bluuebunny/crossref_metadata_2025 huggingface dataset:
A STUDY OF STORAGE, CHILD BEHAVIORAL TRAITS, AND MOTHER'S KNOWLEDGE OF TOXICOLOGY IN 52 POISONED FAMILIES AND 52 COMPARISON FAMILIES
Authors: Baltimore Charles L. , Meyer J.
Published: December 2021

A study of 52 families with children under 6 years ingesting poison was conducted in a defined population of Albemarle County, Virginia.

Fifty-two comparison families were randomly selected from neighbors of the poisoned families. The poisoned and comparison groups were the same in distribution among such categories as race, family size, mean age of poisoned and comparison children, sex, urban-mixed-rural residency, and socioeconomic class. By definition, the groups differed in that the comparison group had no histories of accidental poisonings in comparison children or their siblings.

A statistically significant relationship was found between "pica" and "daredevilness" in children and poisoning accidents.

There was no statistically significant difference in mother's knowledge of toxicity of medicines and household products, nor in the number and storage pattern of potentially toxic substances accessible to children who are 2½ years old and have average abilities.

The study suggests that parental ignorance of toxicity, and carelessness in storage are merely secondary environmental factors which may be manipulated to decrease the ease and frequency with which the accident occurs. Emphasis upon child development and family attitude aspects would appear to deserve much higher priority in view of the existing evidence.
GRANULOMATOUS COLITIS IN CHILDREN: A STUDY OF 25 CASES AND COMPARISON WITH ULCERATIVE COLITIS
Authors: Korelitz Burton I. , Gribetz Donald , Kopel Frederic B.
Published: December 2021

Twenty-five children with granulomatous colitis were followed for a mean of 17 years to determine natural history and late results. In all the children the rectum was initially free of disease. Complications occurred in 84% and only three patients responded favorably to a medical program. Surgery was required in 68% (74 operations in 17 patients). Following 14 ileocolostomies there was proximal spread of disease in 7 and distal spread in 8 after varying periods. Nine ultimately required ileostomy, which also was no protection against proximal extension. The prognosis was worse when the terminal ileum was originally involved.

The high incidence of postoperative complications and proximal extension encourages persistence in medical therapy, contrary to the attitude in managing ulcerative colitis in children. The surgical procedure of choice when the rectum is free of disease is an ileocolostomy, since anticipated extension might not occur for a prolonged period of time.
THE SURGICAL CORRECTION OF MINOR HYPOSPADIAS WITH CHORDEE
Authors: Nesbit Reed M.
Published: December 2021

Some children with balanitic (first degree) hypospadias need surgical corrections to assure normal sexual function; many, however, do not need an operation. The author discusses how to distinguish between the two groups of cases. He also describes a new, safe, and simple operation for correcting the abnormality, when indicated–the "check-vein" procedure.
CEROID ACCUMULATION IN A PATIENT WITH PROGRESSIVE NEUROLOGICAL DISEASE
Authors: Levine Arthur S. , Lemieux Bernard , Brunning Richard , White James G. , Sharp Harvey L. , Stadlan Emanuel , Krivit William
Published: December 2021

After ceroid deposits were noted in a bone marrow aspirate, this patient's degenerative neurological disease was studied extensively. Ceroid, a highly oxidized lipid related to the universal "wear and tear" pigment of old age, was found in brain, renal, liver, spleen, and intestinal tissue. Because of this unique presentation of ceroid storage, the nature and cause were investigated.
DIAGNOSIS AND TREATMENT: APPROACHES TO NEWBORN INFANTS OF TUBERCULOUS MOTHERS
Authors: Avery Mary Ellen , Wolfsdorf Jack
Published: December 2021

The management of the infant of a tuberculous mother requires individualization with respect to consideration of the state of maternal disease, likelihood of congenital infection, and subsequent risk to the infant. If the mother has active disease and is sputum positive, BCG and separation of the infant until he becomes tuberculin positive, or the mother becomes sputum negative are recommended. If the mother is sputum negative, and known to be taking medication regularly, on if the mother has a history of tuberculosis adequately treated, she should have a chest film at delivery and 3 and 6 months thereafter, and the infant should be tuberculin tested every 3 months. The use of BCG in such an infant is optional, but it should be considered if careful followup of the infant is uncertain.
The Effect of Exogenous Pancreatic Enzymes on Fat Absorption
Authors: Mullinger Margaret
Published: December 2021

Cystic fibrosis of the pancreas is an inherited disorder in which progressive pulmonary disease is combined with malabsorption resulting from pancreatic insufficiency. In recent years the management of most children with this disorder has included the prescription of various preparations of exogenous pancreatic enzymes in an attempt to correct malabsorption.

There have been numerous reports of methods used in the measurement of the degree of malabsorption. Using fat balance measurements where 4-day fecal fat collections were employed as the reference standard, Goldbloom, et al.1 compared the reliability of the absorption of vitamin A, I131 triolein, and butterfat absorption as determined by the rise in serum optical density.
Letters to the Editor
Authors: Haggerty Robert J.
Published: December 2021

I am glad to have Dr. Yankauer correct my error of history. In checking with old-timers about Rochester, it is clear that Kaiser was the dove of his day. But, failing to put the brakes on the massive community-wide tonsil and adenoid program, he had the perceptiveness to organize the follow-up study.

A further sidelight on history: Kaiser was the butt of a good deal of hostility from the academic profession who felt he had instituted the study in Rochester and who, because of this, kept him from membership in the American Pediatric Society for many years.
Plan, Operation, and Response Results of a Program of Children's Examinations (PHS Publication No. 1000, Series 1, No. 5). Washington, D.C.: U.S. Government Printing Office, 1967, 56 pp., $0.40 (address: Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402)
Authors: McDowell Arthur J.
Published: December 2021

This report from the National Center for Health Statistics describes in detail the second cycle program of the Health Examination Survey, the selection and examination of a probability sample of the nation's noninstitutionalized children 6 to 11 years of age. The examination focused primarily on factors related to growth and development and included: examination by a physician and a dentist; a variety of tests, procedures, and measurements; and tests administered by a psychologist. The report describes the development of the survey plan, the sample design, the content of the examination, and the operation of the survey, including steps taken to combat measurement error.
Cellular Aspects of Developmental Pathology, by Robert P. Bolande, M.D. Philadelphia: Lea and Febiger, 1967, 374 pp., $16.50
Authors: Vawter Gordon F.
Published: December 2021

This essay is fun to read, lucid in style and presentation and worthwhile in the material selected for emphasis. This is no exhaustive treatise submerged in microscopic minutiae but rather it is an exciting union of the dicta of the molecular biologist with those whose interest is the clinic and laboratory. The emphasis is upon principles with supporting illustrations; the strongest sections are those dealing with infections and immunology. Relatively few quibbles seem justified either as regards the occasional firm positions taken without acknowledgment of the strengths of dissenting opinion or as regards the non-uniform quality of some of the photographic reproductions.
Pathology of Infancy and Childhood, by John M. Kissane, M.D., and Margaret G. Smith, M.D. St. Louis: The C. V. Mosby Company, 1967, 1082 pp., $39.50
Authors: Vawter Gordon F.
Published: December 2021

This large, sound, direct, and unemotional book represents a much closer approach to a definitive text of pediatric pathology than has yet been available (outside of the field of neonatology). The format is pleasing to the eye, the illustrations are well selected and of high quality, and the bibliography is unusually complete.

In view of the explosion of knowledge in the biochemical and genetic diseases, those who expect detailed up-to-the-minute discussion of these areas will be somewhat disappointed, although the material covered is well done.
LUNG ASPIRATE PUNCTURE AS A DIAGNOSTIC AID IN PULMONARY TUBERCULOSIS IN CHILDHOOD
Authors: Augusto Schuster C. , Gaston Duffau T. , Eric Nicholls R. , Mario Pino C.
Published: December 2021

Ten infants and children suspected of pulmonary tuberculosis were submitted to lung puncture in an effort to recover tubercle bacilli. From eight infants the organisms were recovered on culture or guinea pig inoculation, and were identified on smear in seven of the eight immediately. Bronchial aspirates, performed in five of these eight patients, were positive in four. Gastric washings from the eight patients positive by lung puncture were negative in all but two. No complications consequent to lung puncture were seen.

This preliminary study suggests that lung puncture may be a safe diagnostic procedure which offers increased likelihood of recovering the organism. In addition, a more rapid diagnosis may be made because of a high rate of positive stained smears.
Gangrene of the Extremity Following Femoral Venipuncture: A Report of Two Cases
Authors: Polesky Reese E. , Harvey J. Paul
Published: December 2021

Two cases of gangrene in the lower extremity of infants following femoral venipuncture have been reported. The potential danger of this procedure in the severely dehydrated infant is to be emphasized. The use of micro chemistry procedures rather than femoral venipuncture is urged. The late sequellae of growth disturbance has been noted.
Platelet Counts in Thriving Premature Infants
Authors: Aballi Arturo J. , Puapondh Yupha , Desposito Franklin
Published: December 2021

Phase platelet counts in a large series of premature infants showed mean levels of 220,000/mm3, 260,000/mm3 and 309,000/mm3 during the first 2 days and in the second and in the fourth week respectively. An additional confirmatory series of infants with weights of 1,500 gm or less showed comparable values. These were followed during the first 2 days, the sixth or seventh day, the tenth or eleventh day, the fourteenth or fifteenth day, and the twenty-eighth to thirtieth day. Mean values were 203,000/mm3, 255,000/mm3, 272,000/mm3, 309,000/mm3, and 354,000/mm3, respectively. A steady rise was generally observed during the first month of life irrespective of birth weight. In the first 2 days of life, platelet values under 150,000/mm3 are more common in premature infants than in full-term babies. However, counts under 100,000/mm3 at any time are unusual and suggest a search for pathological factors. Figures under 50,000/mm3 should be considered frankly abnormal under any circumstances.
Cerebral Palsy: The Preschool Years, Diagnosis, Treatment and Planning, By Eric Denhoff, M.D., Springfield, Illinois: Charles C Thomas, 1967, 125 pp., $7.50
Authors: Paine Richmond S.
Published: December 2021

In somewhat over 100 pages, Dr. Denhoff discusses various types of syndromes of cerebral dysfunction and then goes on to make particular reference to cerebral palsy. Signs pointing to high risk during the mother's pregnancy and in the perinatal period are discussed together with physical examination and diagnosis. Outlines for recording the neurological examination at different ages are furnished and the changing picture with increasing age is considered. The final 34 pages are devoted to various approaches to treatment.
VENTILATION-PERFUSION RELATIONSHIPS IN CHILDREN WITH HEART DISEASE AND DIMINISHED PULMONARY BLOOD FLOW
Authors: Lees Martin H. , Burnell Richard H. , Morgan Clarence L. , Ross Benjamin B.
Published: December 2021

Pulmonary function of infants and children with diminished pulmonary blood flow was studied by measurement of alveolar ventilation and alveolar-arterial gas tension differences of O2, CO2, and N2. The increased ventilation of these subjects was found to be effective in CO2 elimination (arterial CO2 tension, 31 mm Hg), but there was evidence of considerable unevenness of distribution of ventilation/perfusion ratios (VAQ). A measure of the degree of VA/Q unevenness was obtained by use of the urine-alveolar nitrogen tension difference.

It is likely, under the prevailing conditions of hyperventilation and hypoperfusion, that maldistribution of perfusion is the major abnormality. Uneven distribution of perfusion is most probably due to the effects of gravity enhanced by low pulmonary artery pressure and blood flow—an exaggenation of the normal physiologic relative overperfusion of the lower-most parts of the lung.
THE VALUE OF HYPOSENSITIZATION THERAPY FOR BRONCHIAL ASTHMA IN CHILDREN—A 14-YEAR STUDY
Authors: Johnstone Douglas E. , Dutton Arthur
Published: December 2021

The clinical course of 210 children with perennial bronchial asthma was followed in a prospective controlled study in which one half of the children received placebo injections while the other half received conventional hyposensitization therapy. Of the 130 children still under observation at the time of their sixteenth birthday, 22% of the placebo-treated children were free of asthma compared to 72% of the treated children. In the treated group the rate of loss of asthma may be related to the dose of antigen received in hyposensitization therapy. Whereas 66% of the "1/5,000" group were free of asthma at the end of the study, 78% of the "highest tolerated dose" group were symptom free in their sixteenth year. The likelihood of a child outgrowing asthma was not significantly influenced by his sex, age of onset, or severity of his symptoms when first seen. A previous history of hay fever increased the likelihood of a child's asthma persisting into adolescence.
FAILURE TO INDUCE SCURVY BY ASCORBIC ACID DEPLETION IN A PATIENT WITH HURLER'S SYNDROME
Authors: DeJong Bernard P. , van B. Robertson W. , Schafer Irwin A.
Published: December 2021

An infant with Hurler's syndrome was placed on an ascorbic acid-deficient diet at age 10 weeks. The clinical, radiological, and chemical changes that occurred during 1 year on this diet are described. Although the disease was progressive in the skeleton, there was little clinical involvement of the liver, spleen, cornea, and brain. Physical growth and psychomotor development were within normal limits during the year. The urinary excretion of glycosaminoglycans was not altered by ascorbic acid depletion. The clinical variability observed in Hurler patients precludes any conclusions as to the effect of this diet on the natural history of this disease.

Ascorbic acid levels became undetectable in the plasma and buffy coat, respectively, at 16 and 32 weeks of the diet. Even after 52 weeks on the scorbutogenic diet, the patient did not demonstrate any clinical or chemical evidence of scurvy, and wounds healed normally. This raises the question whether isolated ascorbic acid deficiency with an otherwise adequate diet will produce infantile scurvy, or whether patients with Hurler's syndrome have a unique requirement for vitamin C.
THE ICHTHYOSIFORM DERMATOSES
Authors: Esterly Nancy B.
Published: December 2021

The Term ichthyosis describes a group of heritable disorders which are characterized by cutaneous scaling. The visible scale differentiates these disorders from xeroderma in which the skin is dry but does not visibly desquamate. Many classifications of the ichthyoses have been proposed, but most are descriptive and contribute little to an understanding of etiology and pathogenesis. Often clinical variants or patients with minor associated anomalies have been categorized separately on an empirical basis and, in some cases, several names have been used for one entity to indicate severity of involvement.

The most useful classification appears to be that of Wells and Kerr,1 who segregated the various types by their pattern of inheritance and retained the nomenclature in common usage. Differences in clinical features and histologic patterns also correlate with these genetically distinguishable types. Thus, with careful attention to the distribution and type of scale, family history, and skin histology, the physician will be able to classify patients in a meaningful way. Such an approach is helpful for several reasons. The prognosis, troublesome features, and degree of handicapping differ for the various ichthyoses. Sensible genetic counseling, an important part of the management of such patients, is possible only with the correct diagnosis. Moreover, clinical investigation of affected individuals will be further confused unless the entity under study is well defined. The need for an understanding of the physiologic and biochemical defects of ichthvotic skin is underscored by the limitations of currently available therapy.

The four major types of ichthyosis include: (1) ichthyosis vulgaris, transmitted as an autosomal dominant trait; (2) sexlinked ichthyosis, transmitted as an Xlinked trait; (3) bullous congenital ichthyosiform erythroderma (CIE), inherited as an autosomal dominant trait; and (4) nonbulbus congenital ichthyosiform erythroderma, autosomal recessive mode of inheritance (Table I).
The Effect of Phenobarbital on Diphenyihydantoin Metabolism in Children
Authors: Buchanan Robert A. , Heffelfinger John C. , Weiss Charles F.
Published: December 2021

Children appear to have a significantly accelerated rate of diphenyihydantoin metabolism after pre-treatment with phenobarbital.
Hyaline Membrane Disease in Twins
Authors: Neligan Gerald , Robson Evelyn , Hey Edmund
Published: December 2021

We were very interested to see the data from Czechoslovakia and Baltimore supporting the view that there is a higher incidence of hyaline membrane disease (HMD) in the more severely stressed, second-born than in the first-born members of twin pairs; our experience in this geographically intermediate part of the world has been very similar ever since we have had reliable data available. The following results summarize our findings in this hospital during the years 1955-1968.
COMPREHENSIVE CARE OF A MENTALLY RETARDED, ADOLESCENT HEMOPHILIAC WITH A TONGUE-BITING TIC
Authors: Bowden Douglas M. , Rothenberg Michael B.
Published: December 2021

A complex case of chronic tongue biting in a mentally retarded, adolescent hemophiliac is presented to demonstrate principles of comprehensive care. Problems arising out of (1) the psychosocial status of the child and parents, (2) psychodynamics of individual physicians, and (3) group dynamics of the medical team are described. Specific countermeasures are spelled out. Particular attention is given to the problems faced by clinic and ward pediatrics in dealing with chronic, life-threatening illness when continuous monitoring of psychogenic factors is essential to appropriate management.
INTRAPERICARDIAL TERATOMA: A CAUSE OF ACUTE PERICARDIAL EFFUSION IN INFANCY
Authors: Reynolds James L. , Donahue John K. , Pearce Charles W.
Published: December 2021

On the basis of personal experience with two patients and a review of the 35 previously reported cases, we described the pathologic and clinical features of intrapericardial teratoma. This tumor is single, large, encapsulated, multicystic, and pedunculated. It is attached by a short fibrous stalk or pedicle to the adventitia of one or both great arteries.

Only 2 of the 37 intrapericardial teratomas were malignant. The tumor is found predominantly in children, usually during early infancy, and among cardiac tumors of childhood it is second only to rhabdomyoma in frequency. Acute or chronic pericardial effusion commonly accompanies the teratoma. All young infants reported have had acute pericardial effusion with tamponade. Typically, the associated fluid is serous, sterile, copious, and recurrent; it usually obscures the presence of the tumor. Intrapericardial teratoma is a likely diagnosis in any young infant having such penicardial effusion; other cardiac tumors do not have these clinical features. Artificial pneumopericardium will demonstrate the teratoma, and operation is curative if the tumor is benign. Uncontrollable bleeding from the aorta on dissection of the tumor stalk has been an operative hazard; but, if anticipated, it can be avoided.
Letter to the Editor
Authors: Sinclair John C. , Engel Knud , Silverman William A.
Published: December 2021

Like early feeding, early attempted correction of acidosis can have different meanings. Our babies (median postnatal age 5 hours) were treated as early as we could obtain the necessary observations. Some were born at other hospitals and were transported to us. Of course, we agree that, with different organization of perinatal care, earlier therapy is possible. It is the evaluation of our therapeutic efforts, however, which mainly concerns us. Dr. Aclin claims to have produced "a significant decrease in morbidity and a decrease in the occurrence of a subsequent respiratory distress syndrome" with immediate postnatal rapid infusion of sodium bicarbonate.
Newborn Infants of Tuberculous Mothers, Further Comment
Authors: Cohen Sanford N. , Weber Wendell W.
Published: December 2021

In their recent article, Avery and Wolfsdorf discussed INH prophylaxis of infants of tuberculous mothers and stated, "The unusual reactions of infants to many pharmacologic agents, with respect to absorption and excretion, have necessitated great care in matters of dosage and indications in infancy." The Committee on Drugs commented, in the same issue, that the pharmacology of INH has not been systematically studied in the newborn infant.

We have been studying the characteristics of the hepatic enzyme which catalyzes the acetylation of INH and sulfonamides.
Abnormal Sexual Development: A Genetic and Endocrine Approach to Differential Diagnosis, by Daniel D. Federman, M.D. Philadelphia and London: W. B. Saunders Co., 1967, 206 pp., $8.75
Authors: Bongiovanni Alfred M.
Published: December 2021

There is much duplication in the area of medical texts, and so-called monographs often yield little that is not to be found in standard textbooks. Not so with Dr. Federman, who brings a special and personal flavor to his subject. He states that his monograph is "written for general physicians" and indeed the presentation is marked by clarity and breadth. He begins with a succinct description of normal sexual differentiation, proceeding to cytogenetics, disorders of gonadal development (appropriately subdivided), disorders of fetal endocrinology, and disorders of puberty, including delayed and precocious development.
LIVER BIOPSY IN THE DIAGNOSIS OF INFANTILE OBSTRUCTIVE JAUNDICE
Authors: Brough A. Joseph , Bernstein Jay
Published: December 2021

Slides of 97 liver biopsies performed in 87 infants with obstructive jaundice due to neonatal hepatitis and extrahepatic biliary duct atresia were reviewed in order to evaluate the histopathologic criteria for establishment of the diagnosis. Biopsies were interpreted in the absence of clinical information and were designated as representing either hepatitis or biliary atresia. Adequate followup data were available in 64 cases to establish the validity of the diagnosis. Twenty-three of 23 patients diagnosed as having hepatitis either recovered or had demonstration of the patency of the extrahepatic bile ducts. Thirty-nine of 41 patients designated as having atresia were shown to have an obstructive lesion. Of these, 36 were, on the basis of the clinical course, surgical findings, and cholangiographic data, considered to be examples of extrahepatic bile duct atresia. Three patients had liver biopsy changes identical to those of atresia: two choledochal cysts and one obstructive plug of bile in the common bile duct. Two other patients subsequently became anicteric. Diagnostic error, which was based on histopathologic interpretation of both needle and open liver biopsies, was 3.5%.

While 80% of the biopsies were obtained at laparotomy, the application of the cited histopathologic criteria should result in a similarly high degree of accuracy in interpretation of percutaneous needle biopsies.
CLINICAL LABORATORY EXPERIENCES WITH A MORE ATTENUATED ENDERS' MEASLES VIRUS VACCINE (MORATEN) COMBINED WITH SMALLPOX VACCINE
Authors: Weibel Robert E. , Stokes Joseph , Buynak Eugene B. , Leagus M. Bernice , Hilleman Maurice R.
Published: December 2021

A premixed and lyophilized preparation of the more attenuated (Moraten) line of Enders' live measles virus vaccine combined with calf lymph smallpox vaccine was evaluated in a smallscale study in which the vaccine was given by jet gun. There was no evidence for interference between the two viruses. All the children responded serologically to both viruses and showed immune or vaccinoid reactions on challenge with smallpox vaccine given by the ordinary multiple puncture method. There was no apparent increase in clinical reaction beyond that expected following smallpox vaccine given alone.
PEDIATRIC PERCEPTIONS: PEDIATRICS IN CZECHOSLOVAKIA
Authors: Bates Talcott
Published: December 2021

On May 22 and 23, 1968, I visited the Health Ministry of Prague, C.S.S.R. A clinic and day nursery were visited, and interviews with physicians and health workens were held. In the light of social and political trends in both the C.S.S.R. and the United States, this visit, informally reported, may be of interest.

On entering the Ministry, which I did without appointment or introduction, I was met by a Miss Anna Vislocka, an attorney, whose job it was to see that I met the proper staff member from a standpoint of mutual interest and linguistic ability, Dr. Jiri Dunovsky.

Dr. Dunovsky is a pediatrician who started his career in practice, developed special interest in abandoned children, became a district pediatrician, and was recently appointed to the Health Ministry. His special responsibilities at the Health Ministry are the social problems of pediatrics, adoption, abandonment, nurseries, and orphanages. He is currently developing a postgraduate course in social pediatrics for doctors in pediatric practice. Dr. Dunovsky and I spent the morning at his office. The following evening, having said he would meet us at our hotel, he took Mrs. Bates and myself out for an evening, which included a visit with several colleagues with whom we talked until the early morning hours. There is a great reservoir of friendship for the United States in Czechoslovakia. The following morning Dr. Amalie Gutman, pediatrician in charge of District 9, Prague, picked me up in her chauffeurdriven car, and we visited a district clinic and a nursery school.
Lewis Webb Hill
Authors: Buffum William F.
Published: December 2021

The spirit moves me to write about a friend of ours-and of many readers of Pediatricsdr. Dr. Lewis Webb Hill.

Lew Hill died June 30, 1968. Nearly 60 years before, in the class of 1913 at the Haryard Medical School, he and I were together not only at work but also in our few hours of relaxation. From the first, his wry sense of humor added to the enjoyment of those about him. His education continued with a medical internship at the Massachusetts General, the Floating, and the Children Hospitals, all in Boston.
More on Transfer of Medical Information
Authors: Cunningham Nicholas
Published: December 2021

Dr. Auld's gripe (Pediatrics, 42:1014, 1968) about how hard it is to get useful patient information from colleagues is probably shared by many of us. But, since pediatricians are among the busiest (and least well remunerated) specialists, more than griping and pleading for better rapport will be needed to get results. Two avenues suggest themselves.

The first is to automate both the recording and reproduction of medical records. If all our notes were dictated, using standardized nomenclature and units of mensuration, and then transcribed for standardized forms, our records would become both more accessible for ourselves and more easily reproducible for our colleagues.
MIST THERAPY RECONSIDERED; AN EVALUATION OF THE RESPIRATORY DEPOSITION OF LABELLED WATER AEROSOLS PRODUCED BY JET AND ULTRASONIC NEBULIZERS
Authors: Wolfsdorf Jack , Swift David L. , Avery Mary Ellen
Published: December 2021

Aerosol deposition in the upper and lower respiratory tract using technetium-labelled water aerosol, produced by jet and ultrasonic nebulizers, with and without 10% propylene glycol, was examined under conditions of nasal, normal mouth, and tube breathing in 15 normal adults. With nasal breathing, 91.5% (± 5.5) and 83.2% (± 6.3) of the mass of the aerosol produced by the jet and ultrasonic nebulizers, respectively, was deposited in the upper respiratory tract. Similar fractional depositions were observed with the addition of 10% propylene glycol. When breathing was carried out via a mouth tube, 43% to 59% of the mass of the aerosol produced by the nebulizers was deposited in the upper respiratory tract. The mass median diameters of the available aerosols produced by the jet and ultrasonic nebulizers were 6.0 µ (geometric standard deviation = 2.5) and 2.8 µ (geometric standard deviation = 2.1), respectively; the densities of the aerosols produced were 8 and 34 µl/liter air. With nasal or normal mouth breathing, the volume of water, in aerosol form, that could be deposited per 24 hours in the lower respiratory tract of an adult was calculated to be about 6 ml and 49 ml for the jet and ultrasonic nebulizer, respectively.
DR. THOMAS MORGAN ROTCH WRITING IN 1903 LEAVES UNANSWERED THE ROLE OF MATERNAL IMPRESSIONS DURING PREGNANCY AS A CAUSE OF PHYSICAL OR MENTAL DEFECT IN THE INFANT
Authors: C. T. E.
Published: December 2021

The idea that abnormalities in the infant may be produced by impressions on the pregnant woman's imagination dates back to the earliest days of medicine. Even Dr. Thomas Morgan Rotch, Professor of Pediatrics at the Harvard Medical School, seemed unwilling to give up this hypothesis as late as 1903, as seems apparent in the following quotation from his famous textbook of pediatrics:

A few words should be said concerning the subject of maternal impressions. For many years there has been accumulating a considerable amount of evidence showing that a violent mental impression made upon a woman who is at the time carrying a child may be followed by a physical or mental defect in the child which bears a striking relation in character to the impression made upon the mother. Thus, Sir Walter Scott narrates that King James the First could not endure the sight of a drawn sword. This feeling had been attributed by those who believe in maternal impressions to the terror which his mother experienced at witnessing the murder of Rizzio. Still more numerous are the facts adduced to prove that bodily defects, such as harelip, club-foot, and hairy mole, may be caused by strong impressions of pain or terror experienced by the mother at the time when the foetus is in a certain stage of intra-uterine development. Interesting as these instances are, it is the general belief that nothing more has been proved than that they depend on a coincidence.

The final decision on this obscure subject must rest on future investigation, and until something more definite is known we should guard a woman during her pregnancy from all unpleasant impressions with far more care than we do at present.1
Letter to the Editor
Authors: Jennison M. Harry
Published: December 2021

The questioner raises two important issues related to the Academy statement on family life and sex education. (1) Do family life and sex education programs in schools serve as an effective preventive measure, or "immunization," against social health problems? (2) Are physicians and teachers adequately trained to carry out their roles in family life and sex education programming? What is needed in graduate and postgraduate training (in-service programs) which will improve quality of physician and teacher participation?
Teaching the Troubled Child, by George T. Donahue, Ed.D., and Sol Nichtern, M.D. New York: The Free Press, A Division of the Macmillan Co., 1968, 202 pp., $2.45
Authors: Trouern-Trend John B. G.
Published: December 2021

Here is food for thought for anyone who subscribes to the basic assumption that "problem children" are managed most efficiently by exclusion from their normal environment, in order to place them in various "specialized facilities."

Teaching the Troubled Child is aimed at that wide audience, both lay and professional, which has direct or indirect involvement in the process of education. Its scope is ambitious-to challenge some current basic concepts in the field of education; to offer its message as a path toward a solution of a serious, nationwide problem; to describe the educational project in which these ideas were nurtured and evolved; to present a detailed apologia in anticipation of criticism and scepticism.
THE EFFECT OF SINGLE PRENATAL AND NATAL COMPLICATIONS UPON THE DEVELOPMENT OF CHILDREN OF MATURE BIRTHWEIGHT
Authors: Buck Carol , Gregg Rose , Stavraky Kathleen , Subrahmaniam Kathleen , Brown Josephine
Published: December 2021

Children of mature birthweight were followed prospectively to the end of their first year in school to determine the effect upon their development of complications in one of the following areas: pregnancy, labor, or obstetrical anesthesia. Non-English speaking and one-parent families, and children of mothers with poor reproductive histories or infections during pregnancy were excluded.

Only in the comparison of the children exposed to preeclamptic toxemia with their controls was it possible to demonstrate an unfavorable difference in intelligence and behavior. The difference was small and barely significant statistically.
Sir Robert Hutchison, A Corrected Attribution
Authors: Jenkins Ramon B.
Published: December 2021

In his Presidential Address, Dr. George Logan (Pediatrics, 43:125, 1969) quoted a "bit of free verse, a sort of prayer," he had found on the wall of a ward office of the Royal Infirmary of Edinburgh, and he mentioned that it is attributed by some to the surgeon, Sir Jonathan Hutchinson.

It was, in fact, written by a pediatrician, Sir Robert Hutchison (without an "n"), who, in a letter entitled "Modern Treatment" ( Brit. Med. J., 1:671, 1953) wrote:
Early Child Care: The New Perspectives, by Caroline A. Chandler, Reginald S. Lourie, and Ann Dettuff Peters, edited by Laura L. Dittmann. New York: Atherton Press (70 Fifth Avenue, New York, New York 10011), 1968, 385 pp., $8.95
Authors: Ross Ralph A.
Published: December 2021

This volume is a compilation of views expressed by a group of participants recognized for their knowledge of physical, mental, and psychologic growth and development. The conferences were sponsored by the National Institute of Mental Health, the Children's Hospital of Washington, D.C., and the Committee on Day Care of the Maternal and Child Health Section of the American Public Health Association in a series of conferences in 1964 and 1965.

The stated goal of these conferences was to establish a consensus to provide the practitioner with guidelines for early child rearing which might be useful, especially for individuals providing group care for young children and infants; these goals, unfortunately, were impossible to attain.
CARDIAC CATHETERIZATION, CARDIAC SURGERY, AND THE NEWBORN INFANT—1969
Authors: Fyler Donald C.
Published: December 2021

Surgical successes in newborn infants with critical cardiac defects challenge pediatricians, pediatric cardiologists, and thoracic surgeons to recognize, diagnose, and correct these lesions. The report of Varghese and his colleagues documenting the management of 100 consecutive infants with apparently life-threatening cardiac malformations will be of interest to all concerned.

Such newborn infants present formidable problems. The difficulties of recognizing which infant has a naturally fatal lesion, the suddenness and rapidity with which the clinical course may shift downwards, the logistics of transferring a sick infant to a center equipped and staffed for emergency cardiac catheterization and emergency surgery, the technical difficulties of miniaturizing equipment for cardiac catheterization and cardiac surgery, and the inherent risks of diagnostic catheterization and cardiac surgery in seriously ill babies are sobering obstacles.
PREVENTION, DIAGNOSIS, AND TREATMENT OF LEAD POISONING IN CHILDHOOD
Authors: Alpert Joel J. , Breault Henri J. , Friend William K. , Harris Virginia G. , Scherz Robert G. , Semsch Robert D. , Smith Hugo D. , Coleman Allan B. , Chisolm Julian J.
Published: December 2021

Lead posioning in childhood must be approached as a chronic disease requiring comprehensive, long-term, medical and social management of the child and his family throughout the preschool years. This is because of the combination of poor housing containing lead paints, childhood pica, and personal-social deprivation. New sources of lead, such as general contamination of the environment from industrial and motor car exhausts, must also be considered. While diagnosis and therapy are important, the pediatrician's professional responsibility to his patient and community must include prevention. An effective program for the prevention and management of childhood plumbism requires the coordinated and sustained efforts of pediatricians; health department personnel; allied health professionals, such as medical social workers and child guidance workers; the executive, legislative, and judicial authorities of the community; and the community itself.

Medical surveillance of the health of young children is almost as urgent a requirement in the case of the asymptomatic child with pica and an increased body burden of lead as it is for the child suffering from plumbism. Through such surveillance, dangerous conditions in the environment of the child can be discovered and eliminated, and the care of the threatened child can be maintained until the threat has subsided. In this manner, the incidence of the disease can be reduced ultimately to the vanishing point; meanwhile, fatalities can be prevented, and the damage to the brain of poisoned children, which often follows in the wake of lead encephalopathy, can be greatly diminished. Pediatricians have opportunities through health programs in urban areas to develop preventive techniques and to contribute significantly to the prevention of lead poisoning among children.
Artificial Sweeteners and Fetal Malformations: A Rumored Relationship
Authors: Hillman D. A. , Fraser F. C.
Published: December 2021

The increasing number of pharmacologic agents available with and without prescription must constantly be assessed as possible teratogens. The suffering and disability that resulted from delay in recognizing the effect of thalidomide on the developing fetus demands a system of reporting that would quickly detect an increase in the malformation rate. The surveillance system recently developed in Sweden shows that this is feasible, but no such system is yet available to physicians in America.

We have recently examined two infants coming from the same township in Upper New York State and presenting roughly the same assciation of unusual anomalies.
Heterotopic Gastric Mucosa in the Cervical Esophagus a Possible Cause of Fatal Aspiration
Authors: Libcke John H.
Published: December 2021

In a case of fatal aspiration of gastric contents, gross islets of heterotopic gastric mucosa were found in the cervical esophagus. It is postulated that they may have triggered the aspiration through a local irritative effect.
The Pediatric Convalescence Hospital
Authors: Jennison M. Harry
Published: December 2021

I was delighted to read Dr. Frederic Burke excellent analysis of the important and unique role of the specialized children hospital designed to meet the complex needs of long-term childhood illness (PEDIATRICS, 43:879, 1969). We operate a similar intermediate-care children hospital facility at Stanford, having a parallel historical origin which has now evolved into a comprehensive program providing inpatient and outpatient care, teaching and training, and research in the chronic diseases of childhood and youth.
MENTAL RETARDATION IN A FAMILY WITH PHENYLKETONURIA AND MILD HYPERPH ENYLALANINEMIA
Authors: Cohen Bernard E. , Szeinberg Arieh , Berman Wifred , Aviad Yermiahu , Crispin Moshe , Hirshorn Nina , Golan Rachel
Published: December 2021

A highly inbred family with five mentally retarded persons is described. Two sibs presented typical characteristics of phenylketonuria, while one mentally retarded sib did not show any biochemical abnormality. The mother and maternal uncle had mild hyperphenylalaninemia.

It is pointed out in the discussion that, while the mental retardation (at least in some of these subjects) may be independent of disturbances of phenylalanine metabolism, it is possible also to explain all the findings in the family on a unified basis, involving a variant hyperphenylalaninemia with tolerance increasing with age and "maternal phenylketonuia."
PEDIATRIC PERCEPTIONS: DELIVERY OF HEALTH SERVICES FOR HANDICAPPED CHILDREN AND YOUNG ADULTS IN EUROPE
Authors: Smith Donald C. , Lindsay Thomas C.
Published: December 2021

In all European countries visited there is evidence of considerable progress in the development of imaginative and flexible programs for the care of handicapped children and youth. This is true of efforts directed toward prevention and early case finding, and in the provision of both ambulatory and residential care. Admission to an institution for the child or young adult does not necessarily end in lifelong incarceration. In most instances it is assumed that, with proper and aggressive management, progress will be achieved and that, as the child needs change, appropriate modifications in his overall plan of treatment can and will be made.

Our observations reveal that general medical care programs do not, in themselves, ensure that children and youth will receive needed medical care. This is likely to happen only when a special organizational unit at the national level is charged with the responsibility of evaluating and delivering care to this uniquely vulnerable-and readily identifiable-segment of the population.

As traditional professional and institutional methods become obsolescent, improved health services for children and youth will require an even higher degree of organization at national, state and local levels. It would seem important for us in the United States to capitalize fully on experience gained in other countries whose health problems are not fundamentally different than our own.
Hazards of Skimmed Milk, Unboiled and Boiled
Authors: Berenberg William , Mandell Frederick , Fellers Francis X.
Published: December 2021

In infants ill with gastroenteritis, serious hypernatremia may be produced by the feeding of fat free milk which has been boiled and not reconstituted. Equally severe disease may be produced by large volumes of nonboiled fat free milk.
Letter to the Editor
Authors: Milunsky Aubrey
Published: December 2021

I would like to thank Dr. Rovescalli for pointing out the four or five lines in his Italian text on mongolism in which he mentions patients with mongolism and cystic fibrosis. Unfortunately, no evidence for the diagnosis of cystic fibrosis is provided (e.g. sweat test results). The poor reproduction of the adjoining slide of the pancreas leaves the point further unresolved, since in this disorder the pancreas may appear entirely normal on microscopy in the early weeks of life.
Reflectorization: A New Defense Mechanism Against Automobile Injury to Pedestrians
Authors: Burg Frederic D. , Diamond Eugene
Published: December 2021

A major problem exists in the United States today. This problem is pedestrian-auto injuries and deaths. In 1967, 9,400 pedestrians were killed. Of these 9,400 deaths, 2,750 of those who died were children less than 15 years of age. This may be compared to 4,100 children who died of all forms of malignancy under 15 years of age. Of the 9,400 pedestrian deaths, 5,100 of these occurred at night. The problem of how to help prevent these deaths and injunies is of major significance.
Tropical Nutritional Disorders of Infants and Children, by C. C. DeSilva, M.D., F.R.C.P., and N. G. Baptist, Ph.D., F.R.I.C. Springfield, Illinois: Charles C Thomas, 1969, 266 pp., $11.50
Authors: Béhar Moisés
Published: December 2021

Readers of this book will find a simple description of the physiological and biochemical mechanisms of the nutritional deficiencies commonly found in the tropical and subtropical areas of the world.

The first two chapters review the still somewhat enigmatic problems of human growth. This is done by analyzing the known hormonal and nutritional factors important to man and the role that some of these factors play in physical growth and, possibly, the mental development of most of the world's children who continue to grow up in countries where malnutrition is widespread.
WELCOMING REMARKS
Authors: Low Merritt
Published: December 2021

The American Academy of Pediatrics has long been interested in the control of Childhood Injuries; its first formal committee was the Committee on Accident Prevention.

The pediatrician is a primary accident preventer and should indeed have a big stake and commitment here. He is basically a "consumer," yet he must be convinced of the product he uses and in turn passes on. Though he has the humility of an amateur, he is allied with the expert and begs for his help. He sees the great strides made by industry, even in the newly developing area of "off-the-job" safety, and the advances made in the therapeutic but not the prophylactic responsibilities of accident prevention as he surveys the situation. Yet, is he truly convinced? If so, he could do more.

We exhort ourselves to immunize our children with a safety vaccine, but is this just borrowed jargon? What are the ingredients of the vaccine? Are they dead or alive? Where are the field trials? Where are the proving figures of effectiveness? A hard look shows us that this number one health problem is not being solved. (I scarcely need remind this group of the statistics and facts: 15,000 children under 15, including 5,000 pre-school children, die of accidents in the United States each year; 15 million children go to doctors for care of accidents in a year; all accidents cost the country over 15 billion dollars a year). In our primary reliance on the tool of "education," we fall victims to the fact-of-life fallacy-if we provide facts we automatically get results.