bluuebunny/crossref_metadata_2025 huggingface dataset:
Letter to the Editor
Authors: Strober Warren
Published: December 2021

The question raised by Dr. Johnson concerning the conclusions of the paper "Albumin Metabolism in Cystic Fibrosis" is whether or not there is a causal relationship between the demonstrable change in plasma volume and hypoalbuminemia, or merely a correlation between the two. Dr. Johnson cites evidence that alterations in colloid osmotic pressure may result in hypoalbuminemia by (1) primarily affecting albumin synthetic rate, and by (2) causing an expansion of the plasma volume. Let us accept, for purposes of this discussion, that increased colloid osmotic pressure does indeed have these effects, and, further, that these patients with cystic fibrosis had an increased colloid osmotic pressure.
Prompt Reporting of Reactions to Vaccines
Authors: Smith Margaret H. D.
Published: December 2021

I hope you can publish without delay this comment on the recent letter from Dr. Niv.

Dr. Niv's letter was referred to tile National Communicable Disease Center (NCDC) in Atlanta, and Dr. A. W. Karchmer, Chief of the Investigations and Evaluations Section of the Immunization Branch, replies as follows:

We have been and will continue to be interested in receiving reports of clinical illnesses in which a relationship to administration of a vaccine is questioned. To date we have received no report of significant clinical reactions temporally related to the administration of mumps vaccine (MUMPS-VAX)
Surgery in Infancy and Childhood, ed. 2, by Wallace M. Dennison, M.D. (Glasg.), F.R.C.S. (Edin.), F.R.S.C. (Glasg.) with contributions from teaching colleagues in the Glasgow Medical School. Edinburgh and London: E. and S. Livingstone, Ltd., 1967, 597 pp., $12.00 (The Williams and Wilkins Company, Baltimore, exclusive U.S. agents)
Authors: Eraklis Angelo J.
Published: December 2021

This handbook on pediatric surgery fills a very special purpose in the education of primary physicians, medical students, and nurses. It does so by providing a broad coverage of surgical topics in an abbreviated, easily comprehensible manner accompanied with ample pictorial and diagrammatic descriptions; there is also a concise discussion of the etiology, clinical manifestations, and methods of therapy of the surgical problems the practitioner is most likely to encounter. The photographs and diagrams of clinical material more than compensate for the text's brevity.
THE PRESIDENT OF YALE IN 1760 DESCRIBES A PECULIAR ERUPTION OF THE SKIN IN A YOUNG CHILD
Authors: C. T. E.
Published: December 2021

Presidents of Yale—to my knowledge—no longer submit clinical descriptions of unusual illnesses supported with their microscopic observations of the responsible "pathogen" to newspaper editors for publication as front-page items. Perhaps this practice should be revived because few physicians have ever equalled Yale's President Thomas Clap's (1703-1767) captivating clinical note cited below, which was published in the September 1, 1760 issue of the Boston Gazette.1 Thomas Clap served as Rector from 1740-1745 and as President of Yale College from 1745-1766. He was known to be a dogmatic and obstinate Congregational clergyman and Newtonian scientist who was in constant touch with Benjamin Franklin and other colonial men of science concerning experiments here and abroad.2

New Haven, August 16 (1760)

A Few Days ago, a Child belonging to Mr. Moses Belcher of this Town, had a cutaneous Eruption, considerably resembling the Chicken Pox; the Pustules became very protuberant, near as big as a Duck shot, the Heads being dark colour'd and the rest yellowish. Upon opening Some of the Pustules, there Appeared to be a Great Number of Animals in them which were scarce discernable by the naked Eye, but seen to be Animals by their Swift Motion in crawling. One of them was brought to the College (Yale) and being viewed in the Microscope, it appeared to be a perfect Tortoise, or Turtle with upper and lower Shells, each divided into about ten Partitions which were beautifully coloured, red, yellow, and white.

The Head, Tail and Legs appeared very distinct; but the Eyes did not grow in the head, but as it were out of the Shoulders, and stood upon two Pillars very much resembling those of a Lobster.
A DAILY PLAN FOR THE DOMESTIC EDUCATION OF YOUNG GIRLS AS SUGGESTED BY A BOSTON MOTHER IN 1829
Authors: C. T. E.
Published: December 2021

The early school laws, at least in New England, did not provide for the education of young girls. In fact, these laws did not even recognize girls, expressly stating that "the word ‘children’ is to be interpreted to mean ‘boys.’ " There was no controversy on the subject. It simply appears that it was considered unnecessary that girls be instructed in the public schools.1 Nevertheless, either at dame schools or at home, most girls learned at least to read and sew. Writing was thought to be much less important; even at the time of the Revolution, many of the patriots' wives and mothers could not write. It was not until 1822 when Boston became a city that girls were permitted access to the common (public) schools.

See table in PDF file

One Boston mother who was bothered by this discrimination in the education of young girls wrote a popular book in 1829 on the domestic education of girls. From the examples cited in this book, girls had an active and, by our standards, a long day, with little time to themselves.2 The scheme given here, which was meant for a girl between 10 and 12 years of age, would seem too demanding to me for our girls of the same age.

The last question before going to sleep—What good have I done today?
A SIBSHIP WITH BARTTER'S SYNDROME: FAILURE OF TOTAL ADRENALECTOMY TO CORRECT THE POTASSIUM WASTING
Authors: Trygstad Carl W. , Mangos John A. , Bloodworth James M. B. , Lobeck Charles C.
Published: December 2021

A family in which three of four children are affected with Bartter's syndrome is described. The three affected sibs had hypokalemia and persistent urinary potassium loss. Two also were hyponatremic despite hyperaldosteronism. Because of the persistent urinary potassium loss, thought to be due in part to the hyperaldosteronism, a total adrenalectomy was performed in one affected child. His urinary potassium loss was not affected by this procedure. It was concluded that adrenalectomy should not be performed in these patients and that the hypokalemia is not due to the hyperaldosteronism. It is possible that the primary defect is in renal reabsorption of both sodium and potassium.
STUDIES IN GROWTH AND DEVELOPMENT
Authors: Verghese Kannarkat P. , Scott Roland B. , Teixeira Gertrude , Ferguson Angella D.
Published: December 2021

Physical measurements were obtained from 2,632 healthy North American Negro children of low income families. Their ages ranged from 3 months to 17 years. Comparison with similar studies revealed the height and weight of the Negro children to be similar to those of North American Caucasian children. However, the head circumference and stem length were found to be consistently smaller than Caucasian children.

At 1 year of age the weight, head, and chest circumferences of Negro infants of this study were significantly smaller than the same measurements previously reported for infants of the same race from middle income families in the city.

Comparison is also made with studies on Negro children in West Africa and Jamaica.
Ambulatory Pediatricians of North America, Unite! Run, Do Not Walk to Your Nearest Grammar School
Authors: Goldbloom Richard B.
Published: December 2021

The continuing "explosion" of scientific information and the arborization of medical specialties have caused physicians to invent names and catch phrases to define their new activities. Regrettably, much of this latter-day vocabulary is unmusical and clumsy. Some examples represent a downright assault on the English Ianguage. It is alarming that a profession whose members demand such precision in their work would tolerate such slapdash semantic shenanigans.

One has winced at such utterances as "examination of the chest showed no pathology;" one has cringed when otherwise esteemed colleagues have indulged in such semantic horrors as "coagulogram" and "febrile agglutinins;" but, in years to come the one atrocity whose promulgation may be remembered with particular mal de mer by the older pediatricians will be the term "ambulatory pediatrics."
Albumin Metabolism in Cystic Fibrosis
Authors: Johnson A. Myron
Published: December 2021

It appears that Dr. Strober and I disagree on the implications of the word "cause" (Pediatrics, 44:144, 1969). The paper in question did not even consider the possibility that some other factor(s) could result in increased blood volume and decreased albumin synthesis concurrently. One possible third factor is the acute inflammatory response. If such be the case, even normal albumin synthesis may represent a compensatory response to the hypervolemia.

The arguments in Dr. Strober's reply are based, in part, on the speculation that the liver is incapable of producing albumin at a rate much above the normal, resting rate.
Infant Nutrition in the Subtropics and Tropics (World Health Organization Series No. 29), ed. 2, by Derrick B. Jelliffe, M.D., F.R.C.P., F.A.P.H.A. Geneva: World Health Organization, 1968, 335 pp., $9.00 clothbound
Authors: Scrimshaw Nevin S.
Published: December 2021

Since its publication in 1955, the WHO Monograph, Infant Nutrition in the Subtropics and Tropics by Derrick Jelliffe, has been indispensable reading and reference for persons dealing with pediatric problems in the developing areas of the world. Its review of infant feeding practices in tile subtropics and tropics was unique, and its description of nutritional diseases among young children in these areas was concise and reliable. The chapters on improving infant feeding, preventing nutritional disease, and introducing nutrition education were by far the best published guidelines available.
Pediatric Surgery, Vol. 1, ed. 3, edited by Orvar Swenson, M.D. New York: Appleton-Century-Crofts, Education Division, Meredith Corporation (440 Park Avenue South, New York, New York 10016), 1969, 768 pp
Authors: Kiesewetter William B.
Published: December 2021

Ten years ago there were two standard textbooks of pediatric surgery in English, one of which had only recently been written by Dr. Swenson. Since that time, the whole field has been inundated by a variety of books on the entire field of pediatric surgery, as well as many of its sub-specialties. In spite of this, Dr. Swenson's third edition of his book will serve a very real purpose both for pediatricians and surgeons.

The current edition is an ambitious undertaking in two volumes by the members of the surgical staff of the Children's Memorial Hospital in Chicago.
Let Children Be Children: How Modern Adults Can Give Wise, Loving Guidance to Boys and Girls from Infancy Through the Pre-teen Years, by Freda S. Kehm, Ph.D., and Joe L. Mini, Ed.D. New York: Roland E. Burdick (291 Broadway, New York, New York 10007), 1968, 160 pp., $4.95
Authors: Alpert Joel J.
Published: December 2021

This interesting book, patterned after the senior author's apparently successful television program, contains a great deal of information written, for the most part, in an effective way. Some useful references are included.

The book has some serious limitations. First, the authors like to quote other people. The result of this is nonsense of the following kind: "Dr. Willis J. Potts in quoting Dr. T. Berry Brazelton's study, etc., etc. says;" "Dr. Peter H. Wolff found Burton L. White and Peter W. Castle discovered...."
THE ORIGIN OF THE WORD PICA
Authors: C. T. E.
Published: December 2021

I suspect that few pediatricians know the etymology or origin of the word pica; few words in medicine have a more fanciful background.

Pica was first used as a term for a perverted craving for substances unfit to be used as food by Ambrose Paré (1509-1590). Pica is the medieval Latin name for the bird called the magpie, who, it is claimed, has a penchant for eating almost anything. When we say a child is suffering from pica, we are really calling him a magpie.1 Furthermore the French form of pica is pie. The word piebald, which is often used in relation to Waardenburg's syndrome, is compounded from pie, a magpie, and bald, from the Welsh word meaning a white streak on the forehead.2 Since the magpie is also black and white, the word piebald to describe the forelock of white hair surrounded by the patient's normal darker colored hair is based on solid etymologic evidence.
RIEGER'S SYNDROME
Authors: Feingold Murray , Shiere Frederic , Fogels Helmi R. , Donaldson David
Published: December 2021

Three generations of a family with Rieger's syndrome are presented. Ocular and dental abnormalities constitute the major manifestations. Hypodontia, microdontia, enamel hypoplasia, missing teeth, peg-shaped teeth, and malocclusion are frequent oral findings. Hypoplasia of the maxilla causes the mandible to appear prominent, giving the patient a prognathic appearance. Aniridia, hypoplastic iris, and glaucoma are the major eye problems. The propositus also has short stature and decreased growth hormone levels which have not been reported before in this syndrome. The importance of early diagnosis is stressed in order to preserve the remaining dentition by proper dental care and to be aware of the possibility of the presence of glaucoma, which should be treated as soon as discovered.
Antibiotics and Their Effect on Bordetella pertussis in the Nasopharynx
Authors: Adasek Peter J. , Meyer Marie N. , Ray C. George
Published: December 2021

Antibiotic therapy of varying dose, type, and duration was given to 11 infants and children with clinically and laboratory proven pertussis, and cultures and FA studies were used to determine their nasopharyngeal carriage of B. pertussis organisms. Nine of the 11 patients were found to still be harboring the organisms at the conclusion of the initial course of therapy.

It is recommended that patients with pertussis who are treated with antibiotics should not be assumed to be non-contagious after therapy is completed and that appropriate bacteriologic or FA studies are essential in determining whether nasopharyngeal carriage still exists.
Transient Left Bundle Branch Block in a Neonate
Authors: Brinsfield Dorothy
Published: December 2021

A neonate with transient, benign left bundle branch block has been presented. There is no similar case report in the literature. The etiology of the left ventricular conduction delay is unknown, but there was no clinical evidence of a congenital anomaly or of infectious mayocarditis. The finidings of this infant differed from those of adults in that there was wide splitting of the second heart sound throughout the respiratory cycle, no gallop sounds, and the initial forces of the QRS were atypical. These differences are thought to represent the expected findings of LBBB in a newborn.
A Neurological Study of Newborn Infants, by David J. Beintema with a preface by Heinz F. R. Prechtl (Clinics in Developmental Medicine No. 28). London: Spastics International Medical Publications in Association with William Heinemann Medical Books Ltd, 1968. 178 pp., $4.80
Authors: Koenigsberger M. Richard
Published: December 2021

There are two main ways in which this 178 page volume (appendixes and references included) should prove valuable. The first is in answer to questions one and two posed by the author in the introduction: "What is the developmental course of neurological signs during the neonatal period, and how consistent are single neurological signs in individual babies from day to day?" For anyone who wants to know how the Mono response, the rooting reflex, the crossed extensor reflex, and at least 28 other neonatal responses vary through the first 9 days of life, this carefully done study is an essential reference.
HEALTH SERVICES FOR HANDICAPPED CHILDREN—MEANWHILE, BACK IN THE STATES . . .
Authors: Green Morris
Published: December 2021

The report by Smith and Lindsay in this issue encompasses with admirable conciseness and useful critique their recent examination of health services for handicapped children in Europe. Although it seems appropriate that we consider for application in this country those arrangements and techniques found helpful in countries abroad with health problems similar to our own, there are some realistic and limiting differences.

The outstanding dissimilarity is the degree of national commitment to services for handicapped children. Whether based on self-interest alone-or compassion-a sense of national obligation at least equal to that in the European countries is a prerequisite to any broad advancement in services for handicapped children in this country.
Near Fatality in an Infant Following "Lomotil" Poisoning
Authors: Bargman Gerald J. , Gardner Lytt I.
Published: December 2021

Harries and Rossiter,1 and others2-5 have recently reported the death of a 2 year old boy following the accidental ingestion of "Lomotil" tablets (0.025 mg atropine sulfate and 2.5 mg diphenoxylate hydrochloride per tablet). Several additional reports of Lomotil poisoning were published this year.2-5 We would like to describe the near fatality of a white, 20-month-old girl, following the accidental ingestion of "Lomotil" tablets.

On the morning prior to hospital admission, the child was noted by her mother to have ingested about 16 "Lomotil" tablets, by estimate.
Mist Therapy Reconsidered—Humidified Tents vs. The High Humidity Room, Further Comment
Authors: Griffiths John C. , Baker Harry
Published: December 2021

It is gratifying that Avery and her group, in a recent paper, have by careful thought, knowledge of physics, and the alchemy of mathematics helped substantiate some of the statements we made in the paper which dealt with the size of water droplets in relation to the obstructive respiratory ills of childhood. In their report, indicated above, these workers deny the value of a humidified plastic tent (or mist tent) and mention several possible adverse effects when these tents are used.
CHILDHOOD INJURIES: A CHALLENGE TO SOCIETY
Authors: Watson William
Published: December 2021

The general public still seems largely unaware of the cost in human lives, health, and happiness of the present toll of accidental injury and death in our society. This applies particularly to death and injury of children. Those people professionally involved in the end results-the physicians and others who see the unnecessary suffering-recognize the extent of the problem, but outside this group even the educated public displays a curious indifference. In a recent book on contemporary social problems, there is no mention of accidental injury and death throughout the whole 600-odd pages.

The reasons for this neglect and indifference to a problem whose incidence and consequences could probably be reduced are unclear. Even in the matter of automobile accidents, which kill some 50,000 persons annually in the United States and maim and injure hundreds of thousands of others, there appears to be a fatalistic acceptance which is quite extraordinary when one reflects on it. It is a great pity that all motor car accidents do not happen on the same day; perhaps the shock of seeing American highways reduced to the condition of a battlefield might dramatize the problem sufficiently for steps to be taken about controlling it.

The public's acceptance of death on the highway contrasts sharply with its responsiveness to dramas involving very rare diseases or conditions: the polio vaccine deaths of a few years ago, for example, in which, statistically speaking, the danger was infinitesimal. The debate about guncontrol legislation is another case in point. This has been dramatized by the deaths by gunfire of a small number of prominent men within a limited period, but the fact that more than 500 children lose their lives every year as a result of shootings seemed unable to generate an equal display of concern, despite the fact that ours is a society in which the child is supposed to be revered.
PHYSICAL ABUSE OF CHILDREN
Authors: Gil David G.
Published: December 2021

One of the basic obstacles to the development of effective countermeasures against accidental injury is the fact that the intensity of public concern over a particular type of injury-producing episode bears little relationship to its prevalence or to the seriousness of its consequences. An aircraft accident that takes 40 lives receives national attention through the mass media, whereas the fact that 150 persons died on the highways on the same day (and on every subsequent day) goes virtually unnoticed. The entrapment of a handful of children in discarded refrigerators has produced major changes in federal, state, and local laws; the death and injury of fifty times that number from accidental gunshot wounds has failed to produce even minimally effective legislation for the regulation of firearms. The "box office" appeal of various types of accident would make an interesting study; certainly in the absence of some knowledge of this phenomenon the cost-effectiveness principle is almost impossible to apply to accident counter-measures.

The following paper deals very productively with this problem. For a number of years the "abused" or "battered" child has elicited very strong concern on the part of professionals in law, medicine, social work, and child care. And one consequence of this concern has been the establishment of legislative machinery and a reporting system. Good epidemiological research reveals, however, that child abuse, despite the intense response that it has aroused, has, in fact, relatively low prevalence and that, by implication, the funds and manpower that it now absorbs more appropriately be devoted to a more signfficant cause of childhood injury. Unfortunately, legislative and administrative routines, once established, tend to perpetuate themselves. It will be interesting to note whether, in the light of the epidemiological findings, the reporting requirements will be withdrawn.

Another major contribution of this paper is its attribution of child abuse to the social rather than the psychological characteristics of the parents. Although the past decade has witnessed an increasing concern with poverty and the poor, virtually no attention has been devoted to the differential vulnerability to accidental injury of children in various socioeconomic levels ard subcultural groups. Our increased understanding of cultural deprivation and of lower-class life style gives us ample material for speculation about this differential, but such speculation is hazardous, and systematic empirical research must be undertaken. Meanwhile the present paper and the one by Kravitz and Driessen offer us useful guidelines.
Plasma Lipoprotein Lipase in Children with Idiopathic Nephrotic Syndrome
Authors: Hyman Lawrence R. , Wong Paul W. K. , Grossman Aaron
Published: December 2021

Plasma lipoprotein lipase activity was determined in six children with idiopathic nephrotic syndrome and in six controls. The mean lipoprotein lipase activity was significantly lower in the symptomatic nephrotic patients. This decreased enzyme activity may contribute to the hyperlipemia usually observed in the nephrotic syndrome.

See table in the PDF file
Letter to the Editor
Authors: Allen V. Robert
Published: December 2021

The Committee on Youth has tried to present a brief discussion of drugs which are primanly abused by adolescents. Emphasis was placed on those drugs whose properties might be relatively unfamiliar to pediatricians. Alcohol and tobacco were reluctantly omitted solely in the interests of brevity. Similarly, it was decided to omit footnotes and voluminous documentation, and to offer instead a list of general references to which the pediatrician might turn.

The controversy over marijuana arises in part because there is as yet no definitive answer to the question of whether fostering dependency on a chemical will necessarily lead to increased dependency in terms of a total life experience.
Multidisciplined Patient Care Rounds
Authors: Cochran William D.
Published: December 2021

I would like to rise in defense of my colleague, Dr. Brazelton, and of his Letter to the Editor1 which stimulated the Editor's answer, the criticisms of Dr. John P. Fields2 and the presentation of the House Officers1 views by Drs. Lovejoy, Hollister, and Mclnerney.3

Perhaps not known to Dr. Field but known to those of us associated with Harvard Medical School and the Children's Hospital Medical Center of Boston, there is little if any formal instruction in psychology at the medical school level or formal psychiatry and psychology at the pediatric training level.
PLAUSIBILITIES AND POSSIBILITIES IN EARLY EDUCATION
Authors: White Sheldon H.
Published: December 2021

Early education became a topic of great public interest about 5 years ago, when Head Start was being established and support was being mustered for it. One problem maintaining the racial issue clearly lay in the schools. Minority group children were flunking out of society in their public school years and more and more evidence showed that their difficulties were already apparent in the first grade. It seemed reasonable, then, to move toward preparing these children for school by the establishment of programs of preschool education.

However reasonable the mission of compensatory preschool education, its implementation had to be attempted in the face of important shortages of information and resources.
OBJECTIVE MEASUREMENT OF INTERPUPILLARY DISTANCE
Authors: Pryor Helen B.
Published: December 2021

A simple objective method of measuring interpupillary distance is described. Normal racial differences in the cephalic index must be considered before diagnosing ocular hypertelorism, and patients should be compared with their own racial norms. Measurement of interpupillary distance has diagnostic value in craniofacial dystoses.
The Development of Immunological Factors in Infants with Hyperbilirubinemia
Authors: Nejedlá Zdenka
Published: December 2021

Twelve infants with neonatal hyperbilirubinemia caused by Rh or ABO incompatibility were followed for 1 year after birth. Antibodv determinations for diphtheria, tetanus, pertussis and three strains of E. coil (026, 055, and 079) were done. The results were compared with those from a control group of 25 healthy infants and from 40 infants who had received exchange transfusion after birth. The data suggests that bilirubin is a causative factor in the significant depression of antibody levels against diphtheria, tetanus, and pertussis in infants with hyperbilirubinemia when compared to healthy infants.

[see pdf for figures]
Caffey's Syndrome: Some Unusual Ocular Manifestations
Authors: Galyean James , Robertson William O.
Published: December 2021

Infantile cortical hyperostosis (Caffey's syndrome) apparently led to clinical and radiographic evidence of maxillary bone involvement in a 3-month-old-girl. Concomitant glaucoma occurred. Concurrent remission of both processes occurring within 4 months suggests an etiologic relationship.
MARIJUANA: CLINICAL, PSYCHOLOGICAL, AND LEGAL ASPECTS
Authors: Bates Talcott
Published: December 2021

Much has been written about marijuana. It has been described as a hallucinogen and as the cause of many shortand long-term effects. Its use has been considered by many as the first step toward addiction to more dangerous substances. The use of marijuana is now widespread. Among the undergraduate body of one large Western American university, about 70% of students have used the drug. The pediatrician to whom parents and members of the community at large may turn for advice is faced with the prospect that his patients of today may use marijuana tomorrow. Is this worse or different than today's adults who drink alcohol? Youth says, "this is our drug."
National Policy on Drug Abuse
Authors: Gabel Marc C.
Published: December 2021

The article, "Drug Abuse in Adolescence" by the Committee on Youth, gives a concise summary of the role pediatricians can play with their individual patients. What is left out, is the national role that pediatricians should play in influencing legislation that may well be harmful to this constructive role. By using repression rather than education, federal and state laws may well drive youths away from contacts with members of the society who might yet be able to work with them.
Letter To The Editor
Authors: Allen V. Robert
Published: December 2021

Dr. Gabel feels that pediatricians should take a stand on influencing national policy regarding drug abuse. His point that legal repression of one drug may lead to the use of a worse drug has been expressed frequently of late. The argument that any action "may lead to something worse" is incontestable as an argument. The proponents of repression counterargue, for example, that legalizing marijuana will cause more people to smoke it and that marijuana will serve as an introduction to the use of more dangerous drugs.
Fibrin Split Products in Serum of Newborn: Possible Technical Errors
Authors: Hathaway Wm. E.
Published: December 2021

The paper of Drs. Stiehm and Clatanoff1 indicates that the cord blood of 65% of vaginally delivered and 58% of C-section delivered normal infants contains very significant (5—30 mg/100 ml) amounts of fibrin split products (FSP). These elevated levels of FSP fall to zero by 24 hours of age. Our recently published data agree that normal infants 12 to 48 hours of age rarely show increased levels of FSP. However, regarding cord blood, our unpublished data are distinctly different than that reported by Drs. Stiehm and Clatanoff.
Letter To The Editor
Authors: Gilchrist Gerald S.
Published: December 2021

The article entitled, "Split Products of Fibrin in the Serum of Newborns," by Drs. Stiehm and Clatanoff (Pediatrics, 43: 770, 1969) deserves further comment, in the light of their conclusion that the presence of split products of fibrinogen (SPF) in newborn serum within the first 24 hours of life is not of pathological significance. I do not believe that these conclusions can be drawn until two further points are clarified with respect to methodology.

First, the authors specify that their SPF assay was performed on serum which was obtained after the blood was allowed to clot and retract for 1 to 3 hours before centrifugation.
HOW SAFE IS PUPIL TRANSPORTATION?
Authors: Charles Seymour , Shelness Annemarie
Published: December 2021

School bus transportation, a small but highly significant section of public motor vehicle transportation, was selected for study. The evidence discloses that accepted safety features and practices are largely being ignored. Drivers, whom the safety establishment has traditionally indicated for accident causation, are not being selected, trained or supervised in accordance with any uniform guidelines. Four states do not require a medical examination, four require one only prior to employment, at infrequent intervals, or for drivers over 65.

Seventeen states permit school buses to be driven by 16- and 17-year olds, 14 states set a minimum age limit ranging from 18 through 20; 19 states require that schoolbus drivers be at least 21.

Although many states recommend maximum bus driver age limits, actually a total of 35 states set no maximum age limit. In 11 states 65 is the upper driver age limit, and in four others the limit is 70.

The majority of states do not conduct an adequate bus driver education program. Higher wage scales and professional status might alleviate the present shortage of drivers in some areas.

Substantial research on means of crash attenuation and occupant protection has not been implemented. Hostile interiors which have injury potential should be eliminated. Drivers should wear safety belts to insure maintenance of seated position and vehicle control in a collision. All passengers should have seat belts, but only in association with safety seats. Small school buses offer considerably less crash protection than standard full size buses.

Serious weaknesses in operational practices include allowing youngsters to stand in buses, the lack of auxiliary supervision to the driver by another responsible adult, and the careless practices in the crossing of children to and from the stopped bus. The importance of better driver supervision is stressed.

Effective countermeasures call for the Federal Government to develop uniform safety standards for the design of buses and for the operation of this essential public service to the youth of our nation.
AUDIOLOGICAL FINDINGS IN HEARING LOSS SECONDARY TO MATERNAL RUBELLA
Authors: Borton Thomas E. , Stark Earl W.
Published: December 2021

The purpose of this investigation was to describe the audiological findings in hearing loss secondary to maternal rubella. The mothers of all but three of the 80 subjects contracted rubella during the first trimester of pregnancy. Over 75.0% sustained the infection during the second or third month of gestation. The greatest incidence of additional congenital defects was found in those instances in which maternal rubella occurred during the first month of pregnancy. In almost all instances, all other congenital abnormalities had been identified prior to diagnosis of hearing impairment. Therefore, careful attention should be given to the possibility of undiagnosed hearing impairment being present in children whose mothers contracted rubella during the time of pregnancy.

Audiograms were available for 55 of the subjects. The majority of these 55 subjects demonstrated hearing impairments classified as moderately severe to profound in degree. Ear differences were found in only 16 (29.0%) of the 55 children. No audiometric configuration emerged as representative of hearing impairment secondary to maternal rubella. Nevertheless, 40% of the audiograms were falling in pattern. The majority of the subjects demonstrated sensorineural impairments. However, about one-fourth exhibited mixed-type losses, according to the audiogram.
DUODENAL ULCER IN CHILDHOOD
Authors: Rosenlund Mary Loretta , Koop C. Everett
Published: December 2021

There has been some disagreement concerning the admittedly rare incidence of duodenal ulcer disease in children. Because of conflicting reports from other pediatrics centers, we have reviewed the records of all patients admitted to The Children's Hospital of Philadelphia in the past 20 years (1948 through 1967) in whom duodenal ulcer was diagnosed by x-ray, at operation or on postmortem examination (Table I).

There were 27 children between the ages of 15 days and 15½ years, with well established duodenal ulcers. Six of these were female (22%). The age at presentation was scattered, but the majority were between 2 and 11 years of age. Presenting complaints were varied: gastrointestinal bleeding was most common in the younger age group, while abdominal pain, usually persistent and intermittent, was the most common symptom in the older children.

The diagnosis of duodenal ulcer was made by x-ray examination in 22 patients and at operation in 2; and the ulcers were discovered only at autopsy in 3 children. All the ulcers were duodenal; the precise location was not specified in 9, but 11 were bulbar and 7 were postbulbar. Complications of the ulcer were noted in 9 patients.

Perforation occurred in 7 patients, leading to death in 4 (all had disease of the central nervous system) and repeated bleeding in 2. Etiology of the ulcer disease was determined in 15 of the children, but the cause was unknown in 12.

Our series is concerned only with duodenal ulcers which, admittedly, comprise the greatest percentage of peptic ulcers.
Lichen Striatus: Report of a Case
Authors: Alden Errol R. , Moyer Donald G.
Published: December 2021

Lichen striatus, a rare dermatosis presenting as a linear band of lichenoid papules predominantly on the extremities, has not been described in recent English pediatric journals, although the disease is seen primarily in children. It must be differentiated from other linear dermatosis, such as linear ectodermal nevus, verruca at sites of skin trauma (such as a scratch), herpes zoster, lichen planus, linear psoriasis, and lichen nitidus, but the clinical course and histology should help to distinguish lichen striatus from the other conditions. This report describes a typical case of lichen striatus in an infant younger than any child with this condition found in recent Emiglish literature.
Letter To The Editor
Authors: Snyder Russell D. , Mortimer Joan
Published: December 2021

Dr. Snyder and Mrs. Mortimer comment as follows:

Doctor Faigel's comments are very pertinent to the problem of childhood dyslexia. It appears to us also that some children without special remediation overcome or disregard their disability and become quite successful and well adjusted as adults. A clue to proper management of dyslexic children could probably be obtained by careful study of this group of adults. A tape recorder is a very beneficial aid to some but by no means all of these children.
An Introduction to Virology, by Clyde R. Goodheart. Philadelphia/London/Toronto: W. B. Saunders Company (West Washington Square, Philadelphia, Pa. 19105), 1969, 432 pp. $10.00
Authors: Medearis Donald N.
Published: December 2021

Dr. Goodheart points out in his introduction that this book is intended for "the student who is interested in viruses from the basic standpoint and who wants to learn of the contributions made by virologists to the understanding of the molecular basis of genetic expression." I agree. The book is not for the general pediatrician or the pediatrician who has a subspecialty interest in a field other than infectious disease or genetics. The book would serve well the pediatrician, or any physician, interested in infectious disease, and it would serve well the student embarking upon fellowship training in laboratory investigations of infectious disease.
The Delinquency Label: The Epidemiology of Juvenile Delinquency, by Victor Eisner. New York: Random House, 1969, 177 pp., $5.95
Authors: Deisher R. W.
Published: December 2021

The author effectively uses the methods of epidemiology to look at youth vulnerable to delinquency. While this subject may be of less interest to some pediatricians than others, it is dealt with in a manner that should be very helpful in making physicians more aware of this important social problem. Much on this subject previously has emphasized the preventive role of pediatrics, especially in regard to early child rearing. The author in this volume has concentrated on another aspect of the problem which has seldom been pointed out to physicians.
Handbook of Cardiology, by L. Jerome Krovetz, M.D., Ph.D., and Gerold L. Schiebler, M.D., with a foreword by Richard T. Smith, M.D. New York/Evanston, London: Hoeber Medical Division, Harper and Row, 1969, 388 pp., $16.50
Authors: Fashena Gladys J.
Published: December 2021

This concise, highly readable compendium grew out of an optimistic attempt by the authors, some years ago, to cover the field of pediatric cardiology in a 2-day lecture seminar! The general aim is to offer a brief basic introduction to pediatric cardiology, with emphasis on fundamental general considerations as well as the more common disease entities. The first 11 chapters deal with the basic tools of pediatric cardiology such as anatomy and embryology, experimental production and genetics of cardiac anomalies, abnormal hemodynamics, the physical examination, and the various modalities of laboratory examination.
Adolescent Nutrition and Growth, edited by Felix P. Heald, M.D. New York: Appleton-Century-Crofts, Division of Meredith Publishing Company (440 Park Avenue South, New York, New York 10016), 1969, 258 pp. $7.95
Authors: Gallagher J. Roswell
Published: December 2021

During each of the past 5 years the children's Hospital of the District of Columbia and The George Washington Medical Center have offered a postgraduate seminar on Adolescent Medicine. This volume's chapters are the edited recordings or manuscripts of the 8 presentations given in 1966 on adolescents' growth and the 10 given in 1967 on their nutrition.

Conducted by authorities in their fields, these excellent seminars have been designed to furnish further information to those concerned with adolescents' medical care and to stimulate them and those primarily interested in the seminar's topic, to develop new ideas and approaches to relevant problems.
NEONATAL MYASTHENIA GRAVIS: REPORT OF TWO CASES AND REVIEW OF THE LITERATURE
Authors: Namba Tatsuji , Brown Stuart B. , Grob David
Published: December 2021

Two male infants with neonatal myasthenia gravis are described. The serum of one patient and his myasthenic mother had no neuromuscular blocking activity or antinuclear globulin. Striation binding globulin was positive in the serum of the mother, but not the infant. Eighty two collected patients are reviewed. Incidence was 12% of babies born to myasthenic mothers. Onset was within 72 hours of birth. Mean duration was 18 days and maximum was 47 days. Nine patients died, with a mean duration of 6 days and a maximum of 21 days. The remaining patients recovered without recurrence, except for recurrence at 2 years in one patient. Manifestations were feeding difficulty (87%), generalized weakness (69%), respiratory difficulty (65%), feeble cry (60%), and facial weakness (54%), including ptosis (15%). Pharmacologic tests with neostigmine or edrophonium were positive in 86%. Management consisted of anticholinesterase medication in 81% for a mean of 21 days and general care, particularly respiratory care. The mothers all had generalized myasthenia gravis. Four mothers did not receive anticholinesterase medication and nine had undergone thymectomy. Eleven mothers subsequently had a second affected child, and five mothers had a normal child. There was no relation of neonatal myasthenia to striation binding or antinuclear globulin in serum of mother or infant.
Letter To The Editor
Authors: Gillespie James B. , Lynch John P.
Published: December 2021

For the Academy, Dr. Gillespie and Mr. Lynch replied as follows:

We appreciate your remarks concerning the Academy's cooperation in preparing Redbook's Young Mother manual. Interestingly, we have received 33 letters concerning development of this publication. Thirty-one of these letters have supported our efforts to provide young mothers with information about infant care through the Young Mother manual. Pediatricians writing the Academy have suggested that the manual be sent to 24 hospitals now not receiving it.
Abstracts and their Accumulation
Authors: Rowley William F.
Published: December 2021

I am sure that like myself everyone is bothered by how much he actually retains of the material he reads or scans, and also by his ability to retrieve references. Some journals, for example the New England Journal of Medicine, have abstracts of the articles available on printed cards which can be reviewed and filed. I have found this useful and believe it would be worthwhile for Pediatrics to consider doing this. However, as an alternative and one that has the advantage of being almost immediately available, I would like to let others know of a procedure that I have found helpful.
Letter To The Editor
Authors: Gil David G.
Published: December 2021

Dr. Gil comments as folllows

Dr. Fontana's comments on my paper reflect a clinical prespective on child abuse, which may be appropriate in dealing with individual incidents, but not in unravelling the nature and scope of a complex phenomenon involving medical, psychological, social, cultural, and legal aspects. To Dr. Fontana, child abuse is merely a "pediatric syndrome" and he questions, by implication, the credentials of nonmedical investigators of the phenomenon. Such a narrow conceptualization reflects the "emotional bias and vested interest" to which Dr. Fontana objects so eloquently in his letter.
Incident of Salt-Losing Congenital Adrenal Hyperplasia
Authors: Vines Robert
Published: December 2021

In New South Wales we have long been aware that, in our community, the incidence of the salt-losing variant of congenital adrenocortical hyperplasia differs from that reported in the literature. It was of interest then to read of the similar incidence found by Drs. Marks and Fink1 and the even higher incidence reported by Dr. Cohen.2

At the Royal Alexandra Hospital for Children, over the last 17 years 78 children have been seen suffering from congenital adrenocortical hyperplasia.
Letter To The Editor
Authors: Meyer Roger J.
Published: December 2021

Dr.Meyer writes:

Thank you for the opportunity of viewing Dr. Fontana's comments on Dr. Gil's report. I concur with Dr. Gil's assessment of the situation and find it regrettable that this useful contribution was not seen in perspective. It was our intention in both the 1966 and 1968 National Childhood Injury Symposium issues to present this problem as an important component of the injury spectrum and to offer some evidence of its epidemiology and expression as a symptom of disordered family life.
Epidemiology of Mongolism, by Abraham M. Lilienfeld with the assistance of Charlotte H. Benesch. Baltimore: The Johns Hopkins Press, 1969, 145 pp., $7.00
Authors: Penrose L. S.
Published: December 2021

Any discussion on the epidemiology of mongolism is bound to cover a great deal of ground which is already well trodden. However, the subject is so complex and so many inaccurate or mutually contradictory statements have been published that Dr. Lilienfeld's work serves a useful purpose. The compiler of the present volume is an experienced epidemiologist and, for the most part, gives a clear account of the phenomena encountered. So much effort has evidently been expended on this that it seems worthwhile making a fairly careful examination, pointing out some things which appear to be obscure or which could be amplified with advantage.
NEONATAL SEPARATION: THE MATERNAL SIDE OF INTERACTIONAL DEPRIVATION
Authors: Barnett Clicord R. , Leiderman P. Herbert , Grobstein Rose , Klaus Marshall
Published: December 2021

On page 197 of the February issue Dr. Barnett's name should have been spelled Clifford.
DR. JOHN THOMSON, THE FATHER OF SCOTTISH PEDIATRICS, AN ABSTEMIOUS MAN HIMSELF, WRITES ABOUT THE MEDICINAL VALUE OF ALCOHOL FOR SICK INFANTS AND CHILDREN
Authors: C. T. E.
Published: December 2021

Dr. John Thomson (1856—1926), the foremost pediatrician of Scotland in his day, published a textbook of pediatrics in 1898 entitled Guide to the Clinical Examination and Treatment of Sick Children. In this book, acclaimed by many to be one of few classic pediatric texts written in the last hundred years, Thomson, who in all likelihood rarely—if ever—drank himself, strongly recommended alcohol as a medicinal measure for sick infants and children.1 He wrote:

Alcohol is also frequently of great use in acute disease, in childhood as in later life. In ordinary feverish illnesses, stimulants are not required; but, if there are signs of heart failure or if a typhoid condition should set in, they are urgently called for. Alcohol is also useful in various exhausting conditions, such as the pulmonary and other complications of whooping-cough or measles, and in septicaemia. It is often valuable in children with atrophy, and especially in those who have been greatly reduced by diarrhoea and vomiting.

Alcohol may be administered in the form of brandy, whisky, wine, or sherry whey. For dispensary patients in general it is best to order whisky, as it is more easily obtained of good quality than the other forms of stimulants. If it is desirable to give small doses of alcohol to an infant whose surroundings are such as to render it inadvisable to order plain whisky, a few drops of rectified spirit or brandy may be added to each dose of any medicine that he is taking. When whisky is ordered for young babies it must not be given too concentrated—not more than fifteen drops to the teaspoonful.
Letter To The Editor
Authors: Asnes Russell S.
Published: December 2021

Thank you for the opportunity to answer Dr. Werthmann's letter.

The confusion with regard to the studies of Drs. Weldon and Odell, and Panagopoulos, et al., resulted from the omission by the printer of a line from our original answer to Dr. Hall's letter. The response in question should have read "Shapiro reported a 0.62% mortality rate for 3,395 exchange transfusions. Weldon and Odell reported a 0.6% mortality rate for 351 exchange transfusions. Panagopoulos, et al. reported a 0.66% mortality for 606 exchange transfusions."