bluuebunny/crossref_metadata_2025 huggingface dataset:
DIAGNOSIS AND TREATMENT: HYALINE MEMBRANE SYNDROME
Authors: Smith Clement A.
Published: December 2021

THE usual introductory note above should sufficiently explain why this short paper is added to the many and longer ones on a subject now actively influenced not only by investigation but also by speculation and innovation.

Few pathological states can confront the conscientious pediatrician with more doubt as to the plan he should follow or with more difficulty in knowing whether his plan is actually effective. Exact diagnosis and evidence of ultimate failure of treatment are available if the infant dies and an autopsy can be performed. But equally exact diagnosis and equally clear evidence that treatment has influenced the outcome are unfortunately not available if the infant recovers. Not only does recovery occur in about half of all cases in which the clinical diagnosis of hyaline membrane syndrome (H.M.S.) is reasonable, but recovery in milder cases may begin within a few hours of onset and is always essentially established within a few days. Clinical (and even chemical) response to therapy is hard to identify with certainty under such rapidly changing conditions. To some extent these same difficulties apply also to the evaluation of measures for prevention.

Clinical Diagnosis

Clinical diagnosis of H.M.S.(for which the reader may substitute other designations, including the idiopathic respiratory distress syndrome (RDS) so long as he recognizes the same syndrome under his designation) should begin with history and physical examination. In the author's hospital, at least one chest roentgenogram is usually included, as well as some or all of the chemical measurements described below. Because laboratory and clinical resources for diagnosis and treatment of so common a condition will necessarily vary, simpler procedures will be presented, although their derivation from more elaborate ones will occasionally be described.
PREPARED INFANT FORMULAS AND COMMERCIAL FORMULA SERVICES
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

Traditionally, formulas fed to infants in hospitals are prepared in the hospital formula room. In recent years, commercial formula services, representing alternate sources of infant formulas, have been developed and may eventually replace hospital formula rooms. These services represent acceptable sources for formulas fed to hospitalized infants, provided standards of sterility and nutritional quality are scrupulously maintained. The general nature of the two major types of formula services has been described, and some factors deserving consideration in regard to use of formula services have been presented.
Nuclear Projections of Neutrophils in the D (13-15) Trisomy Syndrome
Authors: HECHT FREDERICK , SCOTT C. RONALD
Published: December 2021

The purpose of this letter is to provide criticism of a recent paper (Pediatrics, 35:712, 1965) in which nuclear projections in the neutrophils of one boy with 13-15 trisomy were compared to those from 7 "normal controls," 4 of whom were females. The findings suggested to the authors that "the presence of nuclear projections in neutrophils is not of practical value in the diagnosis of the 13-15 trisomy syndrome in the neonatal period."

We are critical of the authors' choice of controls and disagree with their conclusions for the following reasons: (1) The 4 female "controls" had a significantly greater mean number of projections per cell than did the 3 male controls (P < 0.001).
Pilonidal Lesions in Infants
Authors: SHAW ANTHONY
Published: December 2021

I take issue with Dr. Lewin's article, Pilonidal Cyst in Infancy, Pediatrics, 35:795, on several counts. First of all and most important, the evidence on which he claims to be making a historical first case report is very shaky indeed. I do not believe that "strongly suggestive" clinical and anatomic evidence is a sufficiently strong platform on which one should base such a claim. Dr. Lewin is basing his entire thesis on the fact that his patient developed an abscess (subsequently a sloughing cellulitis) in an area where congenital sinuses are occasionally observed.
Letters to the Editor
Authors: LEWIN RICHARD A.
Published: December 2021

I must agree with Dr. Shaw that the term pilonidal sinus, like so many medical terms in common use, is an unwanted legacy of former days. I used it only because its meaning is generally understood, and I cannot believe that a term such as presacral sinus, which Dr. Shaw uses to describe a lesion lying posterior to the sacrum, is any less inaccurate or misleading.

As for the evidence presented in the case report, I was at great pains to point out that there could be proof of the diagnosis without biopsy; but I contest his implied assumption that such a diagnosis cannot be made on clinical and anatomical grounds alone.
ESOPHAGEAL HIATUS HERNIA IN INFANCY AND CHILDHOOD
Authors: Humphreys G. H. , Wiedel P. D. , Baker D. H. , Berdon W. E.
Published: December 2021

Observations on the treatment and course of 34 patients with esophageal hiatus hernia seen at the Babies Hospital in New York between 1943 and 1963 have been reviewed. These patients, ranging from birth to 12 years of age when first seen, presented symptoms of vomiting in the first weeks or months of life in the majority of cases. Sixteen were treated without operation (5 being asymptomatic). Twelve of these had good or fair results; 2 died.

Eighteen were treated surgically, twenty-three operations being performed. Results are not comparable, since those surgically treated represent, in general, patients in whom the diagnosis was made too late for effective non-surgical treatment. Fifteen obtained good results, seven by simple transthoracic repair and eight following esophagectomy. Five operations failed, requiring reoperation. There were two deaths.
Overestimation of Nutritional Requirements; Leucine-Sensitive Hypoglycemia
Authors: FORBES GILBERT B.
Published: December 2021

A number of factors conspire to promote overnutrition for the modern child. One such factor–the overestimation of nutritional requirements–is illustrated by the report of H. Roth and S. Segal (Pediatrics, 34:831, 1964) on the dietary treatment of leucine-sensitive hypoglycemia.

I refer to the statement that the proposed diet involves a ". . . limitation of dietary protein, but sufficient protein is supplied to fulfil the minimum requirement" (italics mine). The leader is then directed to a diet providing 40-44 gm of protein (of which about 30 gm is from animal sources) for a child of 18-36 months of age.
Management of Acute Viral Bronchiolitis in Infancy
Authors: CANBY JOHN P.
Published: December 2021

In the recent article by Drs. Wright and Beem, "Acute Viral Bronchiolitis in Infancy" (Pediatrics, 35:334), they state that tracheotomy should be condemned in the therapy of this illness. Although I agree with most of their points, I must take issue with this particular statement. We have found, at this hospial, that tracheotomy may be a life-saving procedure in the child who is severely afflicted with bronchiolitis. This may not be an isolated opinion since Dr. Walter Anyan, who has recently joined our staff, after serving a year as Registrar at St. Mary's Hospital in London, England, reports that he also has seen tracheotomy to be of benefit.
Letters to the Editor
Authors: WRIGHT F. HOWELL , BEEM MARC O.
Published: December 2021

Elsewhere in this issue of Pediatrics, Drs. Canby and Redd describe experiences which clearly controvert our categoric banishment of tracheotomy in the treatment of bronchiolitis. We ought to have been more temperate and said that tracheotomy should be considered only in unusual circumstances–a view with which Dr. Canby apparently agrees.

It is interesting to speculate upon why the infants he described had unusual trouble—trouble which in at least two instances was noted to come on suddenly in the course of a routine attack of bronchiolitis.
Encephalopathy or Encephalitis-like Syndrome
Authors: Scurletis Theodore D.
Published: December 2021

The recent publication of Gerald S. Golden, M.D. (Pediatrics, 36:67, 1965) entitled "encephalopathy and Fatty Change in the Liver and Kidney" describes the case of a child who died of encephalitic-like disease. I quote from his article:

"Reports of a new syndrome, the chief manifestations of which are hypoglycorrhachia, disturbances of the state of consciousness, and vomiting, are reviewed and a case presented. The pathological manifestations are quite consistent and include massive fatty infiltration of the liver without necrosis, fatty changes in the epithelium of the proximal convoluted tubules of the kidney, and deposits of fat in the endothelium of many of the cerebral vessels.
Use of Priscoline in Hypoperfusion (Hyaline Membrane) Syndrome (Continued)
Authors: Stern Leo , Beaudry Pierre H.
Published: December 2021

We should like to comment on the letter by Dr. Cotton regarding the use of tolazoline HCL (Priscoline) in the management of Hyaline Membrane Disease (Pediatrics, 36:149, 1965) and to report our own experience with its use.

The theoretical basis for the use of such therapy is based upon the role of pulmonary asoconstniction and subsequent hypoperfusion of the lung as a central pathologic mechanism n the disease.1 In suggesting this mechanism, it is proposed that acetylcholine, as well as both the inhalation of oxygen and the rapid orrection of acidemia with bicarbonate will ilate the pulmonary vessels.
Long-Term Continuous Electrocardiographic Recording in Pediatric Patients
Authors: MORGAN BEVERLY C. , DEANE PHILIP G. , GUNTHEROTH WARREN G.
Published: December 2021

A continuous electrocardiographic system, previously utilized primarily in the evaluation of adult patients has been described as modified for pediatric use. Its usefulness in evaluating arrhythmias in infants and children under a variety of circumstances has been demonstrated with four case reports.
Assessment of Cerebral Palsy
Authors: DENHOFF ERIC
Published: December 2021

When the "Complete Cerebral Palsy" textbook is written many portions of Holt's Assessment of Cerebral Palsy will be included. He has a typical British flair for "no nonsense with therapy." Holt states his goals and he achieves them. The goals are to guide the physician interested in this complex syndrome to precise observation and recording of gross and fine motor activities. He is particularly concerned with posture, tonus, locomotion, and hand use.

The text does not cover equally important aspects of cerebral palsy which are the psychological, perceptual, educational, and social elements. Etiology was purposely omitted because this has been covered in other texts.
COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION, American Academy of Pediatrics
Published: December 2021

COUNSELING on feeding and nutrition is one of the cornerstones of continuous health supervision of infants and children. It is to the family physician or pediatrician that many parents turn for guidance in relation to the feeding and nutritional problems of their children. It is he who promotes normal growth and development through teaching the mother since only by educating the mother will there be any insurance that the diet of her child is nutritionally sound. He is also concerned with nutrition and diet as an integral part of medical diagnosis and therapy. He has numerous opportunities to apply the concepts of nutrition in health promotion, in disease prevention, in the diagnosis of disease, treatment of disease, and in rehabilitation from chronic illness.

The pediatrician's participation in community health services, such as well-child conferences and school health programs, frequently brings him into contact with municipal public health agencies. Such agencies often have many services available to help the pediatrician fulfil his role in promoting and maintaining the nutritional health of his patients and their families.

Nutrition services provided by state and local departments of health are directed primarily toward meeting the needs of specific groups, although at times the "group" may be the entire community. Efforts in nutrition counseling relate to those groups toward which specific health department activity is directed, e.g., expectant mothers, infants, children with handicapping conditions, children in day-care or other group-care settings, and many others with special requirements.

Pediatricians can look to public health agencies for a variety of nutrition services such as consultation on nutrition, dietary counseling services for patients, diagnostic nutrition services, provision of special dietary products, dietary consultation to hospitals and other group-care facilities, and nutrition education materials for their own reference as well as for use by their patients.
Letters to the Editor
Authors: GITZELMANN RICHARD
Published: December 2021

As Dr. Rapkin has stated, a high dose of raffinose given by mouth did produce diarrhea in a healthy boy. However, it would be hard to administer the same quantity of raffinose in the form of soybean formula. This is best demonstrated by the following table of the chemical composition of soybeans in weight percentage (compiled from K. Täufel et al., Zschr. Lebensmittel-Unters. und-Forschung, 112:31, 1960):

[See Table in Source Pdf.] As can be seen, stachyose and raffinose together compose about 5% of the wet weight of the beans.
Letters to the Editor
Authors: LEPOW MARTHA L.
Published: December 2021

The correspondent and his associates have demonstrated that a larger dose of mumps vaccine will be followed by more rapid appearance of antibody in a few subjects. Perhaps a more potent preparation would increase the likelihood of producing rapid protection. Their findings are interesting. We fail to see the relevance of these comments to our paper. The study reported had a limited objective; to see whether a previous skin test will invalidate a subsequent one. We were not attempting to produce immunity.
Spanish Summaries
Authors: COLEMAN ALLAN B.
Published: December 2021

Regarding the summaries in Spanish, I have found them to be an excellent means of expanding my vocabulary of technical terms, since they are usually literal translations of the English summaries at the end of the papers. I was struck by a minor error in the October issue (Pediatrics, 36:592. 1965) which points up the problems of translation and communication troubles of our shrinking world.

In the summary of the paper by Scriver and Davies the term ion exchange resin is translated as "resina para el intercambio de hierro," which translated back means resin for the exchange of iron.
Growing Up, How We Become Alive, Are Born and Grow
Authors: WHIPPLE DOROTHY V.
Published: December 2021

Parents in today's world usually accept the fact that they should answer frankly questions from young children concerning procreation, birth, and the difference between boys and girls. These questions, however, make many a parent uneasy. Parents worry lest they say too much, or not enough; they worry if children are too curious, or if they fail to ask the right questions. Parents quite often ask for help from their pediatricians as to how best to carry out their responsibilities in the difficult area of sex education.
Brain-Thyroid Relationships, Ciba Foundation Study Group No. 18
Authors: CRIGLER JOHN F.
Published: December 2021

This "compact" report of a Ciba Study Group presents current information on (1) physiological mechanism of thyroid regulation by the hypothalamus and pituitary, including a discussion of the role of hypothalamic temperature responsive centers on thyroid activity; (2) the role of thyroid hormones in brain development; and (3) the effect of congenital hypothyroidism and of hyperthyroidism on neurological function with respect to intellect and behavior.

The neurophysiological papers by Harris, Reichlin, and Anderson, dealing with our present knowledge of the source and nature of "thyrotropic-releasing factor" (TRF), and of the interrelation between the neutral and hormonal (thyroxine and the sympathomimetics) thermoregulatory factors involved in maintenance of thermal homeostasis, are factual, interesting and provocative.
The Undescended Testicle: How Long to Wait?
Authors: KLEIN ROBERT
Published: December 2021

I am somewhat reluctant to comment upon Dr. Bongiovanni's article (Pediatrics, 36:786, 1965) on the undescended testicle since it is certainly the most reasoned and unemotional statement I have seen about the problem in a long time. However, I think the next to last sentence undoes much of the good of his presentation. Dr. Bongiovanni dispassionately reviews the subject and rightly points out that there is insufficient evidence to decide how long testes may remain in the abdomen without suffering irreversible damage.
Letters to the Editor
Authors: KOTTMEIER PETER K.
Published: December 2021

Thank you for the Dr. John G. Loeffler's letter and for giving us the opportunity to write a rejoinder to his remarks which were certainly well taken.

Dr. Loeffler's rejection of barium enema and rectal biopsy in a child of 2-3 years of age with chronic constipation and stool in the rectal ampulla appears to be justified. We did not emphasize the rectal examination and presence of stool in the ampulla, since in our experience stool can be found in the ampulla even in a patient with Hirschsprung's disease, especially with a low segment.
Accident Research
Authors: EVERIST BRUCE W.
Published: December 2021

This two pound tome should be made required reading for all accident prevention enthusiasts, amateur and professional alike. In this unique volume the authors have brought together a sizeable sample of studies concerned with the methodology of accident research. The authors' comments appear at the beginning and at the end of most of these studies. The book is not an anthology, for the authors' intent has been to present all approaches to research, yet the articles cited are, in general, of excellent quality and the authors are assiduous in pointing out the "inattention to basic principles of research methodology."
Radiologic Diagnosis Infants and Children
Authors: LOPRESTI JOSEPH M.
Published: December 2021

This book represents the first American text on this subject since Caffey's classic Pediatric Radiology. It should prove useful to those who are interested in this specialty.

Some of the descriptive text is too brief. However, the radiographic reproductions are excellent. Such illustrations are "worth a thousand words." The author glosses over some controversial subjects, e.g., peptic ulcer in children hiatal hernia in infants.

The organization of the text follows a timehonored one, starting with the skull and proceeding through various systems.
Tuberculin Test for Tuberculosis after BCG-Vaccination
Authors: ROSENTHAL SOL ROY
Published: December 2021

In the October 1965 issue of your journal, Dr. Martin Lifschitz of the Division of Indian Health reported on the results of the tuberculin testing of 250 Navajo infants and children who had been vaccinated as newborns with BCG. His group found not only a low incidence of conversion to 5 TU of PPD after vaccination, but also that the average diameter of the reactions was small. These results are at variance with those which we have obtained at the Tice Clinic.
Letters to the Editor
Authors: LIFSCHITZ MARTIN
Published: December 2021

Thank you for the opportunity to reply to Dr. Rosenthal's letter. When Dr. Rosenthal spoke to me about this matter I had already left Fort Defiance and merely reaffirmed my impression that a single drop of vaccine had been the dose employed. Subsequently however, I have discussed the procedure with the staff at the Fort Defiance Indian Hospital and they have assured me that a sufficient quantity of vaccine (three drops) to cover the grid area has always been used, including the period of our study.
Alterations of the Fundus in Hypernatremia
Authors: APOSTIKIS DR. COSTOS
Published: December 2021

Disturbance in electrolyte equilibrium as a result of dehydration, especially hypernatremic dehydration, seems to have a considerable influence on the eye, besides its effect on the central nervous system.

In 18 infants suffering from dehydration observed at the children's hospital "Saint Sophia" in Athens, nine presented varying degrees of hypernatremia. Seven of these, with higher values of Na in the serum ranging from 160 mEq to 182 mEq, displayed a pathological image of the fundus, consisting of an edema of the area between disc and macula, undefined disc limits, and, occasionally, small spotted capillary hemorrhages.
Further Dangers of Diphenylhydantoin
Authors: HALL BRYAN DAVIS
Published: December 2021

Dr. Claude D. Lauriault's communication (Pediatrics, 37:341, 1966) concerning the toxicity of diphenylhydantoin was timely and representative of many of the problems we have seen with the prolonged use of Dilantin. Some other serious problems in this regard were noted by our staff in an 11-year-old white male recently.

This child had been referred to us from a smaller Kentucky city as a possible Hodgkin's disease. He had been on the verge of irradiation therapy because of hepatosplenomegaly, hilar adenopathy, and a bone marrow aspirate with "atypical" lymphocytes.
Fundamentals of Clinical Hematology
Authors: PEARSON HOWARD A.
Published: December 2021

The authors' stated purpose is to produce for the student and practitioner a text which is "concise . . . and yet comprehensive." A completely successful compromise between these divergent, perhaps mutually exclusive, aims is probably impossible. In their attempt for completeness, the authors sometimes present facts without qualifications or attempts to place them into proper perspective and balance. For example, in a discussion of the platelet, it is stated "a plasma factor is required for normal platelet production and absence has been demonstrated to result in thrombocytopenia."
Biochemical Approaches to Mental Handicap in Children, A Symposium of the Society for the Study of Inborn Errors of Metabolism, held at Liverpool University on September 16, 1964
Authors: EFRON MARY L.
Published: December 2021

The second symposium of this new society was intended to present a few of the latest developments in this rapidly progressing field, and to review certain limited topics in depth. The seven papers included in this volume cover many very different aspects of the field of biochemical genetics.

Dr. Nina Carson reviews her findings from a mass survey by urine testing of almost 3,000 retarded patients; this very productive study first uncovered homocystinuria. The results will interest the many investigators concerned with screening for metabolic disorders, although none of the diseases are discussed in depth.
Editor's Note: Doctors Falek, Schmidt and Jervis commented as follows:
Authors: Schmidt Rina , Jervls George A. , Falek Atrhur
Published: December 2021

We should like to thank Drs. Opitz and Smith for their detailed commentary on our report of chromosome anomalies in a large pedigree with de Lange syndrome. It is certainly most kind of them to postulate that our patients represent a new multiple anomaly. However, whether or not all cases of de Lange syndrome have a common etiology is at present unknown, and it would be most presumptuous of us to assume that our cases compose an entirely new disorder.
Letter to the Editor
Authors: Eisenberg Leon
Published: December 2021

Dr. Mason and I clearly disagree. Each of us has stated his view. I doubt seriously that either of us will persuade the other. What will matter to pediatricians will be the evidence on which our arguments are based.

The pendulum swings-agreed. The problem, however, is whether truth is to be found at absolute rest.

For all the air of gentle chiding and sweet reasonableness Dr. Mason assumes to begin with, his draconian beliefs issue forth in his last paragraph-and they could hardly differ more from my own.
The History of Paediatrics: The Progress of the Study of Diseases of Children up to the End of the XVIIIth Century, by George Frederic Still, M.D. London: Dawsons of Pall Mall, 1965, 526 pp., 5.10.0 ($15.50)
Authors: Radbill Samuel X.
Published: December 2021

First published in 1931 as an enlargement upon the Fitzpatrick lectures which were given a few years earlier at the Royal College of Physicians in London, the original edition of this book had become a rarity thanks to Hitler's bombers which destroyed all but about 800 copies. Now this facsimile reprint will meet an eager welcome. It complements Ruhräh's Pediatrics of the Past, which Still, in his preface, described as so "masterly and delightful an anthology." Using the biographical method, the growth of medical interest in children is traced chronologically from Hippocrates to Jenner, a period from about 400 B.C. to 1800 A.D. An appendix listing pediatric inaugural dissertations written between the years 1573 and 1799 and another listing minor writings, dissertations, and pamphlets from 1729 to 1797, as well as an index of names and subjects, add to the usefulness of the book.

George Frederic Still (1868-1941), whose last name is the eponym for juvenile rheumatoid arthritis (the theme of his graduation thesis in 1897), was one of the first in England to devote himself to pediatrics as a modem specialty. He was the first professor of diseases of children in King's College, London, and the author of many important pediatric papers, as well as several books among which is his popular and beautifully written textbook on Common Disorders and Diseases of Children. But his most enduring gift to mankind is this remarkably accurate and scholarly study of the history of pediatrics. This reprint is a photocopy of the original.

Nothing but the name of the publisher on the title page has been altered, which will prove a boon to true scholars even though it stops short of the nineteenth and twentieth cunturies.
ATAXIA-TELANGIECTASIA: IMMUNOLOGIC AND VIROLOGIC STUDIES OF SERUM AND RESPIRATORY SECRETIONS
Authors: Bellanti Joseph A. , Artenstein Malcolm S. , Buescher Edward L.
Published: December 2021

Studies of antibody function in three patients with ataxia-telangiectasia are presented. Absence of serum γA-immunoglobulins was found in two of the patients; the third had normal amounts of this immunoglobulin. Nasal secretions of all three possessed γG- and γM-immunoglobulins; in 2 of 3 patients a variant immunoglobulin, not clearly γA, was detected in nasal secretions. Following fractionation of their sera by gel filtration with Sephadex G-200, neutralizing antibody to poliovirus 1, influenza A2/63, parainfluenza 3, and echovirus 28 were found in association with the γM- and γG-immunoglobulins in two patients and with all three immunoglobulins in the third. The pattern of neutralizing antibody in nasal secretions paralleled that of serum. Since the nasal secretions lacked or were markedly deficient in γA-immunoglobulins, the specific viral antibody detected therein was attributed to the increased concentrations of γM- and γG-immunoglobulins found. The data suggest that although patients with ataxiatelangiectasia lack the normal complement of γA-immunoglobulins in nasal secretions, they do contain antiviral antibody, but in association with other immunoglobulins.
PRENATAL AND POSTNATAL DEVELOPMENTAL CONSEQUENCES OF MATERNAL PHENYLKETONURIA
Authors: Fisch Robert O. , Walker William A. , Anderson John A.
Published: December 2021

Two children, one homozygous and the other heterozygous for phenylketonuria, born of an untreated phenylketonuric mother were found to exhibit intrauterine growth retardation and persistent postnatal growth retardation. Microcephaly was present in both children at birth. Microcephaly, mental retardation, and growth retardation were present in the heterozygous child at 5 years of age and in the untreated homozygous child at 2 years of age. The possibility that the comparatively high phenylalanine level in the mother's blood and the concomitant abnormal metabolism had a detrimental effect on the child's prenatal growth and predetermined the rate of their postnatal physical as well as mental development, was discussed.
Current Pediatric Therapy 1966-1967
Authors: FAIRCHILD JOHN P.
Published: December 2021

This is the second edition of a book that has already demonstrated its value through vast use. It has been expanded to 956 pages with approximately 40% of the authorship altered. This change as mentioned in the preface is to provide a variety of viewpoints; it certainly does just that. In addition, the editors were more than liberal in the variety of formats accepted for publication, which adds to the value of this volume. Each contributor presented as much or as little as he felt was necessary.
HEALTH OF ENROLLEES IN NEIGHBORHOOD YOUTH CORPS
Authors: Eisner Victor , Goodlett Carlton B. , Driver Maynard B.
Published: December 2021

The medical examination records of the first 165 enrollees in one urban Neighborhood Youth Corps were reviewed. The review revealed that the majority of the enrollees were in need of medical or dental services or both. Problems in the identification and treatment of medical conditions in this group are discussed. The importance of advanced planning of health care for this group is emphasized, and suggestions are made for such a health plan.
CARCINOMA OF THE THYROID IN CHILDREN AND YOUNG ADULTS: IATROGENIC RELATION TO PREVIOUS IRRADIATION
Authors: Hagler Sumner , Rosenblum Philip , Rosenblum Arthur
Published: December 2021

Fifteen cases of carcinoma of the thyroid and four cases of thyroid adenoma in children and young adults are reported. In all, except one, irradiation had been given to the head, neck, or chest of these patients 5 to 17 years previously.

These observations suggest that carcinoma of the thyroid in children is related to irradiation, often prescribed for uncertain therapeutic effect. Irradiation to the head, neck, or chest of infants and children should be avoided wherever possible.

We believe these cases represent a remarkably high incidence of thyroid neoplasia to occur in a single practicing pediatric office. The practicing pediatrician who now follows his patients longitudinally from infancy through adolescence has a unique opportunity to observe the development of disease, even years later.
TIME, MOTION, AND PEDIATRIC PRACTICE
Authors: Ross RALPH A.
Published: December 2021

SOME interesting observations of what the modern pediatrician does with his time appear elsewhere in this issue. We believe the results could be applied, with minor variations, to the work of almost any practitioner located in the vicinity of a university teaching center. Where large university hospital staffs are not nearby to support the men in practice, more of their time is probably spent "with children who . . . require their special talents." But even then, is the amount of time so spent as great as the pediatrician would like? And, whether a university clinic is near or not, would many practioners today be able to devote much more than the mere 15 minutes which Dr. C. "although rushed," devoted to "a child with an emotional problem?"
Relationship Between Erythrocyte Glucose-6-Phosphate Dehydrogenase and the Hemolytic Anemia of Infection
Authors: FIKRIG SENIH , CHUN THERESA , WATSON JANET
Published: December 2021

A correlation between hemolytic anemia due to infection and red-cell G-6-PD enzyme deficiency was investigated in 36 patients with severe infections (mainly meningitis). No such correlation was demonstrated in this particular group.
Letters to the Editor
Authors: SALBER EVA J.
Published: December 2021

There are some points in Dr. Robertson's letter to which I feel I need to reply.

I do not know what the effect of including colored mothers would have been on the incidence of breast feeding in Boston. I deliberately kept my group homogeneous in this respect and, if I had included colored mothers, I would have analyzed their data separately and only if I had found no difference would I have combined the two groups.
INFORMED CONSENT
Authors: SILVERMAN WILLIAM A.
Published: December 2021

THE special position of infants and young children as subjects in therapeutic and non-therapeutic investigations is highlighted by recently renewed emphasis on the need to obtain formal consent, when (in the words of a National Institutes of Health memorandum) "procedures deviate from accepted medical practice." Who should act for the very young patient by giving consent based on informed understanding? Most codes for investigators specify that consent may be given only by parents or guardians. In these circumstances parents and guardians are forced into the role of arbiters required to make exceptionally difficult judgments in situations which increase in complexity each day that our knowledge increases.
PERIPHERAL BLOOD PLASMACYTOSIS FOLLOWING SYSTEMIC EXPOSURE TO PHYTOLACCA AMERICANA (POKEWEED)
Authors: Barker B. E. , Farnes P. , LaMarche P. H.
Published: December 2021

MITOGENIC properties of extracts from Phytolacca americana (pokeweed, scoke, inkberry) for human peripheral blood cells in vitro have been reported from this laboratory. Subsequently, the appearance of leukocytes typical of early and late members of the plasmacytic series was described in the peripheral bloods of two of the authors (P.F. and B.E.B.), who received accidental systemic exposure to the mitogen. Effects of phytomitogens on human cells in vivo are not established, although a number of investigators have administered phytohemagglutinin from Phaseolus vulgaris to patients with aplastic anemia, hoping that the "transformed" lymphocytes might possess hematopoietic potentialities and repopulate the marrow with useful cells. Interpretations of such studies have been complicated by the small numbers of patients studied, the natural course of this group of anemias, simultaneous use of other therapy, and other variables.

More information has been accumulated about the effects of phytomitogens on peripheral blood cells in vitro. The process of "transformation" or blastogenesis of lymphocytes, whether induced by plant extracts or specific antigenic stimuli, appears to involve an immune mechanism, although morphologic differentiation toward the plasmacytic series is not seen in the in vitro environment.

Recently, we have had the opportunity to study serial blood films from children who received systemic exposure to pokeberry, either through proven oral ingestion (berries recovered from vomitus), or by exposure of fresh cuts and abrasions to pokeberry juice in the course of handling the berries. In each of these instances large cells morphologically typical of plasmablasts and proplasmacytes, and mature plasma cells were found in the peripheral blood films for periods up to 2 weeks following exposure. Mitotic cells were present in the peripheral blood during the first 10 days after exposure (Fig. 1 and 2).
DIAGNOSIS AND TREATMENT: EPIDEMIC GASTROENTERITIS, PRESUMABLY VIRAL
Authors: Webb Clarence H. , Wallace William M.
Published: December 2021

EPIDEMIC GASTROENTERITIS is a frequent problem in the pediatric office and outpatient department. It is known to the public by numerous synonyms ("intestinal flu," "gi. grippe," "the winter vomiting disease," "epidemic vomiting," "acute nonspecific gastroenteritis," "the stomach virus," or, simply, "the bug"). Despite the scant references to this disorder as an entity in pediatric literature, it seems now to be the most frequent gastrointestinal infection, past 1 year of age, in this country. Sporadic occurrence is year-round but the season of greatest frequency is November through April. During this season, epidemic gastroenteritis generally ranks next to viral respiratory infection, otitis media, and streptococcal disease among pediatric infections.

The seasonal incidence, the sudden endemics, the short incubation period of less than a week, and the occasional respiratory symptoms have suggested that viral agents of the respiratory group are responsible for the disease, but attempts to isolate a specific agent have been fruitless. When enteroviruses have been implicated, especially ECHO type 18, the epidemics have been minor and have occurred during the summer months. Recurrent attacks in the same child, during a given winter on in subsequent years, indicate that the etiology is multiple or that solid immunity seldom develops from a single attack.

SYMPTOMS AND CLINICAL COURSE

The cardinal symptoms are nausea, vomiting, diarrhea, fever, abdominal pain, and anorexia. Less often, aching, dizziness and malaise are noted. The onset is typically with explosive vomiting, occurring at intervals of 10 to 30 minutes oven the first 4 to 8 hours, then spontaneously diminishing in frequency.
XI INTERNATIONAL CONGRESS OF PEDIATRICS TOKYO, NOVEMBER 1965
Authors: Vahlquist B. , Ota K.
Published: December 2021

IT HAS become usual in our congresses to have at least one topic dealing with pediatric education. Thus, at the Lisbon Congress in 1962 a group panel discussion was organized, co-sponsored by WHO, on "Preventive Pediatrics in the Under-graduate Curriculum" (Acta Paediat., Suppl. 151, 1963). At this Congress a somewhat different approach has been chosen, the session has acquired the rank of a plenary meeting, and the introductory talks will give a short presentation not only of pediatric education today, but also of future trends.

"Medicine is a life-long study" is a slogan which is rightly gaining ground, and which holds true for all medical disciplines, pediatrics included. It is just as pertinent whether we deal with pediatric specialists, with general practitioners, or with district officers of health. This means that the scope of education and the general methods for learning should attract an attention which goes far beyond university circles.

The first chair of pediatrics was created in 1845 in Stockholm. Today Sweden has one chair of pediatrics for every million inhabitants, roughly speaking. Still, much remains to he done. The comparatively low infant mortality figures, about 15/1,000. should not obscure the fact that much unnecessary sickness still exists among children in our country also, and that the time and interest devoted to mental behaviour problems in the younger age groups are quite inadequate.

In a recent sociological study in Sweden, a number of adults were asked which qualities in the doctor they appreciated most. It is revealing that the majority gave priority to understanding and friendliness. It may well be that knowledge and skill were taken for granted, but still the result reminds us of the fact that the basic needs of human beings are not always provided by technological progress.
Danger of the Folding Gate
Authors: SIMMONS JOHN WEBB , HATCHER ROBERT A.
Published: December 2021

This is written to call attention to a possible hazard from a device commonly used by parents of small children. The device is a folding accordion-type gate used by parents as a barrier (also called an "expandable gate").

The parents of a 2½-year-old tot installed such a gate in the doorway of their son's room. In attempting to climb over the gate, the child slipped and caught his neck between the topmost bars with his feet off of the floor.
Letters to the Editor
Authors: GOTOFF SAMUEL P. , COCHRAN WILLIAM D.
Published: December 2021

Doctors Minden and Rothberg properly point out that certain immunological tests are more efficient in detecting γM than γG antibody, and we concur that, when one is examining antibody synthesis on a molecular level, tests which detect the primary interaction between antigen and antibody are more desirable. Until very recently the latter tests have been restricted to highly purified protein antigens, and only tests which detect secondary manifestations such as bacterial agglutination, hemagglutination, bacteriolysis, opsonization, and mouse protection tests have been used to study antibodies to the complex antigens of Gramnegative bacteria.
The Prenatal Lung
Authors: AVERY MARY ELLEN
Published: December 2021

This book, consisting of 13 pages of text and 113 photomicrographs, is a very superficial study of six human fetal lungs from 6½ weeks to 29 weeks' gestational age. Only one specimen was studied by serial sections and reconstruction. The information presented is that which can be derived from inspection of 5 or 10 micron sections stained only with hematoxylin and eosin.

The questions which the pediatrician might ask the anatomist concern the time of appearance of lymphatics, secretory cells, and dimensions of airways and terminal sacs at different gestational ages.
A FOLLOW-UP REPORT ON A STREPTOCOCCAL AND RHEUMATIC FEVER EPIDEMIC
Authors: Zimmerman Robert A. , Siegel Alan C.
Published: December 2021

Data have been presented relating an epidemic of streptococcal infection associated with a high incidence of rheumatic fever in a community to a follow-up period in which bacteriological and immunological data were obtained from the same community. Although the carrier rates of Group A streptococci diminished slightly between these two periods, the most striking observation was the disappearance of an epidemic Group A, Type 5 from the school population. A significant decrease in ASO was noted in this same population between the two sampling periods, which were 1 year apart, despite the fact that 58% of the effective participants acquired Group A streptococci during an endemic year with no resulting rheumatic fever. Previously described criteria for prediction of an epidemic were applied to both periods and were found to be valid. Recommendations for civilian mass prophylaxis may still be made on the basis of these criteria.
Protecting the Pre-school Child
Authors: MAYER JEAN
Published: December 2021

This collection of essays, all written by extremely competent individuals, is a very useful introduction for anyone interested in the nutritional needs of pre-school children and their fulfilment. This age group is particularly vulnerable to malnutrition in that these children have less access to good quality protein than an adult, greater nutritional requirements than older children, and they no longer have the source of first quality protein constituted by maternal milk. It is in this age group that the protein-calorie malnutrition syndromes kwashiorkor and marasmus are most often found.
II. PAPERS SUBMITTED IN PREPARATION FOR THE INSTITUTE ON PEDIATRIC RESIDENCY TRAINING
Authors: Lawson Robert
Published: December 2021

AT THE first meeting of the American Academy of Pediatrics in 1931, a committee was established to explore the possibility of Board certification. After consultation with representatives of the national societies then in existence, the American Board of Pediatrics was incorporated in 1933. The purpose was to certify a man as a specialist in the practice of pediatrics and an early decision was that the qualifications should be set up by the men practicing in the field. It is of interest that other suggestions such as separate state qualifying boards, certification by the National Board of Medical Examiners, or certification by a board run by the medical schools were all rejected. The decision was made that the Board be formed by appointment of three men by each of the prominent pediatric groups of the time, the American Academy of Pediatrics, the Section on Pediatrics of the American Medical Association, and the American Pediatric Society. Once appointed, the Board members would not be responsible to the appointing societies. After discussion by the three societies, the Board was formed. Dr. Borden Veeder, to whom I am indebted for some of this background, was the first president, Dr. Henry Helmholz, vice president, and Dr. C. Anderson Aldrich, secretary. Because of the need for more help in the actual examinations, the Board appointed additional interested pediatricians as official examiners. In general, succeeding appointments to the Board were made from this latter group. In 1960, the charter and by-laws were modified to spell out the method of appointment so that at present the term of appointment is six years. After the lapse of one year a man may be appointed for one more term.
EXPERIMENTAL DESIGN IN STUDIES OF THE NEWBORN
Authors: SINCLAIR JOHN C.
Published: December 2021

ANSWERS to pressing questions of life and health in the neonatal period are being widely sought in both therapeutic trials and nontherapeutic investigations. As the search for knowledge about "babies" continues, it may be helpful to relate the accumulating evidence of the heterogeneity of this population to problems of experimental design.

Obvious differences among babies may be noted first (Table I). Variation among newborn infants in age, size, and resting metabolism may approximate the changes in these dimensions to be observed over the greater part of the remaining life span. It would seem as inappropriate for the small and large neonate to be included together in experimental studies under the label "baby," as for the baby, child, and adolescent to be grouped with the adult under the heading "people."
BIOLOGICAL FREUDIANISM
Authors: Dubos René , Savage Dwayne , Schaedler Russell
Published: December 2021

Many experiences of early life affect the biological characteristics of the adult in a lasting manner. This phenomenon has been illustrated by epidemiological observations in man and by several experimental models in mice.

It has been shown, for example, that when newborn animals are nursed by mothers fed diets that are slightly inadequate, their size remains subnormal throughout their life span, even though the young are fed an optimum diet after weaning. A similar depression of growth can be produced by subclinical infections shortly after birth.

Decrease in resistance to various forms of stress can be brought about in young animals by various types of nutritional and environmental disturbances so mild that their effects are not recognized when the animals are maintained under usual laboratory conditions.

These findings indicate the possibility of devising laboratory models for the analysis of many puzzling sociomedical problems.
MODIFICATION OF THE SCHEDULE OF MYELINATION IN THE RAT BY EARLY NUTRITIONAL DEPRIVATION
Authors: Benton John W. , Moser Hugo W. , Dodge Philip R. , Carr Sheila
Published: December 2021

Relative nutritional deprivation was produced in groups of 16 to 21 newborn rats who were all nursed by one dam (deprived group) and compared with control litters containing 10 or less animals. Both groups were weaned at 21 days and thereafter allowed an unlimited supply of food.

There was diminished somatic growth in all of the deprived group and, at 2 and 3 weeks, the weight of many of the deprived animals was approximately one-half that of the controls. Brain weight, total brain lipids, cholesterol, and phospholipids were reduced to approximately 80% of the control. Brain cerebrosides were affected to a greater extent than the other lipids, being only 50% of the control values. Histological sections showed less myelin. At 6 weeks, following 3 weeks of ad lib. food intake, the body weight, brain weight, and concentrations of the brain lipids of the initially deprived animals were essentially equal to those in the control animals.
FAMILIAL HEMATURIC NEPHRITIS
Authors: Rome Leonard , Cuppage F. E. , Vertes Victor
Published: December 2021

This report concerns the evaluation of a family of patients with familial hematuric nephritis. Studies included genetic patterns, ophthalmologic and audiometric evaluations, laboratory tests of renal function, and renal biopsies. The characterization of the results is discussed in light of the possible pathogenesis and significance of this disease.