bluuebunny/crossref_metadata_2025 huggingface dataset:
Letter to the Editor
Authors: May Charles D.
Published: December 2021

I cannot improve on the statement in our paper (Pediatrics, 49:542, 1972) where the sentence following the one quoted by Dr. Glaser reads: "We wish to emphasize the aim of the study was not clinical evaluation, but to find dosage regimens which gave dependable immunochemical responses worthy of clinical trial." Our "impressions" concerning the clinical manifestations were provided at the request of reviewers of the manuscript. Nothing more regarding clinical efficacy was entertained. No elucidation can come from comparing our impressions with the clinical impressions set forth in the paper by Baldwin and Glaser.
The Tonsillectomy Problem
Authors: Shaw Edward B.
Published: December 2021

I read Dr. Paradise's article re tonsillectomy in May Pediatrics with interest and approval. I believe, however, that no two clinicians or team or collaborative effort could agree sufficiently on indications for this operation and its beneficial later effects to constitute a significantly controlled study.

In the 1920s tonsillectomy was performed as routinely and for as little reason as circumcision is today. This operation was most frequently performed following frequent respiratory infections in early school years and the improvement attributed to tonsillectomy came at a time when immunity status of the child had improved due to these infections.
Juvenile-Type Diabetes Mellitus and its Complications, edited by Karl E. Sussmann, M.D. Springfield, Illinois: Charles C Thomas, 1971, 485 pp., $32.50
Authors: Azubuike J. Chukwuemeka
Published: December 2021

At a time when few topics in medicine are free of dogma, it is refreshing to read a book which makes an impartial attempt to present the facts as they are, while at the same time mentioning the preferences of the authors.

Each of the book's chapters deals with present day investigations concerned with juvenile diabetes mellitus. In the last few paragraphs of each the author summarizes the present consensus of opinion. The chapter on the metabolic aspects of insulin deficiency beautifully illustrates this point.
Long-Term Follow-up of Neonatal Hepatitis: Safety and Value of Surgical Exploration
Authors: Lawson Edward E. , Boggs Joseph D.
Published: December 2021

A retrospective analysis of 23 patients with neonatal hepatitis revealed two classes of cases: familial (5) and sporadic (18). All five patients with familial disease and nine of those with sporadic disease underwent diagnostic laparotomy and liver biopsy; in the remaining nine sporadic cases, operations were not done. The patients subjected to surgery had a worse outcome than those in the nonsurgical group. However, familial neonatal hepatitis had significantly more serious morbidity and mortality than the sporadic disease, whether or not surgically treated. Moreover, when the familial cases were excluded from the total surgical group, no statistically significant difference in outcome appeared at long-term follow-up between the operative and nonoperative sporadic groups. We suggest that familial obstructive neonatal jaundice caused the apparent poor prognosis in our total operative series. Exploratory laparotomy, without biliary duct exploration, need not alter the future course of infants with neonatal hepatitis who lack a positive family history. Therefore, early laparotomy may be safe and useful not only in establishing diagnosis, but also in salvaging a small number of infants with surgically correctable biliary atresia.
Cotton Mather Anguishes Over the Consequences of His Son's Inoculation Against Smallpox
Authors: C. T. E.
Published: December 2021

Cotton Mather (1663-1728), usually remembered for his theological and historical writings, was also much concerned with medicine. He was interested in many aspects of contemporary science and became one of the few colonial members of the Royal Society of London.

In 1721, when a smallpox epidemic hit Boston, Mather urged Boston physicians, particularly Zabdiel Boylston, to employ the inoculation technique used by the Turks as a means of preventing fatal cases of the disease. In his Diary, Mather records the anguish he suffered for having taken this stand.

[May] 26 [1721]. The grievous Calamity of the Small-Pox has now entered the Town. The Practice of conveying and suffering the Small-pox by Inoculation, has never been used in America, nor indeed in our Nation, But how many Lives might be saved by it, if it were practised? . . .

[June] 13. What shall I do? what shall I do, with regard unto Sammy? He comes home, when the Small-pox begins to spread in the Neighbourhood; and he is lothe to return unto Cambridge. I must earnestly look up to Heaven for Direction. . . .

[July] 16. At this Time, I enjoy an unspeakable Consolation. I have instructed our Physicians in the new Method used by the Africans and Asiaticks, to prevent and abate the Dangers of the Small-Pox, and infallibly to save the Lives of those that have it wisely managed upon them. The Destroyer, being enraged at the Proposal of any Thing, that may rescue the Lives of our poor People from him, has taken a strange Possession of the People on this Occasion.
Infant Survival Following Protracted Fetoplacental Separation
Authors: Coen Ronald W. , Papile Lu-Ann , Flgueroa Rolando , Henderson Virginia M.
Published: December 2021

The following case study reports on the survival of a male infant following complete fetoplacental abruption of 75 minutes' duration. The mechanisms by which he survived are unclear.

CASE REPORT

At 30 to 32 weeks' gestation a 16-year-old female who claimed she was unaware of this, her first pregnancy, had a spontaneous and complete fetoplacental separation, with delivery into a toilet. Not realizing the significance of what had happened, she phoned her mother who lived approximately 30 minutes from the site of the delivery. In the meantime she removed the fetoplacental mass from the toilet without rupturing the chorioamnion and placed it in a paper sack.
Committee on Neoplastic Diseases: Is Liver Cancer Induced by Treating Aplastic Anemia With Androgenic Agents?
Authors: Silverman Frederic N. , D'Angio Giulio J. , Ertel Inta J. , Fernbach Donald J. , Forman Edwin N. , Kushner Joseph H. , Lahey M. Eugene , Thurman Willam G. , Jones Barbara , Miller Robert W.
Published: December 2021

Pediatricians who use androgenic anabolic agents, such as oxymetholone, should be aware of recent evidence that primary liver neoplasia has developed in at least eight patients under treatment for aplastic anemia. The risk of liver cancer may be higher in Fanconi's anemia (four cases) than in other forms of aplastic anemia. A causal relation is not yet certain. The underlying disease itself may have hepatic neoplasia as a complication, which becomes apparent only when survival is extended by drugs or other forms of therapy. Liver neoplasia has not been reported among athletes who use androgenic anabolic steroids to build up their musculature.

If these steroids are used, careful palpation of the abdomen should be done at each examination, for the earliest possible detection of hepatic masses. In one case reported to date, the tumor regressed when administration of the drug was discontinued.
Mucosal Neuroma Syndrome; Pheochromocytoma and MCT Syndrome; and Pheochromocytoma and McTwith Multiple Mucosal Neuroma Syndrome: One or More Syndromes?
Authors: Baum Jules L.
Published: December 2021

In the August 1973 issue of Pediatrics, two articles and an editorial relate to a recently delineated syndrome. In May 1972 this syndrome was defined and consists of pheochromocytoma (P), medullary carcinoma of the thyroid (MCT), multiple mucosal neuroma (MMN) or neurofibroma, intestinal ganglioneuromatosis, highly visible corneal nerves, thickened eyelids, decreased tear function, a characteristic facies, a Marfanoid habitus and an absent flare response following an intradermal histamine injection. It is understandable that the authors and editorialist in Pediatrics overlooked our article as it appeared in the ophthalmic literature.
Letter to the Editor
Authors: Schimke R. Neil
Published: December 2021

I was certainly aware of Dr. Baum's illuminating article when my recent editorial was composed, but for the sake of brevity eliminated a number of references in favor of more comprehensive reviews. I would take exception to the inference that the mucosal neuroma syndrome was first delineated in 1972, since a number of papers might lay claim to that distinction as indicated by Drs. Baum and Adler in their report. Similarly, my co-workers and I have noted on more than one occasion prior to the publication of that paper that the spectrum of syndromes involving medullary thyroid carcinoma may be quite broad, and comprise more than one heritable entity.
Viral Etiology of Cancer: Two Hypotheses With Relevance to Chemical Exposures
Authors: McAllister Robert M.
Published: December 2021

In discussing the area of cell biology in relation to the topic of Dr. Fraumeni's presentation and in relation to the Conference as a whole, I decided to describe two current hypotheses of carcinogenesis-first, the viral oncogene hypothesis proposed by Drs. Huebner and Todaro and, second, the protovirus hypothesis proposed by Dr. Howard Temin. These two hypotheses tend to reconcile the position of the two schools of thought about cancer etiology, namely, the environmentalists and the virologists. Both hypotheses are derived from observations of the RNA tumor viruses, namely, type B virus associated with mammary tumors in mice and the type C viruses associated with leukemia, lymphoma, and sarcoma in a number of animals; with autoimmune diseases in mice; and with a neurologic disease of mice.

VIRAL ONCOGENE HYPOTHESIS

This hypothesis, proposed first by Huebner and Todaro,1 is similar to that stated by Payne and Chubb2 and by Bentvelzen and Daams.3 The hypothesis states that most or all vertebrates contain the genetic information for producing a type C RNA virus in their somatic as well as in their germ cells. This information has been part of the genetic makeup of vertebrates since early in evolution and can persist for many generations in cell culture without overt production of virus. The virogenes (genes for production of type C viruses) and the oncogenes (that portion of the virogene responsible for transforming a normal cell into a tumor cell) are maintained in unexpressed form by repressors in normal cells. Various agents, including physical and chemical carcinogens, may transform cells by switching on the endogenous oncogenic information.
George Armstrong—Father of Pediatrics
Authors: Silver Henry K.
Published: December 2021

Each year the Ambulatory Pediatric Association presents the George Armstrong Award to an individual who has contributed significantly to the goal of improved patient care, teaching, and research in ambulatory pediatrics. Although George Armstrong has been called the father of modern pediatrics,1 many pediatricians are completely unaware of him as a person and of his contributions to child care.

George Armstrong was born in Scotland in 1719. He wanted to be a doctor and started medical school in Edinburgh, but had to drop out for financial reasons before receiving his M.D. degree. Nevertheless, he went to London and set up practice as a general practitioner.
Blindness During Diiodohydroxyquin (Diodoquin®) Therapy: A Case Report
Authors: Fleisher David I. , Hepler Robert S. , Landau Joseph W.
Published: December 2021

A 2½-year-old boy developed optic atrophy during an 11-month course of diiodohydroxyquin (Diodoquin) administration. This drug is currently used for several diarrheal conditions. Iodochlorhydroxyquin (Vioform), a congener of Diodoquin, has recently been implicated as the cause of subacute myelo-optic neuropathy (SMON). Attention is drawn to the possible neurotoxic and retinotoxic effects of Diodoquin. Current recommendations concerning the use of halogenated hydroxyquinolines should be reevaluated in light of these data.
Mutual Support Groups With Parents of Leukemic Children
Authors: Lambi Jacqueline
Published: December 2021

Having read the article, "Group Discussion With the Parents of Leukemic Children," by Heffron et al. (Pediatrics, 52:831, 1973) with great interest, I would like to suggest that similar group meetings are being held at other centers. I draw to your attention the excellent article, "Helping the Parents of Children With Leukemia," by Knapp and Hansen, Children's Hospital of Los Angeles (Social Work, Vol. 18, No. 4, July 1973).

Dr. Brian McSheffrey and I, through our contact with leukemic children in the Pediatric Department of University Hospital, Saskatoon, Saskatchewan, Canada, have been experimenting with mutual support group for parents of leukemic children since November 1971.
Testicular Tumors in Unilateral Cryptorchidism
Authors: Szalay Glenn C.
Published: December 2021

In patients with unilateral cryptorchidism, not only is the descended testis sometimes defective so far as fertility is concerned,1 but sometimes it is the descended testicle that develops the neoplasm. For example, Johnson et al.2 report that "approximately one out of five testicular tumors reported in patients with a history of (unilateral) cryptorchidism have developed in the contralateral scrotal testis." Another reference3 reports a one in six incidence in the descended testis.
Letter to the Editor
Authors: Jaffe Burton F.
Published: December 2021

It is certainly true that a lateral soft-tissue film of the head and neck will reveal a nasopharynx mass and is a reliable technique. A base view of the skull might also be helpful in revealing a nasopharynx mass. However, the techniques mentioned in our article to detect a nasopharynx mass could be performed by the examining physician himself, and should be the first step in evaluating a child with a neck mass when the primary site is unknown.
Fractures and Dislocation in Children, by Andrew G. Pollen. Baltimore: The Williams & Wilkins Company, 1973, 234 pp., $22.50
Authors: Carroll N. C.
Published: December 2021

I found this book to be written in a clear, direct, and concise style. It is beautifully illustrated; the lay-out is such that one can easily look at the figures while reading the text, often without having to flip a page. The book contains a reasonably complete description of fractures and dislocations that are encountered in children.

There are, however, a few points that need clarification. The reader is told how to treat the extension adduction fracture of the proximal humerus in which the proximal humeral fragment buttonholes the deltoid anteriorly.
A Parent's Guide to Children's Allergies, by Emile Somekh, M.D. Springfield, Illinois: Charles C Thomas, 1972, 189 pp., $3.95 paper, $8.00 cloth
Authors: Mueller Harry Louis
Published: December 2021

This book attempts to present a complicated subject in a simple manner to help parents of allergic children in their understanding and care of allergic diseases. It encounters the major problems of all medical books written for the layman in trying to outline diagnosis and treatment in such a way as not to clash with the opinions and directions of the patient's physician and to avoid emphasis because of the author's bias. From the reader's standpoint, it is largely successful in both respects.
The Prenatal Diagnosis of Hereditary Disorders, by Aubrey Milunsky, MB.B.Ch., M.R.C.P., D.C.H. Springfield, Illinois: Charles C Thomas, 1973, 253 pp., $11.75
Authors: Matalon Reuben
Published: December 2021

During the past decade there has been an enormous change in our approach to the problem of crippling genetic diseases and mental retardation. This change came primarily through better understanding of the causes of such disorders, which hopefully will result in either prevention or amelioration of such conditions. The field of prenatal diagnosis offers new opportunities for the prevention of an irreparable genetic disease through early detection.

This book gives a comprehensive review of the subject of antenatal diagnosis, including the basic aspects of the techniques of amniocentesis, and the preservation and handling of amniotic fluid and cells.
DESCRIPTION OF A NEW ENGLAND DISTRICT SCHOOL AS IT APPEARED IN 1804
Authors: C. T. E.
Published: December 2021

The Reverend Warren Burton (1800-1866) of Wilton, New Hampshire described the District School he attended between 1804 and 1817 in these words:

The Old School-house, in District No. 5, stood on the top of a very high hill, on the north side of what was called the County road. The house of Capt. Clark, about ten rods off, was the only human dwelling within a quarter of a mile. The reason why this seminary of letters was perched so high in the air, and so far from the homes of those who resorted to it, was this: Here was the center of the district, as near as surveyor's chain could designate. The people east would not permit the building to be carried one rod further west, and those of the opposite quarter were as obstinate on their side.

The edifice was set half in Capt. Clay's field, and half in the road. The wood-pile lay in the corner made by the east end and the stone wall.... The doorstep was a broad unhewn rock, brought from the neighboring pasture. It had not a flat and even surface, but was considerably sloping from the door to the road; so that, in icy times, the scholars, in passing out, used to snatch from the scant declivity the transitory pleasure of a slide....

The outer side of the structure was never painted by man; but the clouds of many years had stained it with their own dark hue....
Neonatal hypoglycemia: How much does it damage the brain?
Authors: Haworth J. C.
Published: December 2021

Since glucose is the major metabolic fuel for the brain, it is not surprising that hypoglycemia would cause signs of acute brain dysfunction such as convulsions, unconsciousness, and even death. In survivors of prolonged hypoglycemic episodes, permanent neurological sequelae due to cellular injury from deprivation of oxidizable substrate would be anticipated. In the newborn infant, hypoglycemia might theoretically be expected to result in permanent brain dysfunction not only from this cause, but also because glucose is a precursor for the synthesis of macromolecules, such as lipids, proteins, DNA and RNA, which occurs at a high level during the rapid phase of brain growth.1
Unusual Occurrence of Neonatal Septicemia Due to Group G Streptococcus
Authors: Baker Carol J.
Published: December 2021

Baker, C. J.: Unusual occurrence of neonatal septicemia due to group G streptococcus. Pediatrics, 53:568, 1974.

The institution the author was affiliated with at the time of the above study was inadvertently omitted in the April issue. The work is from the Department of Pediatrics, Baylor College of Medicine, Houston.
The American Academy of Pediatrics Involvement in Health Care Financing
Authors: Blim Richard Don
Published: December 2021

In what is considered one of the most important books of the past decade—Future Shock—Alvin Toffler1 describes the sickness that befalls an individual, an organization, or a nation when it is overwhelmed by rapid changes. He asserts that two actions must be initiated if "future shock" is to be minimized. They are (1) make the best assumptions possible about the future, and (2) undertake to control change.

The health care field in the '70s faces many complex and difficult problems. Removing the financial barriers to comprehensive health care for all is but one of these formidable problems. Unquestionably, other problems involving the quality, quantity, efficiency and distribution of health care delivery require continued attention and should be resolved concurrently with the development of methods to finance comprehensive health care for all.

THE DEVELOPMENT OF THE AMERICAN ACADEMY OF PEDIATRICS (AAP) COMMITTEE ON THIRD PARTY PAYMENT PLANS

In October 1956 the AAP appointed a Committee on Medical Care Plans. This committee was active until 1962 and was then dormant until 1964. At that time, the Council on Pediatric Practice was established in response to urgings of a number of Fellows that more consideration be given to the problems of the practice of pediatrics and its socioeconomic aspects. The Executive Board charged the council to concern itself with the delivery by pediatricians of the best possible care for the greatest number of children. At its first meeting in 1964, the council determined that the two items needing most urgent attention were the development of standards for child health care and the problems relating to various third party payment health plans, both private and governmental.
Presidential Address—1974
Authors: Gillespie James B.
Published: December 2021

The history of the American Academy of Pediatrics is a chronicle of practical idealism. I will not attempt to recount recent and past achievements of our society, for most have been well documented. It is beyond my capacity to identify the changes in Academy role and structure which may occur in our rapidly changing and complex social and medical environment. However, I do wish to reflect briefly on certain recent programs and actions which point up the expanding role and broader scope of interests of the Academy. These actions and interests, hallmarks of maturity and enhanced concepts of responsibility and accountability, are significant of our times.

Wisdom has been gained as we have stood upon the shoulders of our predecessors. Today's Academy cannot be separated from the past. We are deeply indebted to the perceptive, astute leadership of other days and to a dedicated membership which, for 44 years, has closely adhered to our stated goals. We continue to value their counsel. The contributions of those who preceded us are the principal reason why we are where we are today.

There is justifiable optimism for the assumption that the Academy will continue its leadership role as the major advocate for improved child health in the Americas. I sincerely believe that success will come to a society whose principal objective is placing concern for others higher on the scale of values of more and more people. We are reassured by a membership and leadership dedicated to service above self. In the words of Robert Frost: "There cannot be much to fear in a country where so many right faces are going by.
The Significance of Anaerobes in Neonatal Bacteremia: Analysis of 23 Cases and Review of the Literature
Authors: Chow Anthony W. , Leake Rosemary D. , Yamauchi Terry , Anthony Bascom F. , Guze Lucien B.
Published: December 2021

Twenty-three newborn infants with anaerobic bacteremia were seen during a 3½-year period, an incidence of 1.8 cases per 1,000 live births, and 26% of all cases of neonatal bacteremia. Clinical manifestations of neonatal anaerobic bacteremia were indistinguishable from other causes of neonatal sepsis. Prolonged rupture of membranes, maternal amnionitis, prematurity, fetal distress, foul odor at birth and respiratory difficulty were the most commonly associated conditions. Although all infants were ill appearing at or shortly after birth, only one death occurred. In our experience, anaerobic bacteremia in the newborn infant may be self-limited with a favorable prognosis regardless of antimicrobial therapy. Anaerobic pathogens, however, may occasionally be associated with serious perinatal morbidity and mortality. Anaerobic cultures employing special media should be performed routinely in all neonates with suspected sepsis, particularly when aerobic cultures have been negative.
Areas of Responsibility in the Health Care of Multiply Handicapped Children
Authors: Kanthor Harold , Pless Barry , Satterwhite Betty , Myers Gary
Published: December 2021

To clarify the roles of primary and consultant physicians in the health care of children with chronic disabilities, 44 mothers of children with spina bifida were interviewed to determine whether a primary physician, a specialist or another source had taken the responsibility for providing the following areas of health care: evaluation and treatment of the chronic disease, advice, future planning, genetic counseling, coordination, emotional support, education, acute illness care, and well-child care.

Specialists provided evaluation and treatment of the chronic disease for all children, while about three fourths of the children received acute illness and well-child care from their primary physicians. The patterns of responsibility for the other areas of health care were less clearly defined. Primary physicians were perceived as contributing little to the rehabilitative and coordinative care for these children; most mothers felt there was no physician responsible for providing overall direction to their children's care.

To provide complete and effective health care to children with chronic disabilities, parents and physicians must clearly understand who is to be responsible for both the specific health services as well as the overall direction of care. A primary physician, a specialty clinic or a "coordinating pediatrician" might effectively play this role.
Two Cases of "Shunt Nephritis"
Authors: McKenzie Sheila A. , Hayden Katherine
Published: December 2021

Two cases of glomerulonephritis associated with infected VA shunts are presented. One of the patients died as a direct consequence of the renal lesion. The importance of early detection of hematuria and proteinuria in children with VA shunts is emphasised.
CITY PLANNING FOR PEOPLE
Authors: Mumford Lewis , Moore H. T. , Deutsch K. W.
Published: December 2021

And it is not as a bold innovator in urban planning, but as an ecologist, the patient investigator of historic filiations and dynamic biological and social interrelationships, that Geddes' most important work in cities was done. He distrusted sweeping innovations and clean slates; as a biologist he knew that small quantities, as in traces of minerals in the diet, might be as important for urban life as large ones, and could be far more easily overlooked by stupid wholesale planning, done at a distance by people who over-valued T-squares and tidiness.
New Pediatric Male Urinal
Authors: Klauber George T. , Lund Sandra T.
Published: December 2021

There has been a considerable need for many years to develop a leakproof urinal for small boys with urinary incontinence. Dissatisfaction with available urinals encouraged our development of the present equipment.

The phallus in young boys is too small for attachment of a conventional condom-type device. Our attention was, therefore, focused on a condom which could be sealed against the skin around the base of the penis. The Hill-Davol condom urinal proved suitable for modification. This was achieved by precutting the diaphragm which fits around the penis and is pressed against the skin around the base.

The diaphragm is an integral part of the condom and is pressed against the skin around the penis.
Home Monitoring for Sudden Infant Death
Authors: Mindlin Rowland L. , Allen John E. , Brinkley Joseph W. , Debuskey Matthew , Friedman David B. , Furst William D. , Healy Alfred , Hunter Gertrude , Scully William E. , Siegel Earl , Wagner Marsden G. , Helfer Ray E. , Clayton Robert J.
Published: December 2021

The lay press has recently published many news items concerning sudden infant death syndrome (SIDS), and especially one concerning the use of home monitoring equipment designed for its prevention. This electronic equipment, which is sold over-the-counter and advertised to prevent SIDS, is not only costly but its sale at this time is premature and should be discouraged. Monitoring should be used only by able research persons until there is better evidence concerning the indications for it.

A number of studies on SIDS are presently in progress at medical centers throughout the United States.1-3 One is examining the relationship of SIDS to sleep apnea; another is studying cardiorespiratory responses and the sleep cycle. It is hoped that these and other studies will soon yield information about the pathogenesis and prevention of SIDS that is lacking at the present time.

The psychological impact on the family of a baby who is being monitored at home must be very great. Failure of the equipment to operate properly is not only a hazard to the baby, but causes the family sleepless nights when there are false alarms, or excessive anxiety if the monitor itself is not attended constantly.

In our present state of knowledge of SIDS, the most important functions of the pediatrician or family physician are to examine the patients he cares for and assure himself that they are in good health; to be well-informed about SIDS; and to give full emotional support to the family of a SIDS baby.

This statement will be modified at the earliest possible moment as warranted by results of scientific research and improvements in the technology of monitoring.
Comment on rubella controversy
Authors: Carver David H.
Published: December 2021

The publication in this issue of the paper by Modlin and his colleagues1 of a review of five years' experience with rubella vaccines is accompanied by a commentary by Drs. Weinstein and Chang discussing the need for further studies of the problem in view of specific questions raised in the commentary. As indicated both in the paper and in the commentary, there has been some controversy as to the best manner in which rubella vaccine can be used to prevent infection of fetuses and the subsequent problems associated with congenital rubella. The members of the editorial board consider it essential that responsible questioning of current policy occur.
Oxygen Plus Pressure Plus Time: The Etiology of Bronchopulmonary Dysplasia
Authors: Philip Alistair G. S.
Published: December 2021

Ten infants developed the chronic pulmonary syndrome designated bronchopulmonary dysplasia, following artificial (assisted) ventilation using a volume-regulated positive-pressure respirator. Despite previous reports implicating elevated oxygen concentrations for prolonged periods of time, only two infants required more than 80% oxygen for more than 24 hours, and only one infant required 60% oxygen for more than 100 hours. "Immature" lungs when exposed to inspired oxygen concentrations over 40% for as little as three days via positive-pressure ventilation may develop bronchopulmonary dysplasia. The role of the underlying disease and the relationship with Wilson-Mikity syndrome remain uncertain.
Prevention of rubella
Authors: Weinstein Louis , Chang Te-Wen
Published: December 2021

Immunization against rubella has been carried out in the United States since 1970. Efforts using three types of vaccine have been directed primarily at preschool children. Despite widespread application of the immunization program, there is still controversy with respect to the efficacy of the vaccine in producing herd immunity and in protecting pregnant women against the risk of bearing congenitally defective children. While it has been the general impression that this program has been highly successful in decreasing appreciably the incidence of this disease in the general population, a number of observations have raised serious questions as to the degree to which this has been accomplished.
Secretory and Serum IgA in Children With Protein-Calorie Malnutrition
Authors: Sirisinha Stitaya , Suskind Robert , Edelman LTC Robert , Asvapaka Chairat , Olson Robert E.
Published: December 2021

The local immune system of children suffering protein-calorie malnutrition (PCM) was investigated by analyzing the amount of immunoglobulins in the nasal washing on admission, repeatedly during 84 days of hospital therapy, and on follow-up, one to two years later. Although measured concentrations of total protein, IgG, and albumin in nasal washings were reduced in children with PCM, only secretory IgA concentrations were significantly lower (P<. 0l) in PCM compared to normal children. Mean secretory IgA concentrations were significantly reduced on admission through hospital day 70 and returned to near normal thereafter. At one to two years after hospital discharge, mean concentrations of secretory IgA in nasal secretions were within normal limits. The concentrations of secretory IgA in nasal washings were lowest at a time when serum IgA was markedly elevated; serum IgA concentrations fell to normal values during dietary treatment. The possible role of secretory IgA deficiency in PCM and infection is discussed.
Transcutaneous Determination of Arterial Oxygen Tension
Authors: Fenner A. , Müller R. , Busse H. G. , Junge M. , Wolfsdorf J.
Published: December 2021

Arterial oxygen tension measurements were performed simultaneously using two different techniques: (1) the conventional method of analyzing a blood sample obtained from the radial artery by means of a Clark electrode and (2) a new method of transcutaneous oxygen tension recording using a newly developed surface electrode containing a built-in heating device to ensure optimal cutaneous perfusion at the site of measurement.

Two groups of newborn infants were used as subjects: (1) 70 clinically healthy babies who were tested during normoxia and hyperoxia (breathing 80% to 100% oxygen) and (2) 20 sick preterm and term infants receiving inspired oxygen concentrations of between 21% and 100% during the measurement.

Our results indicate a satisfactory accuracy for the transcutaneous oxygen tension measurements in normoxia and hyperoxia (percentage coefficient of variation, 15.9% and 24.1%, respectively). In hypoxia agreement between the two methods varies depending on the degree of circulatory derangement. Overall correlation coefficients were greater than 0.85 in each group.
Transcutaneous Oxygen Tension Measurements in Newborn Infants
Authors: Rooth Gosta
Published: December 2021

Attention is called in this brief review article to the development and clinical uses of a new technique for monitoring blood oxygen tensions in newborn infants. This technique uses an electrode recently developed by Huch et al. in Germany to measure arterial oxygen tensions directly through the skin. This device allows for continuous monitoring with a non-invasive technique. The method is now in use in European hospitals. Clinical experiences are cited to document its usefulness.
Limb Blood Flow Following Umbilical Arterial Catheterization
Authors: Powers William F. , Swyer Paul R.
Published: December 2021

Stimulated blood flow was measured in the legs of 28 infants who had undergone umbilical arterial catheterization in the neonatal period. Catheter tips were positioned in the region of the aortic bifurcation, and only an isotonic saline/dextrose solution was continuously pumped through the catheter. The catheters were in place for an average of 58.3 hours (range, 4 to 144), and the infants were studied between 29 and 135 days of age (mean, 67 days). Blood flow in both legs was measured simultaneously by venous occlusion plethysmography using a mercury-in-rubber strain gauge. Analysis of peak stimulated blood flow in each leg and simultaneous flow in the opposite leg showed no difference between flow in the leg whose iliac artery had been catheterized in the neonatal period and flow in the opposite leg (paired t-test = 0.17; P > .50). No chronic, subclinical flow deficiencies of umbilical arterial catheterization were demonstrable. We see no new reason to curtail the judicious use of the umbilical artery catheter.
COMMUNICATION
Authors: Mumford Lewis
Published: December 2021

The best moments of life are usually unplanned for, indeed unplannable. The most one can do in designing a house to further intimacy and family living is to allow enough space to have one occupation take place beside another, so that people will meet spontaneously even when they are not drawn together by a common job. What is wrong with too sedulous a division of labor is simply the fact that it divides people.
Systematic Utilization of Data for Analysis of a Pediatric Emergency-Room Experience
Authors: Lamb George A. , Weinberger Howard L. , Schneiderman Herbert , Goldstein Bruce
Published: December 2021

This report describes the systematic use of emergency-room data to (1) define the experiences of a group of pediatric interns in their emergency-room rotation (especially as they relate to their role as future pediatric practitioners), (2) evaluate, supervise, and learn from their performance in this primary care setting, and (3) provide an ongoing weekly list of illnesses diagnosed in the emergency room as an epidemiological sentinel for the larger community. The future applications of this type of systematic approach, perhaps with computer technology, offer the opportunity for comparison of delivery, quality, and cost of health care between various sources of primary care (emergency-room facilities, private physicians' offices, neighborhood health centers, and health maintenance organizations).
Manpower Training and Child-Development Services
Authors: Fielding Jon , Timmons Hal , Batalden Paul
Published: December 2021

Making quality child-development services available for children of mothers in one vocational training program significantly improved the mothers' performances. On the average, mothers with children receiving these services stayed in the Job Corps longer and more frequently completed their vocational training program. Since longer length of stay and program completion show a positive correlation with a better chance of placement and higher initial wage, the new Job Corps program improves a mother's potential for economic self-sufficiency. In addition, mothers in the program are able to learn how to better understand their children and provide for their needs. Nonresident mothers in the new mother-and-child program perforlned as well as resident mothers. This similarity points towards the widespread potential for initiating similar programs in many vocational training and educational settings. If, as in the Job Corps program, providing quality child-care arrangements for mothers in such settings as high schools, colleges, other manpower training programs, prisons, and places of employment can improve the mother's general motivation, enhance her earning capacity, and improve her ability to be a good mother, then dollars invested in these programs will show a high return.
DOES THIS SOUND FAMILIAR?
Authors: Petersdorf R. G.
Published: December 2021

The major problems of departments of medicine are increased in teaching load, dispersion of house staff through several affiliated hospitals, a lack of resources to do all the tasks asked of them, and a schizophrenia concerning the departments' mission to tertiary subspecialty medicine as opposed to primary or general medicine. The major issue confronting departments of medicine is a solution to the problem of training general physicians.
Not All Children Are Magpies
Authors: Oleske James M.
Published: December 2021

In the past decade the significance of lead poisoning has focused attention on the difficulty of providing preventive medical care for poverty-burdened families living in our urban centers. There has been a great deal published about lead poisoning including several excellent reviews.1-3 I am writing to call attention to the fact that the label "pica" (a depraved compulsive appetite for non-food items) has been very loosely applied to the condition of most children discovered to have elevated body burdens of lead.
Normal Values for Intercanthal Distances of 5- to 11-Year-Old American Blacks
Authors: Juberg Richard C. , Sholte F. Glenn , Touchstone W. Joseph
Published: December 2021

From measurement of the distances between the medial canthi, lateral canthi, and the pupils of 580 black boys and 639 black girls, we present values for these dimensions for 5- to 11-year-old normal subjects. With use of the cranial circumference, we also give normal values for two clinically used indices, the canthal and the circumference-interorbital. Compared with previously published standards, the intercanthal and interpupillary values for black boys significantly exceed those of white boys with only three exceptions involving interpupillary distance, and the values for black girls exceed those of white girls with just two exceptions, one each of the lateral canthal and interpuillary distances. Thus, we suggest that the measurements of a patient be compared with normal standards specific for race as well as age and sex. In contrast, values for neither the canthal nor the circumference-interorbital index of the blacks differed from values available for whites. Consideration of the position of eyes is relevant to the diagnosis of a large number of syndromes.
The Use of Charcoal
Authors: Manoguerra Anthony S.
Published: December 2021

In reading the recently published article by Dr. Alexander Pierce on salicylate poisoning, I noticed what appears to be an oversight on the part of the author. Dr. Pierce recommends giving syrup of ipecac followed by a charcoal slurry and then repeating the ipecac in 20 minutes if vomiting has not yet occurred. It is widely known that activated charcoal will adsorb ipecac and retard its emetic activity. Drs. Corby and Decker,2 in the same issue, refer to this interaction in discussing the use of activated charcoal.
Let's stop looking over our shoulders
Authors: Bergman Abraham B.
Published: December 2021

Of course, I am biased, but I think the place I work is one of the best children's hospitals in the country. We are both a community hospital, where physicians admit their own private patients, and a university-affiliated hospital with a substantial teaching program, a sometimes tense, but generally beneficial combination. We also have an all-women governing board, which is a blessing for a children's hospital. Their ultimate yardstick on tough decisions is to do what's best for the kids. I'm not smug. My colleagues will testify that I perpetually carry a yard-long laundry list of suggested improvements. Overall, though, I'm proud of our hospital and think we're on the right track.
What Are Infants Fed in the United States?
Authors: Fomon Samuel J.
Published: December 2021

Estimates of calorie intake from various sources during infancy are presented in relation to age. The estimates, based on published reports and personal communications to the author, concern total calorie intake and its distribution between milk or formula and beikost (i.e., foods other than milk or formula fed to infants), relative prevalence of breast, formula- and milk-feedings, relative popularity of specific commercially prepared formulas, and percentage of calories consumed in the form of commercially prepared strained and junior foods and "table" foods.
SECOND HAND SMOKE
Authors:   American Lung Association
Published: December 2021

Plenty of ammunition is now at hand to help the nonsmoking majority defend itself against the health menace of "second-hand" smoke.

The American Lung Association rounded up information based on recent research concerning the harmful effects of tobacco smoke on innocent bystanders.

"Sidestream" smoke from the burning end of a cigarette and "mainstream" smoke pulled in by the smoker and then exhaled are more than merely nuisances to the nostrils and eyes of others, the Lung Association said. In an article in its monthly magazine, the Bulletin, entitled ‘Facts About Second-Hand Cigarette Smoke," the agency warned that this "double exposure" offers serious threats to the lungs and circulatory system of the unwilling inhaler. For example:

Twice as much tar and nicotine is found in sidestream smoke from the end of a burning cigarette as in mainstream smoke.

Ten cigarettes an hour smoked in an enclosed auto pollute the air so much that the carbon monoxide doubles in the blood of smokers and nonsmokers alike and could interfere with driving safety.

Parents who smoke at home can aggravate symptoms in asthmatic children and even trigger attacks in some. Even among non-asthmatic children of such parents, researchers found twice as much respiratory illness.

The Lung Association added that researchers found that smoking seven cigarettes in one hour—even in a ventilated room—lifted carbon monoxide levels in the seat next to the smoker to 90 ppm, almost twice the maximum set for industry. In an enclosed auto, smoking ten cigarettes also produced carbon monoxide levels up to 90 ppm.
Thrombotic Complications of Umbilical Artery Catheters: A Clinical and Radiographic Study
Authors: Goetzman Boyd W. , Stadalnik Robert C. , Bogren Hugo G. , Blankenship Willard J. , Ikeda Richard M. , Thayer Joel
Published: December 2021

Catheterization of the aorta via the umbilical artery provides a convenient route for monitoring arterial blood pressure, for obtaining blood specimens for measurement of blood gas tensions and chemistries, and for the infusion of fluids and pharmacologic preparations in sick newborn infants. Use of this technique may be accompanied by a number of complications of which thrombotic phenomena are the most common. Twenty-three of 98 (24%) newborn infants undergoing umbilical artery catheterization were found to have thrombotic complications determined by aortography. No correlation was present between the duration of time that the umbilical artery catheters were in place and the occurrence of thrombotic complications. From paired aortographic or aortographic and autopsy studies in 24 patients, it was concluded that if a thrombotic complication did not occur early, none was likely to occur subsequently. One patient was considered to have died as a direct result of a thrombotic complication. Aortography is a safe, simple, and reliable technique for the early detection of thrombotic complications of umbilical artery catheters. Umbilical artery catheterization is not without risk and careful selection of patients for this procedure is indicated.
Validating the Content of Pediatric Outpatient Medical Records by Means of Tape-Recording Doctor-Patient Encounters
Authors: Zuckerman Alan E. , Starfield Barbara , Hochreiter Clare , Kovasznay Beatrice
Published: December 2021

Information in 51 tape-recorded physicianpatient encounters was compared with information written in the patients' medical records. Diagnoses, chief complaints, scheduled appointments, non-drug therapy, and diagnostic studies were uniformly well-recorded. Medication names were well-recorded but dosages were not. Characteristics of care such as levels of function, probable cause of illness, reason for follow-up, and compliance were recorded poorly. Patients were more likely to know about and understand their diagnosis, and names, dosage, and intended function of their medications when this information was written in the record than when it was not. These findings indicate a relationship between the quality of medical records and the effectiveness of care.
Evaluation of Visceral Larva Migrans by Radioimmunoassay Systems
Authors: Patterson Roy , Roberts Mary , Hart Robert J. , Huntley Carolyn C.
Published: December 2021

A 9-year-old child with miliary pulmonary infiltrates, eosinophilia, and hyperimmunoglobulinemia E recovered rapidly over a four-week period. Subsequent analysis of serum samples by a solid phase radioimmunoassay technique demonstrated IgM, IgE, and IgG antibodies to Ascaris suum antigen which declined following the acute phase of the illness in parallel with a decline in serum IgM, IgE, and IgG concentrations. Precipitating antibodies in serum against Ascaris antigen were demonstrated. The diagnosis is considered to be toxocariasis or ascariasis. The application of sensitive radioimmunoassay techniques of this type should provide a method of earlier diagnosis and the demonstration of rapidly changing antibody levels a method of confirming the diagnosis in parasitic diseases.