional attention and analysis.
PHOTOTHERAPY OF SEVERE UNCONJUGATED HYPERBILIRUBINEMIA: FORMATION AND REMOVAL OF LABELED BILIRUBIN DERIVATIVES
Authors: Callahan Edward W. , Thaler M. Michael , Karon Myron , Bauer Karinne , Schmid Rudi
Published: December 2021

Formation and disposition of the photodegradation products of bilirubin was studied in two infants with severe unconjugated hyperbilirubinemia (Crigler-Najjar syndrome) who responded to phototherapy with a marked and sustained fall of serum bilirubin. During exposure to light, tracer amounts of 14C-bilirubin were infused at constant rates for periods of 10 and 24 hours. Radioactivity in bilirubin and in its photoderivatives was determined in serially collected samples of plasma, urine, and bile. Direct evidence was obtained that light converts bilirubin in vivo to more polar, predominantly diazonegative, and presumably less toxic derivatives which are rapidly excreted in bile and urine without detectable retention in the plasma. These findings provide experimental support for the use of phototherapy in the management of hyperbilirubinemia in infants.
CALCIUM DEFICIENCY RICKETS AND THE RENAL RESPONSE TO CALCIUM INFUSION
Authors: Maltz Howard E. , Fish Mathews B. , Holliday Malcolm A.
Published: December 2021

The diagnosis in a 1-year-old female with skeletal and chemical rickets, generalized hyperaminoaciduria, and metabolic acidosis was uncertain, and primary renal disease (i.e., Fanconi "syndrome") was considered. She had been on a diet which was deficient in calcium (approximately 21 to 36 mg calcium daily) but adequate for phosphorus and vitamin D. Her skeletal and renal lesions resolved within 3 months on a high calcium diet.

Early in her hospital course, an intravenous calcium infusion provided 10 mg/kg calcium, as calcium gluconate over 3 hours; 8 to 10 hours later, a significant reduction in urinary amino acids and phosphorus was observed. The mechanism through which this response was mediated is postulated to be via reduction in circulating parathormone.
Meningitis Due to Mumps Virus in a Child with Acute Leukemia
Authors: Rupprecht Lothar M.T. , Naiman J. Lawrence
Published: December 2021

An 8½-year-old boy with leukemia in remission developed a meningitis-like syndrome associated with increased mononuclear cell count in the cerebrospinal fluid. Examination of the stained CSF sediment showed these to be small lymphocytes rather than lymphoblasts, suggesting a diagnosis of viral meningitis rather than leukemic infiltration of the meninges. Serologic studies gave evidence of a recent mumps virus infection. Viral meningitis should not be overlooked in the differential diagnosis of meningeal reactions in children with leukemia.
LOW BIRTH WEIGHT AND PRENATAL NUTRITION: AN INTERPRETATIVE REVIEW
Authors: Bergner Lawrence , Susser Mervyn W.
Published: December 2021

Birth weight is considered as a possible crucial intervening variable in a causal sequence that leads from prenatal nutrition to perinatal mortality and retarded child development. Birth weight is shown to have a stronger correlation with perinatal mortality than length of gestation. In New York City, if black infants had the same birth weight distribution as white infants, and the same weight-specific perinatal death rates as they now do, their expected overall perinatal death rate would be the same as for white infants.

Three conclusions are germane to the prevention of low birth weight: first, the fetal growth that leads to important variation in birthweight occurs in the last trimester; second, birth weight is influenced by factors in the wider environment as well as in the maternal environment; and third, birth weight is influenced by factors having their origin and effect during gestation.

The role of maternal nutrition during gestation is then examined as a factor in birth weight. Observational studies of circumstances of wartime deprivation support a nutritional hypothesis, but observational studies of everyday diets in pregnancy, and quasi-experimental studies that supplement nutrition in pregnancy, have given equivocal results.

The hypothesis requires fresh testing. An experimental approach can eliminate or control many extraneous and confounding variables.
Letter To The Editor
Authors: Gold Arnold P.
Published: December 2021

Dr. Scanlon's observations concerning the combination of dextroamphetamine and ephedrine in a 7-year-old boy with hyperkinetic behavioral syndrome is most interesting and perhaps bears further investigation.

I am uncertain what was the effect of dextroamphetamine alone referable to the overall behavioral patterns. There are comments referable to headaches and visual phenomena, but there was no clear statement concerning the effect of this drug on hyperkinetic behavior.

In my experience with hyperkinetic children, headache is rarely mentioned as an unfavorable reaction to dextroamphetamine and for this reason I have not had the opportunity to evaluate the combination with ephedrine.
Measles (Rubeola) and Rubella: (1) Dangers of the Layman's Confusion (2) Mass Measles Immunization
Authors: Lewak Norman
Published: December 2021

The apathy of the public (including the medical profession) in regard to the fact that measles can be a dangerous disease has been a concern of mine for the past few years (Pediatrics, 34:438, 1964). Because of that apathy, a mass immunization campaign never occurred and we had unnecessary morbidity and mortality. Routine immunization is now with us; the incidence of measles has finally declined. But the apathy has continued, and since immunity is far from universal, new epidemics are being forecast.
Group at Risk in Low Birth Weight Infants and Perinatal Mortality Supplement 193 of Acta Paediatrica Scandinavia), by Paula Rantakallio. Oulu, Finland: Department of Pediatrics, University of Oulu, 1969, 71 pp., no price given
Authors: Abramowicz Mark
Published: December 2021

In this monograph, Dr. Paula Rantakallio of the Department of Pediatrics, University of Oulu, Finland, presents a useful approach to the related problems of prematurity and perinatal mortality. She has studied all of the 12,000 births that occurred in 1966 in the northern part of Finland and noted the characteristics of mothers whose pregnancies ended in delivery of a low birth weight infant or a perinatal death. These mothers were compared to a sample of the total population with respect to a number of variables that could be characterized at the onset of pregnancy ( maternal stature, history of previous pregnancies, etc.).
Evidence for Delayed Histidine Transamination in Neonates with Histidinemia
Authors: Levy Harvey L. , Madigan Phyllis M. , Peneva Petrana
Published: December 2021

The excretion of metabolites of histidine transamination by histidinemics, specifically imidazolepyruvic acid (IPA), imidazolelactic acid (ILA), and imidazoleacetic acid (IAA) is less in the neonatal and early infancy periods than in later life; whereas, histidine excretion is generally greater in the early months of life. This suggests that early in life the maturation of histidine transaminase may be delayed.

In screening for histidinemia it is important to recognize that in neonates with histidinemia, IPA excretion may be very low or absent and thus that the ferric chloride test may be negative. For this reason screening procedures that detect increased histidine in urine are much more effective in the early diagnosis of histidinemia than are those procedures that detect only increased histidine metabolite excretion.
Fatal Staphylococcal Septicemia Associated with Use of Jet Injector for Measles Vaccination
Authors: Kassanoff Ira , Nahmias Andre J. , Abrutyn Elias
Published: December 2021

Since 1956, when the jet injector was first used extensively for mass immunization, more than 100 million persons have received various vaccines by this method.1 Jet injectors have been used under crude field conditions as well as in the clinic-hospital environment. However, to the authors' knowledge, there have been no reports of lethal septic complications associated with the use of the jet injector gun.1,2

This report describes a fatal case of staphylococcal septicemia temporally associated with measles vaccine administration via jet injector, and calls attention to a severe, albeit infrequent, complication of jet injection.

Case Report

On October 23, 1968, during a community-wide campaign, a 2½-year-old Negro girl, previously in good health, received further attenuated (Schwarz) live measles virus vaccine via jet injector in the left deltoid region.
The Role of Pediatricians in Health Care Delivery
Authors: Crook William G.
Published: December 2021

As a member of the Sub-Committee on Manpower of the Council on Pediatric Practice, I've long been interested in allied health workers. Certainly, when such workers become available and are appropriately coordinated with others on the health team, the skills and talents of physicians can be used more productively. But I feel that the manpower pendulum in pediatrics may be swinging too far in the direction of allied health workers, and causing us to forget the crucial importance of primary physicians in delivering medical care.
The Pediatrician and the Parent: A Neglected Opportunity
Authors: Cardullo Hugo M.
Published: December 2021

Physicians who treat infants and preschoolers have a unique relationship with young parents which permits them to reach a most influential segment of the population. Thereby they have an opportunity to help to preserve and stabilize the fundamental unit of society-the family.

Few would disagree that the child from 0 to 5 years of age is in one of the most receptive periods in his life. Parental influences in the form of words, actions, and attitudes leave deep and indelible marks on the developing child.
CONGENITAL SYPHILIS: RESURGENCE OF AN OLD PROBLEM
Authors: Wilkinson Robert H. , Heller Richard M.
Published: December 2021

Three infants with congenital syphilis, unrecognized and unsuspected until diagnosis by roentgenograms, are described. Absence of this disease from the same children's hospital for the preceding 5 years may in part explain failure to suspect syphilis in these infants. Lack of communication in a period of frequent movement of patients from clinic to clinic and doctor to doctor is also a factor. The current increase in venereal disease requires a tightening of hospital routines and an increased alertness for a well known but temporarily forgotten pediatric problem.
RENAL ANOMALIES IN THE NEWBORN FOUND BY DEEP PALPATION
Authors: Museles Melvin , Gaudry Charles L. , Bason William M.
Published: December 2021

The policy of vigorous palpation of the abdomen during initial examination of 10,000 newborn infants was followed routinely with special emphasis on tracing the outline of the kidneys. Renal anomalies were suspected in 71 infants, and their presence later proved in 55 of these. Horseshoe kidney occurred most frequently, closely followed by unilateral renal agenesis. The ease of examining, the slight expenditure of time, and the relatively high incidence of discovered renal anomalies make this maneuver an important part of the routine examination of newborn infants.
NEONATAL ADRENAL INSUFFICIENCY ASSOCIATED WITH MATERNAL CUSHING'S SYNDROME
Authors: Kreines Kenneth , Devaux William D.
Published: December 2021

A female infant was delivered prematurely to a patient with Cushing's syndrome due to adrenal adenoma. At 20 hours of life the infant developed vascular collapse, hyponatremia, and hyperkalemia. These features of adrenal insufficiency responded promptly to the administration of hydrocortisone and saline. At 7 weeks, responsiveness of the infant's adrenal cortices to exogenous ACTH was demonstrated. Steroid replacement was subsequently discontinued and the infant has remained well.

Attention is drawn to the unusually high prevalence of adrenal adenoma and carcinoma among the reported cases of pregnancy during Cushing's syndrome.
RENAL HOMOTRANSPLANTATION IN PEDIATRIC PATIENTS
Authors: Lilly John R. , Giles Geoffrey , Hurwitz Richard , Schroter Gerhard , Takagi Hiroshi , Gray Samuel , Penn Israel , Halgrimson Charles G. , Starzl Thomas E.
Published: December 2021

Fifty-seven patients were treated with renal homotransplantation from 1½ to 7⅔ years ago; 23 patients were 12 years or younger and the other 34 patients were 13 to 18. Family members (usually parents) were the primary donors in 45 cases. Unrelated volunteers or cadavers donated the other 12 homografts. Immunosuppression was with azathioprine and prednisone, and in some cases also with ALG. Forty-two of the 57 recipients survived for at least 1 year. Additional deaths occurred at 17½ and 19 months leaving 40 recipients (70.2%) alive. Six survivors had successful retransplantation following late failure of their original homografts. Control of rejection was not particularly different than in adult cases. "Homograft glomerulonephritis" was found in chronically tolerated transplants, but no more frequently than in older patients.

Many postoperative problems in the pediatric age group were the consequence of retardation of growth caused either by pre-existing uremia or by the need for high dose postoperative steroid therapy, orthopedic accidents such as femoral and vertebral fractures, and psychiatric complications which led to two suicides. In spite of these difficulties, the meaningful rehabilitation that was obtained in the chronic survivors makes us regard pediatric patients as favorable candidates for therapy with renal transplantation.
Familial Congenital Duodenal Atresia (Continued)
Authors: Mishalany Henry C. , Der Kaloustian Vazken M. , Ghandour Mustafa H.
Published: December 2021

Since publication of the paper on familial congenital duodenal atresia,1 a baby boy (V 25 -see pedigree) was born in November 1970 to the parents of Case 2 reported therein.

The baby weighed 2,360 gm at birth and had a scaphoid abdomen. He became jaundiced during the first day of life (bilirubin 14.9 mg/100 ml total with 0.45 mg/100 ml direct) but did not require an exchange transfusion. He started vomiting nonbilious material from the first day of life.
Insomnia, Tachycardia, and Cola Drinks
Authors: Silver Walter
Published: December 2021

Recently two clinical patterns came to my attention, seemingly unrelated, but in fact having a similar etiology; the first "tachycardia" and the second "insomnia." They appeared in otherwise healthy preadolescents and were related to intake of cola drinks. Both complaints disappeared when this beverage was withdrawn.

I believe it is important to remember that 12 ounces of a cola drink may contain as much as 55 mg of caffeine, which is approximately one half the caffeine content of an average cup of coffee or therapeutic dose.1
Growing Pains: Concerning the Taking of Rectal Temperatures
Authors: Sarshik Milton
Published: December 2021

The publication Growing Pains is a jointly sponsored book of the American Academy of Pediatrics and the American Medical Association. One needs to assume that the instructions therein are fostered and approved by both of these bodies.

I have objection to the portion of the book which nicely orients the mother to what is expected at her office visits-pages 222 on. Under measurements at each visit up until 5 years of age, it is stated that the child's temperature is taken.
Stoffwechsel Des Neugeborenen (Metabolism of the Newborn), edited by Prof. Dr. med. G. Joppich and Prof. Dr. med. H. Wolf. Stuttgart, W. Germany: Hippokrates Verlag, 1970, 447 pp., no price given
Authors: Reimold Ekkehard W.
Published: December 2021

Behind the ambitious title "Metabolism of the Newborn" one finds the transcript of a symposium held in October, 1968 in West Germany. At this meeting a broad spectrum of interesting topics of neonatal metabolism was presented and discussed. There are, for instance, three papers on metabolic and acidbase changes in the fetus, three presentations on protein and amino acid metabolism in the pre- and postnatal period, four papers on the problems of lipid metabolism, and three papers on some hormonal aspects of the newborn period.
FALLS AS CHILDHOOD ACCIDENTS: AN INCREASING URBAN RISK
Authors: Sieben R. L. , Leavitt J. D. , French J. H.
Published: December 2021

Falls from heights accounted for 20% of accidental deaths of children in New York City during 1966, and 67% of the children were under 5 years of age.

A retrospective study of falls involving more than 10 feet during 1966 to 1968 at a single Bronx hospital affiliation disclosed that 55 children were hospitalized from this cause. Five of these hospitalized patients died, and two were found to have significant residua. This retrospective study of hospitalized patients indicates that falls from heights were a health hazard mainly for preschool males during the warmer summer months in the high rise slums of the south Bronx. Preschool children fell exclusively from windows and fire escapes, with little regard for height. Older children fell from dangerous play areas of lesser height. The need for routine installation of effective window guards is obvious.
PRIMARY IMMUNODEFICIENCIES
Authors: Fudenberg H. , Good R. A. , Goodman H. C. , Hitzig W. , Kunkel H. G. , Roitt I. M. , Rosen F. S. , Rowe D. S. , Seligmann M. , Soothill J. R.
Published: December 2021

1. Two registries are to be established in association with WHO, with the object of gathering and recording information on cases of immunodeficiency from all over the world. One registry will comprise cases of primary immunodeficiency that have received transplants of any immunologically competent organ, cell, or cell product, e.g., bone marrow, thymus, or transfer factor. It will be organized by W. Hitzig and M. Seligmann. The other will comprise cases of malignant tumour found in patients with primary immunodeficiency; it will be organized by R. A. Good, who will also arrange for pathological material to be submitted for study by selected pathologists.

The organizers will collate and periodically report on the material in both registries.

2. Standardization of diagnostic procedures and additional studies related to diagnostic tests are required.

a. There is a need for standard preparations of antigens for assessing antibody formation as described. A sufficiently large batch of such antigens should be prepared, and aliquots should be sent, on request, for use by clinicians investigating immunodeficiency.

b. Methods for measuring serum antibodies need to be standardized, and in vitro tests for the measurement of cell-mediated immunity, such as tests for cytotoxicity and macrophage migration inhibition factors, need to be further developed.

3. Therapeutic procedures should be standardized and assessed.

a. Aggregates in immunoglobulin preparations for intramuscular or intravenous injection should be looked for with tests such as those recommended.

b. National agencies responsible for immunoglobulin production should develop stable aggregate-free intact IgG, without fragments and with relatively normal in vivo survival, for the treatment of patients with immunodeficiency.

c. It would be of value to determine the relative effectiveness of therapy with immunoglobulin and with plasma. Clinical trials might be designed for this purpose.

d. Immunoglobulin preparations having high contents of specific antibodies would, if available, be valuable for treatment of patients with specific infections.

e. Further research is required to develop new methods of destroying the biological activity of lymphocytes in whole blood.

f. Pools of immunoglobulin, prepared as Cohn FII from donors with absence of One genetic allotype, may be valuable for the treatment of patients with immunodeficiency who have anti-allotype antibodies.
IDENTITY DEVELOPMENT IN ADOPTED CHILDREN
Authors: Feiertag Richard B. , Fried Ralph I. , Baratz Merrill A. , Cermak Ethel G. , Daniel William A. , Earlywine Josephine L. , Lewis Donald , Seidel Henry M. , Tillman Mary A. T. , Work Henry H. , Chenoweth Alice D. , Vertiz Antonio Prado
Published: December 2021

A recognition of the psychodynamics relating to the adopted child and his family will allow the pediatrician to prevent or modify destructive and harmful behavior. If adoptive families can be helped to understand the uniqueness of their relationship, much anxiety and doubt can be minimized avoided. Every opportunity must be used to develop in the child a sense of worth, importance, and dignity—a true sense of identity. If the pediatrician is aware of this and develops knowledge and expertise in the adoption field, he can contribute significantly in improving the adoptive process.
Is Reaction to the Population Problem Misplaced?
Authors: Day Richard L. , Pinto Peter S. , Corsa Leslie
Published: December 2021

The September issue publishes two letters1,2 about the population problem which, in their enthusiasm for a cause, unintentionally overlook a propaganda trap which can, and in fact already has led to some unhappiness on the part of some conscientious parents who love children. The approach to the problem exemplified by the letters has also led to bitterness on the part of some black people, though admittedly this bitterness is not justified. There is a way around the trap.
Neonatal Seizure States: Electroencephalography and Diazepam
Authors: Wojcik Joseph S. , Lombroso Cesare T.
Published: December 2021

In reading the Letters to the Editor of Pediatrics in issues subsequent to the March 1970 issue, I have been particularly interested in looking for comments of the paper "Neonatal Seizures State" by Rose and Lombroso.1 I found the paper to be very thorough; however, I question whether EEG's are done routinely in newborn infants with seizures states in significant numbers of medical centers. Do you have knowledge of the EEG being a practical or feasible procedure in the newborn?
Richard's Day
Authors: Schaeffer Robert H.
Published: December 2021

I recently saw a child who had developed acute generalized hives in the middle of the night, and, at my request, his mother typed up a list of all the known "things" that had crossed his lips during the preceding day. His mother works and, therefore, makes use of many convenience foods. I thought it might be interesting for your readers to note what the modern American boy eats these days:

The only thing different that Richard has never had before was two ready baked pie shells.
PULMONARY CAPILLARY FLOW IN THE NEWBORN INFANT: A NEW METHOD USING THE PLETHYSMOGRAPH AND NITROUS OXIDE
Authors: Brady June P. , Chir. B. , Rigatto Henrique
Published: December 2021

Pulmonary capillary blood flow(Qpc) was measured in 24 term infants (5 hours to 14 days of age) using the infant plethysmograph and nitrous oxide (N2O). The method is a modification of the Lee and DuBois technique, the deep inspiration being replaced by a brief period of rebreathing 60% N2O and 40% O2 from a 100 ml bag. The rate of uptake of N2O is divided by the mean alveolar N2O concentration and the solubility in cord blood to give Qpc.

There was a significant increase in Qpc with increasing age from 173 ml/kg/min at 24 hours to 230 ml at 14 days (p < 0.0l). As the method does not measure any shunted blood this change could represent decreasing fetal shunts, but as there was a significant increase in heart rate (125/min at 24 hours to 168/min at 14 days) this seems unlikely. It is suggested that this increase in Qpc follows the known increase in metabolic rate in the newly born infant.

In two anesthetized dogs tile mean difference between Qpc measured with this method and pulmonary arterial flow measured directly from a chronically implanted electromagnetic flowmeter was -2.6% S.E.±3.6%.
DURATION OF NEOMYCIN THERAPY FOR ENTEROPATHOGENIC ESCHERICHIA COLI DIARRHEAL DISEASE: A COMPARATIVE STUDY OF 113 CASES
Authors: Nelson John D.
Published: December 2021

The usually recommended 7- to 10- day course of antibiotic therapy for enteropathogenic Escherichia coli diarrheal disease might be undesirable because neomycin can cause a malabsorption syndrome. One hundred thirteen infants with E. coli arrheal disease were randomly assigned to long-term therapy of 10 days or to short-term therapy. For short-term therapy neomycin was discontinued when daily fluorescent antibody and culture tests were negative; therapy averaged 3 days with a range of 2 to 4½ days for all but one patient. The pathogens were susceptible to neomycin in vitro.

The initial bacteriologic response was the same in both groups. Bacteriologic relapse without return of symptoms occurred in 14 of 57 in the longterm group and in 7 of 56 babies in the short-term group. Organisms isolated during relapse remained sensitive in vitro to neomycin. In the long-term group diarrhea lasted significanfly longer with a trend to delayed onset of steady weight gain and infectious complications were twice as common. There was no significant change in indirect hemagglutinin titer between acute and convalescent sera in 91% of specimens. Current recommendations for duration of therapy should be shortened to 3 to 5 days. This study and a literature review also raise doubts about the real value of antibiotics in this disease.
Herpangina and Pleurodynia Associated with Herpes simplex Virus
Authors: Marks Melvin I.
Published: December 2021

Herpangina and pleurodynia are usually associated with Coxsackie A and Coxsackie B virus infections respectively.l,2 Although echoviruses and other etiological agents have also been described with these syndromes, Herpes simplex virus has not.3,4 The present case is unique in two respects; herpangina and pleurodynia occurred simultaneously in the same patient and both appear to be associated with a primary Herpes simplex virus infection.

Report of a Case

A 15-year-old Caucasian male complained of sore throat with dysphagia 5 days prior to admission to hospital and 3 days later developed increased dvsphagia, malaise, anorexia, and a temperature of 103°F. The following day he complained of distressing retrosternal and left anterior pleuritic chest pain accompanied by nausea.
Adrenals in Ectopic ACTH Syndrome
Authors: Halmi N. S. , Omenn Gilbert S.
Published: December 2021

In Dr. Gilbert S. Omenn's1 otherwise excellent review of ectopic hormone syndromes associated with tumors in childhood we find the following sentence: "Completely characterized cases of ectopic ACTH syndrome have bilateral adrenal hyperplasia, normal pituitary basophils, positive assay for ACTH in the tumor, and failure of suppression of elevated plasma ACTH by dexamethasone." I have no personal experience with the ectopic ACTH syndrome in childhood, but in three cases seen in adults the basophils (more accurately, the ACTH-MSH cells among them), far from being normal, showed the expected profound Crooke's hyalinization characteristic of severe hypercortisolism.2
Improved Method of Lumbar Puncture in the Newborn and Small Infant
Authors: Rothman Fredric B. , Byers Randolph K.
Published: December 2021

Successful lumbar puncture in the newborn or small infant is a matter of luck rather than skill. Practice does not make perfect in the execution of this diagnostically major procedure. Thus, the "traumatic" tap is a frequent acute disappointment for even experienced physicians.

For years I'd accepted the vagaries of chance while seeking crucial data about cerebrospinal fluid. Then one night about 5 years ago the frustrating scenario suggested above was again reenacted. The nursery supply of "spinal needles" was exhausted.
VACCINE-ASSOCIATED POLIOMYELITIS IN A CHILD WITH THYMIC ABNORMALITY
Authors: Riker Jeffrey B. , Brandt Carl D. , Chandra Roma , Arrobio Julita O. , Nakano James H.
Published: December 2021

An 8-month-old girld develoepd paralytic poliomyelitis. Twenty-nine days prior to the onset of paralysis she had been in contact with a sibling recently immunized with trivalent oral polio vaccine.

The patient died because of intercurrent respiratory infection. "Vaccine-like" Type 3 poliovirus was isolated from the throat, stool, and postmortem brain and spinal cord spciemens. Histologic examination revealed depltion of all lymphoid tissues. Serum immunoglobulin levels were adequate. We believe this child presents a variant of the syndrome of hereditary thymic dysplasia.
Excerpt XVIII: Boys Fighting
Authors: Cone Thomas E.
Published: December 2021

Children in the early 1800's were offered religious, moral, and intellectual instruction all in the same lesson, as advocated by Dweight.1 Parents, teachers, and ministers firmly believed that they, not Plato, had been the first to imagine, "of all the animals, the boy is the most unmanageable." To some, thrashings were the answer; to Horace Mann, educaton. He wrote "... through the schools we shall teach mankind to moderate their passions and develop their vir tues."2

(With this excerpt, this series comes to an end.)
Neonatal Biliary Tract Infection Coincident with Maternal Methadone Therapy
Authors: Faller W. , Berkelhamer J. E. , Esterly J. R.
Published: December 2021

The increasing incidence of drug abuse has caused considerable concern among health professional groups, but the potential biologic hazards of pleasure giving drugs are poorly defined because of the very limited reliable clinical and laboratory data available. This paucity of information also applies to the role of psychotropic and addicting drugs as teratogenic agents. Chromosomal and congenital defects have recently been associated with LSD,l,2 but no consistent anatomic findings have been found in infants born to opiate-addicted mothers.3,4
Letter to the Editor
Authors: Zellweger Hans
Published: December 2021

It is one of the disasters of our time, that we read too much, too fast and too inexactly and that we are, thus, misled by picking out a single sentence out of context. If Dr. Scheiner would care to read the whole paragraph carefully from which he picked the quoted sentence, we might even agree. What it really meant is that, if physicians and parents have decided to institutionalize a mongoloid child, then parents should be convinced that it is as much for the child's sake as for their own sake.
Letter to the Editor
Authors: Blanton John W.
Published: December 2021

I read the article on vital statistics by Myron E. Wegman in the December 1971 issue of Pediatrics with feelings of gratitude and deep disappointment in Dr. Wegman and Pediatrics.

I was grateful for the reemphasis of the growing discrepancy in rates of infant mortality between whites and nonwhites and the implied unequal distribution of available services of American medicine. Disappointment followed by anger were aroused by Dr. Wegman's reference to "the innate constitutional vigor of black youth," documentation for which he provides by the daily sports pages.
Otitis Media in Infants
Authors: Rothstein Ralph L.
Published: December 2021

Dr. Bland found an increase in otitis media in bottle-fed versus breast-fed infants. He speculates that this may be due to transfer of IgA in breast milk. Another possibility is that the increased incidence of otitis is due to positional differences between bottle- and breast-feeding. Bottle babies are often fed in the recumbent position which promotes entry of milk into the eustachian tubes and the middle ear, whereas the anatomy of the maternal breast requires that the infant's head be vertical during feeding. This concept of positional otitis has been recently reviewed.
Letter to the Editor
Authors: Bland Richard D.
Published: December 2021

Dr. Rothstein has pointed out most appropriately that the relationship between secretory immunoglobulin acquisition via breast-feeding and the apparent lower incidence of otitis media in breast-fed young infants is merely speculative, though consistent with the available immunologic data. I, too, read with interest the retrospective study by Beauregard on "Positional Otitis Media" and the accompanying editorial. I am equally intrigued by the speculative notion that the entry of milk into the middle ear of the supine suckling infant with head extended, so well deomonstrated by Wittenborg and Neuhauser, somehow predisposes to suppurative otitis media.
Letter to the Editor
Authors: Desforges Jane
Published: December 2021

In hemolytic disease, it is always difficult to comment on the properties of red cells which have already been removed from the circulation. One can only study those left behind and presumably, therefore, less injured. However, with the mechanism of immunohemolysis in Rh incompatibility as a prototype, one can propose hemolytic disease of the newborn in ABO incompatibility to be related to a coating antibody which is not complement dependent, rather than to the hemolysin.
PERIODIC BREATHING AND APNEA IN PRETERM INFANTS. I. EVIDENCE FOR HYPOVENTILATION POSSIBLY DUE TO CENTRAL RESPIRATORY DEPRESSION
Authors: Rigatto Henrique , Brady June P.
Published: December 2021

We made 84 studies on 20 "healthy" preterm infants during the first 34 days of life to discover whether infants breathing periodically hypoventilate or hyperventilate and whether the major defect is at the central or peripheral chemoreceptors. Six infants breathed periodically (n = 26) and seven regularly (n = 27) at all times; seven infants breathed periodically (n = 15) or regularly (n = 16) in different studies. In these three groups (periodic, regular, and intermediate), we compared respiratory minute volume and frequency, heart rate, alveolar oxygen tension (PAO2) and alveolar carbon dioxide tension (PACO2) and PO2, PCO2 and pH of arterialized capillary blood, alveolar-capillary differences for PO2 and PCO2, peripheral chemoreceptor sensitivity and CO2 responses. We measured ventilation with a nosepiece and a screen flowmeter. The mean values for the intermediate and periodic groups were similar. There were major differences between the periodic and regular groups. The infants breathing periodically (1) hypoventilated, (2) showed a significant shift of the CO2 response curve to the right with a 22% decrease in slope, and (3) had an increased response to O2. However, the two groups had similar alveolar-capillary PO2 and PCO2 differences. These findings suggest that the major defect is not in the lungs or at the peripheral chemoreceptors but at the respiratory center (or central receptors).
EARLY DETECTION OF PULMONARY FUNCTION ABNORMALITIES IN CYSTIC FIBROSIS
Authors: Lamarre Andre , Reilly Bernard J. , Bryan A. Charles , Levison Henry
Published: December 2021

We studied gas exchange in 19 children with cystic fibrosis in whom measurement of lung volumes, flow rates and airway conductance, diffusing capacity and mixing efficiency were normal.

A significant decrease in arterial oxygen tension was found together with a significant increase in alveolar-arterial difference for oxygen and physiologic dead space/tidal volume ratio. These findings are consistent with evidence that early in cystic fibrosis the site of obstruction is in the small airways. It is also suggested from these data that blood gas abnormalities occur before other parameters of lung function become abnormal.
SLEEP AND ITS DISORDERS IN INFANTS AND CHILDREN: A REVIEW
Authors: Anders Thomas F. , Weinstein Pearl
Published: December 2021

Recently the polygraphic study of sleep has provided techniques for the assessment of central nervous system (CNS) functioning in new-born infants and the diagnosis of sleep disorders in children. First, in this review, the normal developmental course of the "active" and the "quiet" sleep states from birth through childhood is described. Then, within the context of these recent electro-physiologic findings, the abnormalities of sleep state organization during the neonatal period, the physiologic disorders of sleep in older children, and finally, the psychological disturbances manifested through sleep are reviewed.
Tick Toxicosis
Authors: DeBusk Franklin L. , O'Connor Susan
Published: December 2021

In this article we report a case of tick toxicosis. It is hoped that this will serve to remind physicians to consider the possibility of tick toxicosis when confronted with a patient with acute ascending flaccid paralysis or acute ataxia. Tick paralysis, although widely known in many rural areas, is frequently not considered in the differential diagnosis of acute ascending flaccid paralysis; it is even less likely to be considered the basis for an acute ataxia.

Case Report

A 4-year-old Caucasian male was referred to the Emergency Room in May because of rapidly progressive ataxia and nystagmus of 24 hours duration.
Letter to the Editor
Authors: Filer L. J.
Published: December 2021

Availability of fluoride is not to be confused with absorption of fluoride. Fluoride is readily cleared by the kidney, thus, availability must be regarded in terms of retention or net balance. The less than 50% availability of fluoride cited in the Committee report was based on carcass analysis of rats fed fish protein concentrate. Review of the report by Spencer et al. as cited by Hadjimarkos indicates that fluoride or retention balance was 39% to 43% of intake, a value comparable to that observed in the rat.
Letter to the Editor
Authors: Bland Richard D.
Published: December 2021

Possibly no commercial product has achieved such widespread endorsement from the medical profession based on so little meaningful data at considerable cost to the public as soybean infant formulas. This is not to condemn their use, but only to put this type of therapy in its proper perspective, for certainly I too have resorted to this device in the face of frustrating recurrent infection or diarrhea of infants and children.

In response to Dr. Phillips' suggestion, I concur that a trial of milk elimination may be a prudent step in the management of infants with resistant or recurrent bouts of otitis media, prior to placement of P.E. tubes or adenoidectomy.
Complications of Smallpox Vaccination, 1968 Surveillance in a Comprehensive Care Clinic
Authors: Neff John M. , Drachman Robert H.
Published: December 2021

The records of all children who received smallpox vaccination in a large comprehensive care clinic were reviewed for complications. There were 944 vaccinations performed during 1968. Of these, 539 were primary vaccinations, 32 on children in the age group less than 1, and 517 on children in the age group 1 to 4.

There were nine complications observed, all in children in the age group 1 to 4. Five of these complications were generalized erythematous urticarial eruptions, three were auto-inoculations, and one was a secondary bacterial infection at the site of vaccination.
Letter to the Editor
Authors: Harrison Stanley L.
Published: December 2021

I will not attempt to discuss the disagreement between Dr. Eisner and Dr. Gilbert, but would like to inform Dr. Gilbert that the Executive Board of the American Academy of Pediatrics has charged the Committee on Community Health Services with the problem of migrant workers and their families. This committee is to work closely with our Committee on Indian Health, which as an advisory body to the Indian Health Service, has been involved to a considerable extent with the problem of the migrant Indian worker.
The Pathophysiology and Treatment of Drowning and Near-Drowning, by Jerome H. Modell, M.D. Springfield, Illinois: Charles C Thomas, 1971, 119 pp., $9.50
Authors: Giammona Samuel T.
Published: December 2021

This is a timely, concise book concerning drowning and near-drowning in which the latest scientific information as well as discussion of previous and current concepts concerning these problems are presented lucidly. Dr. Modell has had extensive clinical experience in Florida handling the drowning and near-drowning victim. He devotes the major part of his presentation to an explanation, based on his laboratory investigations and review of other works, of the pathophysiology in drowning and near-drowning.

Especially pertinent is the chapter on serum electrolyte changes, in which the differences between fresh water and sea water near-drowning reveal that correction of electrolyte disturbances is of secondary rather than primary importance in the treatment of most human victims in near-drowning as the changes attributed to the composition and the tonicity of the fluid aspirated are not as important as previously stressed.
UNILATERAL RENAL VEIN THROMBOSIS AND THE NEPHROTIC SYNDROME
Authors: Moore H. Leslie , Katz Roger , Mclntosh Rawle , Smith Fred , Michael Alfred F. , Vernier Robert L.
Published: December 2021

Three adolescents with unilateral renal vein thrombosis and the nephrotic syndrome are presented. Light, fluorescent, and electron microscopic examination of bilateral renal biopsy specimens in each patient demonstrated membranous glomerulonephritis in both kidneys. In the first case there was no evidence of preexisting renal disease and the initial biopsy at the time of thrombosis revealed near normal glomeruli on light microscopy. Fluorescent staining and the electron microscope demonstrated immune complex deposition along the glomerular basement membrane. Follow-up biopsy of the same case seven months later showed advanced membranous glomerubonephritis on light and electron microscopy. These cases as well as data from recent animal experiments raise the interesting suggestion that renal vein thrombosis and the nephrotic syndrome might be an immunologic disease. Unilateral obstruction of the renal vein may result in renal antigen release and antigen-antibody complex formation with subsequent glomerular deposition, bilateral glomerular disease, and the nephrotic syndrome.
Excerpt IV: Dog and the Ox
Authors: Cone Thomas E.
Published: December 2021

A CENTURY AND A HALF ago most of our school children were made to memorize large portions of the Bible. One of the favorite quotations to teach children was Proverbs 27:4:

Wrath is cruel and anger is outrageous but who is able to stand before envy?

The fable illustrated below from a widely-used child's reader further reinforced the Biblical admonition about envy.1
Useful Information on Adoption
Authors: Shearer William T.
Published: December 2021

Attention needs to be drawn to an important study of adopted children published recently by Bohman. In this 10- to 11-year follow-up study of children placed for adoption before 2 years of age by the Stockholm Adoption Agency in the mid 1950s, the health, school performance, school behavior, and school adjustment of 168 adopted children were compared to those of an appropriate set of control children. The importance of genetic, prenatal, and perinatal factors for the child's development were investigated as well as the adoptive parent's backgrounds, education, attitudes on child rearing, and socioeconomic status.
Excerpt V: Wolves and the Sheep
Authors: Cone Thomas E.
Published: December 2021

The fable below must have confused the children who read it because its message is the Aesopian one of the wolf in sheep's clothing rather than the Biblical command found in Leviticus 19:18 and in Matthew 19:19 of "Thou shalt love thy neighbour as thyself."1
DISSEMINATED INTRAVASCULAR COAGULATION AND FETAL HYDROPS IN A NEWBORN INFANT IN ASSOCIATION WITH A CHORANGIOMA OF PLACENTA
Authors: Jones C. E. M. , Rivers R. P. A. , Taghizadeh A.
Published: December 2021

Dic in a neonate in association with a chorangioma of the placenta is described. The infant was hydropic and hypoproteinemic, and the heart was enlarged. The results of coagulation studies are tabulated, the clinical course described, and the histological appearance of the tumor and postmortem findings in the infant recorded. Possible causes of the DIC, cardiomegaly, and hydrops are considered.
Congenital Vaccinia: Some Doubts
Authors: Koplan Jeffrey P. , Goldstein Joel , Foster Stanley O.
Published: December 2021

The conclusions reached in the case report of congenital vaccinia by Harley and Gillespie are open to question. Eighteen cases of congenital vaccinia have been desiribed, none with congenital malformations. Two infants survived; both mothers were vaccinated at about 32 weeks' gestation. In studies involving a total of 7,886 vaccinated pregnant women and 8,158 unvaccinated pregnant women, there was no evidence of an increased incidence of congenital malformations in the vaccinated subjects.

There is a lack of objective evidence that the congenital abnormalities described in this patient were related to his mother's smallpox vaccination.
Corticosteroid Therapy of Croup: Rules of Evidence
Authors: Lipman Richard P.
Published: December 2021

The conflicting literature and overheated correspondence on corticosteroid therapy of croup is hardly complemented by "Student's" editorial. His premise that there is a major polarization between practicing physicians who, distrusting controlled studies, put their trust solely in unplanned observation and academicians who illuminate the truth by use of experimental methods is an affront to the intelligence. Taking on the same pseudonym as the brilliant statistician, "Student" raises as a straw man the simple-minded empiricist and slays him with great flourishes of his pen.
EPIDEMIC REAPPEARANCE OF GONOCOCCAL OPHTHALMIA NEONATORUM
Authors: Snowe Robert J. , Wilfert Catherine M.
Published: December 2021

Gonococcal ophthalmia neonatorum has recently reappeared at the Duke University Medical Center in epidemic proportions. Reports from several other institutions suggest that the scope of this phenomenon may well be national (if not international). It is felt that this rise is representative of a general increase in genitourinary gonorrhea in the population. Because of its rapid progression and epidemiologic implications, gonococcal conjunctivitis should be considered in any newborn with purulent ocular discharge. The routine use of silver nitrate should be continued since cessation of such prophylaxis has resulted in recrudescence of disease. Gonorrhea occurs with significant frequency in obstetrical groups to merit attempts at therapy of the gravid mother. Attention to this problem will reach toward the source of gonococcal ophthalmia and assist in interruption of the spread of disease in the adult population.
Selective Intra-arterial Vasopressin in the Management of Stress Ulcers in Childhood
Authors: Lerner Arthur G. , Meng Chien-Hsing , Schneider Keith M.
Published: December 2021

This report introduces an intermediate step between the conservative treatment of stress ulcers in children, and the surgical management of this condition. It is the selective instillation of vasopressin into the celiac axis or one of its branches. It should be employed as a diagnostic and therapeutic modality in those children who do not respond to conservative measures, unless further experience indicates an unacceptable failure or complication rate. Our case illustrates the effectiveness of this technique.
Simplified Screening for Bacteriuria in Children
Authors: Rabinowitz Howard K. , Saitz Edward W.
Published: December 2021

This study evaluated a simple method to screen a general pediatric population for bacteriuria. Voided urine specimens were collected from 833 children without any preparation or instruction of the child. Cultures of these specimens that had a total colony count of 50,000 colonies/ml or greater showed a correlation between predominately one species being found in the screening culture and a positive clean catch culture that was obtained at a later time. All of the positive follow-up cultures occurred in girls. The method used is a simple, reliable, and economical way to screen for bacteriuria in children.