bluuebunny/crossref_metadata_2025 huggingface dataset:
BOOK OF ACCIDENTS
Authors: Cone Thomas E.
Published: December 2021

The unknown author of 1830 warns that "the fastenings of coach doors are never to be depended upon, and children should never lean upon them or against them." With change of the word coach to automobile, the same admonition could be used verbatim by a writer on accident prevention today. But would the modern author's style have the trenchancy of the lesson below?1
Safety in Incubators: A Hazard Now Corrected
Authors: Franklin Margery , Heyn Ruth M. , Roloff Dietric W.
Published: December 2021

A recent experience made us aware of a potential hazard from equipment used in the care of newborn infants. A newborn boy who weighed 1,585 gm after 36 weeks' gestation and thus was small for date, was cared for in an Air-Shields C-86 Isolette, Intensive Care Model. He became very active and was able to change position inside the incubator. On several occasions he was seen with his head or feet pressed against the sides of the incubator.
IMMUNOLOGY IN DEVELOPMENT (Clinics in Developmental Medicine 34), edited by Matteo Adinolfi and prepared by John Humphrey. London: Spastics International Medical Publications in Association with William Heinemann Medical Books Ltd., 1969, 185 pp., $9.50
Authors: Cooper Max D.
Published: December 2021

This book is a collection of articles contributed by a group of experimental and clinical immunologists. It begins with (i) a discussion of the theories which attempt to explain antibody responses, quickly moves on to (ii) a review of the ontogeny of immunoglobulins and complement components in man, considering the fetal and maternal contributions to each system, swings around to (iii ) an interesting review of the phylogeny of immunity which attempts, with some success, to show the relevance of this approach to an understanding of the immune system of "higher" vertebrates such as us, and then breaks into (iv) a particularly well written and illustrated article on what is known about the immunology of mammalian reproduction with particular focus on mothers' tolerance of their embryos who can be regarded as hemi-allografts, immunologically competent themselves for varying periods of their intra-uterine lives.
Loss and Grief: Psychological Management in Medical Practice, edited by Bernard Schoenberg, M.D., Arthur C. Carr, Ph.D., David Peretz, M.D., and Austin H. Kutscher, D.D.S., New York: Columbia University Press, 1970, 398 pp., $12.50
Authors: Schowalter John E.
Published: December 2021

This is one of two books published in 1970 which pediatricians will find useful in understanding the emotional impact and complexities which occur during and following their care of a dying child. The other is William Easson's The Dying Child (Charles C Thomas).

The editors of the book reviewed are founding members of the multidisciplinary Foundation of Thanatology, an organization established in 1968 to advance knowledge about the psychological aspects of death and bereavement.

The volume is divided into five sections.
QUINACRINE FLUOROMICROSCOPY IN THE IDENTIFICATION OF HUMAN MITOTIC CHROMOSOMES
Authors: Alfi Omar S. , Donnell George N. , Derencsenyi Anna
Published: December 2021

Quinacrine fluoromicroscopy reveals a characteristic fluorescent pattern for each of the 23 pairs of the human mitotic chromosomes. The procedure is of particular value in the pairing of the C chromosomes, and in the differentiation of the morphologically similar chromosome pairs 4 and 5; 13, 14 and 15; and so forth.

A study of trisomic Down's cases helped to identify chromosome 21 as the "bright-G" chromosome.

Quinacrine hydrochloride (Atabrine) seems to give a less intense fluorescence, but a clearer pattern for visual observation, than quinacrine mustard.
Increased Incidence of Inguinal Hernia, Hydrocele, and Undescended Testicle in Males with Cystic Fibrosis
Authors: Holsclaw Douglas S. , Shwachman Harry
Published: December 2021

An increase in the incidence of hernia, hydrocele, and undescended testis was observed in males with cystic fibrosis, and to a lesser degree in male siblings and fathers. This increased incidence may be associated with the gene for cystic fibrosis and may be considered a reflection of altered embryogenesis of the wolffian derived structures. The finding of an absent vas deferens at hernia repair or orchiopexy in a child or young adult should suggest the possibility of cystic fibrosis.
Excerpt XV: Troubling the Cook
Authors: Cone Thomas E.
Published: December 2021

Scalding liquids still cause over half of the burns in childhood.1 Although cooks have almost disappeared from our homes, the lesson below–first published in 1830–still contains timely advice for today's children.2 One wonders what treatment was given to the boy who sat down in a kettle of boiling water and whose life was saved with difficulty.
Diagnostic and Screening Procedures for Lead Poisoning
Authors: Lin-Fu Jane S.
Published: December 2021

As a Fellow of the American Academy of Pediatrics and a Pediatric Consultant to the Maternal and Child Health Service, U.S. Public Health Service, I have noted with interest in the Newsletter (December 15, 1970) that the Academy's Committee on Environmental Hazards has endorsed the U.S. Public Health Service's Statement, "Medical Aspects of Childhood Lead Poisoning," recently released by the Surgeon General. But I am rather surprised at the exceptions the Committee took to the Statement, and I would like to take exception to these exceptions.
Screening of Advertising
Authors: Baron John
Published: December 2021

In the May 1971 issue of Pediatrics, the front advertising section, there is an announcement by the Institutes for the Achievement of Human Potential for a course: "Contemporary Concepts and Methods in the Treatment of Brain Injured Children." The Institutes is the organization for Drs. Doman and Delacato1 and their theories of neurological organization. I sent for information and received a catalog of courses and books which dealt with their unproven methods.
Sense of Identity in Children: Adopted and Otherwise
Authors: Kintner Elgin P.
Published: December 2021

As an adoptive father of two children and a natural father of two children all raised in the same family, I realize it is important to help adopted children to "develop a sense of worth, importance, and dignity—a true sense of identity."1 What is said in the statement about adopted children is equally important for natural children, for natural children may have more difficulty along this line than their adopted brother or sister.

Adoptive parents tend to look for hidden psychological problems which might explain minor differences in behavior from what they expected.
Trivalent Oral Polio Vaccine (Continued)
Authors: Aisenson Milton R. , Ghosh Shanti
Published: December 2021

I hesitate to offer the suggestion that Doctor Ghosh's disappointing results with oral polio vaccine1 may have been the result of an impotent product. Its efficacy is affected by heat, by alternate thawing and refreezing, and possibly by antiseptics and other chemicals. Before dismissing oral polio vaccination, these factors should be studied.
Head Circumference in Black and White and Indian (New Delhi) Children
Authors: Nellhaus Gerhard
Published: December 2021

The excellent studies by Wingerd, Shoen, and Solomon1 on "Growth Standards in the First Two Years of Life Based on Measurements of White and Black Children in a Prepaid Health Care Program," and by Ghosh, et al.2 on "Intra-Uterine Growth of North Indian Babies," bear out my finding that ethnic background plays little if any role in head circumference growth,3 and further validate the clinical usefulness of the Composite International and Interracial Head Circumference Graphs.4
What Price Brevity?
Authors: Goldbloom Richard B.
Published: December 2021

I read with great interest the excellent article by Lubchenco and Bard (Pediatrics, 47: 831, 1971) "The Incidence of Hypoglycemia in Newborn Infants Classified by Birth Weight and Gestational Age." By contrast, I read the abstract which preceded it with a mixture of frustration, spleen, and vitriol, in approximately equal amounts.

Anyone but a chronic neonatologist must surely be flummoxed by the profusion of uninterpreted alphabetical abbreviations that dot the textual landscape–in this instance, no less than four (SGA, ACA, LGA, IDM) in three short paragraphs.
Letters to the Editor
Authors: S. C. A.
Published: December 2021

We've been troubled about abbreviations too. As a result, a neat box of them is soon to appear in the lower corner of the first page of each article containing any letters more baffling than kg or I-V, where it is hoped the abstract reader can consult them by vertical nystagmus. Incidentally, a quick count shows that L.O.L. and H.B. saved themselves the writing (and our printers the type-setting) of about 400 words by their not over liberal use of abbreviations.
DIAGNOSIS OF IMPAIRED FETAL GROWTH IN NEWBORN INFANTS
Authors: Miller Herbert C. , Hassanein Khatab
Published: December 2021

Measurements of crown-heel length, head circumference, and birth weight were made on a large number of newborn infants. Birth weight by itself was frequently not a valid measure of fetal growth impairment. By including measurements of body length and head size along with birth weight, four distinct patterns of fetal growth impairment were identified. The four patterns included infants who had abnormally short body lengths for dates, infants who had evidence of disproportionate growth between body length and head circumference, infants who accumulated excessive amounts of soft-tissue mass, and infants who accumulated too little soft-tissue mass. Criteria for diagnosing each pattern were obtained prospectively and have been presented with allowances made for the effects of race, sex, fetal age, and parity on each pattern.

The separate identification of the four patterns provided a more precise description of fetal growth impairment than could be obtained from birth weight and calculated gestational age.
AN EFFECTIVE PROGRAM FOR REDUCING GROUP A STREPTOCOCCAL PREVALENCE
Authors: Zimmerman Robert A. , Biggs Betty A. , Bolin Richard A. , Wilson Elizabeth , Mathews James H. , Cropp C. Bruce , Auernheimer Arthur H.
Published: December 2021

A relatively simple and inexpensive streptococcal control program was applied to two school populations located in an area of high endemicity in Colorado. Throat cultures were obtained from children admitting sore throat and from a small, continuously rotating random sample of the student body. This method of surveillance provided a reliable index of total streptococcal incidence in the two schools. Children with Group A positive cultures sought consultation with private physicians on a voluntary basis. The application of these sampling procedures resulted in a reduction of prevalence rates to less than 5%. Comparable endemic prevalence rates observed in school children in three other Colorado communities averaged 21.9%.

The program described is practical and effective in substantially lowering the incidence of Group A infections and reducing risk to development of nonsuppurative sequelae.
GUIDELINES FOR THE SELECTIVE USE OF THROAT CULTURES IN THE DIAGNOSIS OF STREPTOCOCCAL RESPIRATORY INFECTION
Authors: Honikman Larry H. , Massell Benedict F.
Published: December 2021

A total of 6,093 respiratory and febrile illnesses experienced by children were analyzed with regard to symptoms. Our objective was to devise simple guidelines that would allow for the detection of most clinical group A streptococcal infections while eliminating the need for taking throat cultures in the majority of nonstreptococcal illnesses.

The results of the analysis led to the recommendation that throat cultures be taken in all illnesses with pure or predominant sore throat and fever of any degree and also in all other illnesses with an oral temperature of 101°F or higher even in the absence of sore throat.

Application of these guidelines would have involved taking throat cultures in 29.5% of the 6,093 illnesses observed and would have detected 88.1% of 469 clinical group A streptococcal infections estimated to be capable of causing an antistreptolysin O response and therefore potentially capable of causing rheumatic fever. The need for taking cultures in 70.5% of the 6,093 illnesses would have been obviated.

An additional 376 subclinical group A streptococcal infections capable of producing an antistreptolysin O response were observed in this study. Because of absence of symptoms these infections ordinarily would not have been detected.
SOME PEDIATRIC TERMS ONCE WELL-KNOWN BY PHYSICIANS IN THE PAST
Authors: C. T. E.
Published: December 2021

The list of pediatric diagnoses below were once well-known and accepted terms by physicians who wrote about pediatric illnesses a few centuries ago. I suspect that few contemporary pediatricians will recognize any old friends among the terms which follow:
Complement in ABO—Hemolytic Disease of the Newborn
Authors: Wang May Y. F. W. , Desforges Jane F.
Published: December 2021

Complement titres were measured in three groups of newborn infants from group O mothers:

I. 31 group O infants.

II. 10 group A or B infants with probable ABO hemolytic disease of the newborn (ABO HDN).

III. 18 group A or B infants without ABO HDN.

Seven of the Group II infants had positive direct Coombs' test, and one of these required exchange transfusion; the three babies with negative direct Coombs' test had clinical course compatible with ABO HDN. There was no significant difference in the complement titres among these various groups.

Anti-serum to human C3 and C4 was used to detect complement components on the fetal red cells of 4 infants in Group I, 5 infants in Group II, and eight infants in Group III. The reaction was negative in all these cases.

These results suggest that complement does not participate in the in vivo destruction of red cells in cases of hemolytic disease of newborn infants due to ABO incompatibility.
The Book of Accidents: Designed for Young Children. Published in New Haven in 1830
Authors: Cone Thomas E.
Published: December 2021

In the New England Primer the alphabet was taught by using diminutive illustrations of admonitory sentences. For the letter Z, Zaccheus is shown climbing a tree; the child memorized this rhyme:

Zaccheus he

Did climb the tree

Our Lord to see

In the lesson below the author cites far more likely reasons why boys climb trees.1
Polio Vaccination in Developing Countries
Authors: Brown Roy E. , Katz Michael
Published: December 2021

We have recently come across the Letter to the Editor from Dr. Shanti Ghosh,1 commenting on the trivalent oral polio virus vaccine trials reported by Hardy, et al. in Pediatrics.2

Although 96 to 100% of infants demonstrated satisfactory levels of immunity in Hardy's group, using a microneutralization titer technique, Dr. Ghosh describes disappointing results in children in India and Nigeria as indicated by low seroconversion rates, as well as very low enterovirus excretion rate in pre- and postimmunization specimens (7.8%).
Expiration Dates of Pharmacological and Biological Preparations
Authors: Johnson Kit
Published: December 2021

One of the major problems confronting preventive medicine field practice in developing countries is guaranteeing that drugs and biologicals are still effective at the time of use. This is especially true for live virus vaccines which must be kept within a narrow temperature range. Because of the insurmountable adverse hazards, which sensitive pharmacologicals face in transit from the laboratory to the patient, many ineffective (and thus potentially harmful) drugs and biologicals are administered or many effective drugs and biologicals are discarded because of a suspicious history.
Congenital Heart Disease (Cardiovascular Clinics, Vol. 2, No. 1), by Daniel F. Downing, M.D., Guest Editor. Philadelphia: F. A. Davis Company, 1970, 330 pp., $10.00
Authors: Gersony Welton M.
Published: December 2021

This is a multiauthored, mini-textbook presentation of various aspects of congenital heart disease with much of the text written in outline form; this would be of interest to the pediatrician seeking a synoptic view of the diagnosis and management of congenital heart disease. The text contains information which is often more up-to-date than that found in most pediatric cardiology texts; in fact, many of the references are as recent as 1969, 1 year prior to publication.
SCLEREMA NEONATORUM DESCRIBED FOR THE FIRST TIME IN 1784 BY DR. MICHAEL UNDERWOOD
Authors: C. T. E.
Published: December 2021

Michael Underwood (1737-1820), the most advanced writer on diseases of children in the eighteenth century, was the first physician to describe sclerema neonatorum. His description of this serious disease follows:

It may be proper in this place to take notice of a peculiar tightness and hardness of the skin over almost the whole body, that sometimes attends that kind of purging when the stools are of a waxey or clayey consistence, and usually takes place in the last stage of the disease, always affording a very unfavorable prognostic. It very rarely appears, I believe, but in disorders of the bowels on which account I have not assigned it a distinct head, though otherwise of sufficient importance. This symptom, or perhaps rather disease, somewhat similar to that called hide-bound in quadmpeds has not been mentioned in this view, by any writer on the diseases of infants. The ancients indeed described a somewhat similar affection under the name of Stegnosis and Cutis adstricto, but appear always to speak of it as a complaint of adults, often occasioned by cold. Dr. Denman first took notice of it in children, and has for some years paid great attention to it. It seems to be a spasm depending upon a certain morbid state of the first passages with which the skin is known to have a peculiar sympathy which instead of lying loose and pliable on the cellular membrane, is perfectly rigid as if it adhered to the bones. Some children indeed have been born with the complaint, none of whom have been known to live.
ECG CHANGES IN FATAL IMIPRAMINE (TOFRANIL) INTOXICATION
Authors: Fouron Jean-Claude , Chicoine Raymond
Published: December 2021

A case of poisoning with imipramine (Tofranil) has been followed by serial ECG tracings in an 11-month-old boy. Profound alteration of his myocardial function has been observed during the first 18 hours following absorption of the drug; these cardiovascular perturbations lead to irreversible cerebral damage.

Because of the atropine-like effect of the drug and the report of alteration in the ECG tracing of adult patients under imipramine therapy, it is advised that all children under such therapy be checked with an occasional ECG for possible change in myocardial function.
Transient Lactose Intolerance in Premature Infants
Authors: Abdo-Bassols Felix , Lifshitz Fima , Del Castillo Ernesto Diaz , Martinez-Garza Virginia
Published: December 2021

Healthy premature infants have a relative lactase deficiency resulting in a diminished capacity to digest and absorb lactose.1-6 However, milk formula feedings do not result in diarrhea in these babies. On the other hand, infants with significant intestinal lactase deficiency have diarrhea that characteristically improves after elimination of this disaccharide from the diet.7-8 In some of these patients, the illness began at birth and was classified as a congenital defect.9-11

The purpose of this report is to describe two premature infants who presented transient lactose intolerance since birth. The parents of both patients and two siblings of one were also intolerant to this disaccharide.
Experimental Gestational Mumps Virus Infection and Endocardial Fibroelastosis
Authors: St. Geme Joseph W. , Peralta Hugo , Farias Elvira , Davis Catherine W. C. , Noren George R.
Published: December 2021

A model of persistent gestational mumps virus infection has been developed in the chicken. Virus, inoculated into the yolk sac at 12 hours, persisted throughout fetal life and for a few days following hatch. Although virus was widely distributed in the fetus, inflammatory change occurred only in the heart. Myocarditis was detected initially at 18 days of fetal life, was most impressive at hatch, and resolved within 1 week after hatch. Examination of these chickens at 1 year of age revealed histological evidence of endocardial fibroelastosis.
Pyloric Stenosis: Father and Two Sons
Authors: Meyer Bruce P. , Johnsonbaugh Roger
Published: December 2021

There are multiple references in the literature as to the hereditary nature of pyloric stenosis.1 Many of these are not authenticated due to the lack of surgical and/or autopsy findings. This disease itself is thought to carry an incidence of 3 cases per 1,000 births.2 Carter has done extensive follow-ups on a series of index patients treated operatively from 1920 to 1939. We would like to report a family with the father and first two offspring sons being affected.

Case 1

On October 13, 1937 1-month-old L. H. was seen due to the vomiting of all intake since birth. He had lost 1 pound in the week prior to being seen.
Elevation of Serum Urea Nitrogen in Hypothyroidism
Authors: Penny Robert , Blizzard Robert M.
Published: December 2021

Four of 20 patients with hypothyroidism had elevated SUN or NPN values and three of these four were less than 2 years of age. Nine of the patients had elevated cholesterol values and eight of these nine were older than 2 years of age. Only two of the patients had both values elevated. SUN or NPN values at the upper limit of normal were found in four additional patients and were associated with an elevated cholesterol value in two. All of the patients with elevated SUN or NPN values and seven of the nine patients with elevated cholesterol values had corrected T4 values of 0.9 µg/100 ml or less.
Hypoglycemia and Hypothermia in Terminal Leukemia
Authors: Jaffe Norman , Kim Byung Soo
Published: December 2021

In 1967, Tashima1 stated that hypoglycemia in leukemia was so rare that "its occurrence in the leukemic patient should suggest an islet cell tumor or a concomitant retroperitoneal tumor." Most of the reports of hypoglycemia in leukemic patients were ascribed to in vitro glycolysis by leukocytes and were designated "artifactual hypoglycemia."2,3 Experimentally the phenomenon had been produced in test mice where lymphatic leukemia grows as a solid tumor.4,5

Hypothermia is an occasional manifestation of hypoglycemia; it is receiving increasing recognition and is considered a useful diagnostic aid.6,7 Its appearance is not dependent on the cause of the hypoglycemia.

This patient with acute myelogenous leukemia experienced several episodes of hypothermia and hypoglycemia which responded to intravenous dextrose.
R. Cannon Eley
Authors: Nadas Alexander S.
Published: December 2021

Readers of Pediatrics, pediatricians all over the world, mourn the death of R. Cannon Eley, in Boston on April 29, 1971. The writer hopes that this personal tribute to our departed friend may not be taken as presumptuous by those who have known Cannon much longer.

Dr. Eley's association with pediatrics goes back a long time. He graduated from the University of Virginia (the only one that really counted for Cannon) in 1925 and after 2 years' internship at Charlottesville and at Willard Parker in New York, came to Boston Children's in 1927.
Steroids in Hyaline Membrane Disease
Authors: Tow Abraham
Published: December 2021

A relationship between the adrenal and hyaline membrane disease has been suggested by the report of Naeye, Harcke, and Blanc in the April issue of Pediatrics.1

A few years ago, while active on the newborn service at the Guyan Valley Hospital, I treated a 5 lb Caucasian male premature with dyspnea, marked sternal retraction, and cyanosis. A diagnosis of hyaline membrane disease was confirmed by x-ray. Treatment with oxygen and moisture in an Isolette did not help.
FACIAL PARALYSIS IN CHILDREN
Authors: Manning John J. , Adour Kedar K.
Published: December 2021

In any instance of facial paralysis in a child, an effort should be made to determine immediately whether it is caused by a specific, treatable entity. Of 61 cases of facial paralysis in children seen in a Facial Paralysis Clinic, 38% were not Bell's palsy. Eight of the 61 children had disease amenable to specific therapy available today. Experience with 504 patients of all age groups seen within 4 years has led the authors to abandon facial nerve decompression in the treatment of Bell's palsy.
Letter to the Editor
Authors: Feiertag Richard B.
Published: December 2021

The Committee wishes to thank Dr. and Mrs. Shearer for their comments. We appreciate their concern and will utilize their ideas in future work of our Committee.

Our intent in this statement was to focus attention on an urgent social problem. Many specific approaches to its solution have been advocated and these are evaluated in the statements of other professional organizations.

We will continue to inform ourselves on changes and advances in adoption practice, and will attempt to present a balanced view of these changes to the practicing pediatrician.
Pattern of Multiple Drug Abuse Among Adolescents
Authors: Thompson Richard E.
Published: December 2021

Statistics regarding drug abuse among adolescents seem few and far between, and of questionable accuracy when available. This is easy to understand. In the present adolescent setting, those who have abused drugs may deny it to avoid being "busted," and those who have not used drugs may claim that they have in order to appear to "groove."

Articles such as that by Dodson and colleagues are to be encouraged. Hopefully, treatment centers and consultation agencies involved with the problem of teenage drug abuse will continue to try to support their impressions, which may lag behind changes in drug abuse patterns, by keeping similar statistics.
Mental Retardation and Its Social Dimensions, by Margaret Adams. New York: Columbia University Press, 1971, 315 pp., $10.00
Authors: Pearson Paul H.
Published: December 2021

In a book clearly directed to the professional social worker, Miss Adams has much of interest and value to all professionals working in the field of mental retardation. The concerned physician may wish to read selectively but her lucid style of writing makes for easy and rapid reading.

For the physician involved in programs for the mentally retarded, this book will give new dimensions for the effective use of social workers and to his own direct interaction with the retarded and their families.
THE SYNDROME OF "MESENTERIC ARTERITIS" FOLLOWING SURGICAL REPAIR OF AORTIC COARCTATION
Authors: Ho Edgar C. K. , Moss Arthur J.
Published: December 2021

The mesenteric arteritis syndrome describes a group of complications which may follow surgical repair of coarctation of the aorta. The etiology is unknown but there appears to be a direct relationship to the hypertension which is observed in the postoperative period in these cases. Recognition of this complication and early treatment of the hypertension with antihypertensive drugs will shorten the duration of symptoms, and may prevent the development of bowel necrosis and possible death.
FAMILIAL SELECTIVE IgA DEFICIENCY
Authors: Nell Patricia A. , Ammann Arthur J. , Hong Richard , Stiehm E. Richard
Published: December 2021

Thirteen subjects with selective IgA deficiency were obtained from five separate families. In three families an autosomal recessive inheritance was apparent while an autosomal dominant inheritance appeared very likely in the two remaining families.

An increased incidence of quantitative defects in immunoglobulin synthesis was seen in addition to evidence of abnormal antibody production and increased autoantibody formation.
OTITIS MEDIA IN THE FIRST SIX WEEKS OF LIFE: DIAGNOSIS, BACTERIOLOGY, AND MANAGEMENT
Authors: Bland Richard D.
Published: December 2021

Over a 1-year period, a diagnosis of suppurative otitis media was made in 21 infants less than 6 weeks of age, with symptomatology varying from mild rhinorrhea and cough to irritability and severe, protracted diarrhea. Only four infants presented with fever greater than 38°C. One-third of the patients had been born prematurely, 90% were bottle-fed, and only two had significant congenital malformations. Two-thirds of the babies with otitis of bacterial origin were male.

Infants admitted to the study underwent diagnostic tympanoparacentesis, yielding purulent material and bacterial growth from all but three. The predominant organisms isolated were Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae. In cases of treatment failure, reinfection was most common with Pseudomonas aeruginosa. On the basis of disc sensitivities, only 61% of the exudates from which bacteria were isolated proved amenable to ampicillin therapy alone. Bacteria cultured from nasopharyngeal swabs of the same infants showed a correlation with ear isolations in only 28% of the cases. When a 10-day course of therapy was carried out utilizing antibiotics to which the organism was sensitive, there was a 22% failure rate, suggesting the possible need for more prolonged therapy with a parenterally-administered agent plus ampicillin in the management of otitis media in the neonate and young infant.
FATAL FAMILIAL LEINER'S DISEASE: A DEFICIENCY OF THE OPSONIC ACTIVITY OF SERUM COMPLEMENT
Authors: Jacobs Jerry C. , Miller Michael E.
Published: December 2021

The second family with a deficiency of phagocytosis enhancement (opsonization) related to a dysfunction of the fifth component of serum complement is reported. The clinical entity is similar to that of the first family, as well as that described by Leiner, in 1908. The four cardinal features are: (1) generalized seborrheic dermatitis; (2) intractable, severe diarrhea; (3) recurrent local and systemic infections, usually of gram-negative etiology; and (4) marked wasting and dystrophy.

The diagnostic laboratory finding is the demonstration of deficient opsomc activity in the patient's serum. This demonstration requires a laboratory assay which measures uptake of a particle which requires C5 for total opsonization. Baker's yeast satisfies these requirements, whereas phagocytic assays utilizing such particles as erythrocytes, pneumococci, or latex particles are inadequate screening procedures for C5 deficiency.

A functional assay is necessary, since immuno-chemical measurement of C5 has been normal in all deficient family members.

Life-saving therapy has been administered to two patients with the disorder through the use of fresh plasma. Fresh plasma contains opsonically active C5, which is absent in 5-day-old stored bank blood.

Based upon genetic and laboratory criteria, separate mechanisms of C5 dysfunction may be involved in the present family and that previously reported.
Screening Method for Identification of Infected Infant Following Premature Rupture of Maternal Membranes
Authors: Hosmer Marion E. , Sprunt Katherine
Published: December 2021

The purpose of this paper is to present evidence showing that the methods used in many institutions including The Babies Hospital (New York City) for screening for infection in infants born of mothers with premature rupture of maternal membranes are inefficient and potentially misleading.

The screening procedure under discussion consists of cultures of cord blood (CB) , gastric aspirate (GA), and infant blood (IB) of any infant born 24 hours or more after rupture of the membranes. In actual practice, however, in many instances the IB culture has not been taken unless the infant became clinically symptomatic or the other cultures were reported as positive.
Hydrops Fetalis and Congenital Syphilis
Authors: Bulova Stephen I. , Schwartz Elias , Harrer William V.
Published: December 2021

Hydrops fetalis is associated most commonly with erythroblastosis fetalis due to fetal-maternal incompatibility of the red cell Rh antigens. Many nonimmunologic disorders, including infections, homozygous alpha thalassemia, maternal diabetes mellitus, fetal malformations, the twin transfusion syndrome, and congenital nephrosis, may cause a similar syndrome. Although congenital syphilis has been mentioned as a cause of hydrops fetalis, reports of the association antedate the use of immunologic methods capable of detecting isoimmunization. We report here an hydropic infant with syphilis in whom there was no evidence of Coombs-positive hemolytic anemia, alpha thalassemia, or severe congenital malformations.

See table in the PDF file

See image in the PDF file
Extensive Skin Manifestations of Herpesvirus Infection in an Acute Leukemic Child
Authors: Nishimura Kozo , Nagamoto Akira , Igarashi Masanori
Published: December 2021

A case of atypical and extensive skin manifestation of herpesvirus infection complicated with acute leukemia in a 2-year, 3-month-old girl is reported. Not only varicella-zoster virus but also herpesvirus hominis can cause atypical clinical pattern when complicated in leukemic children.
Letter to the Editor
Authors: Hathaway W. E.
Published: December 2021

Those of us who have investigated the usefulness of the NBT histochemical (slide) test as an aid to the diagnosis of bacterial infections, share part of the skepticism and caution of Dr. Abello. The test can be altered by drug therapy such as prednisone1 or chemotherapeutic agents and in diseases like hemophilia and osteogenesis imperfecta.2 However, it is too early to discard this test or relegate it to the category of the WBC and differential in its usefulness.
Use of Diazepam in Neonatal Narcotic Withdrawal Syndrome
Authors: Rosen Marvin
Published: December 2021

I read with interest and concern the recent article1 by Drs. Nathenson, Golden, and Litt concerning the use of diazepam in the neonatal narcotic withdrawal syndrome. Another recent article in your journal2 points out that diazepam for parental use contains sodium benzoate. Sodium benzoate has the capacity to interfere with bilirubin-albumin binding. There are many other good drugs that the physician may use (paregoric, chlorpromazine, phenobarbital3,4) without theoretically increasing the risk of kernicterus, and perhaps the use of diazepam in the neonatal period for narcotic withdrawal would best be avoided, at least until further information is available.
Diagnosis and Treatment of a Bleeding Diathesis Causing Hematoma of Sigmoid
Authors: Hathaway William E.
Published: December 2021

Several discrepancies in the description of the coagulation data presented in the article by Schiller and others1 are apparent. A patient with "definite" Factor X deficiency of a clinically severe degree should have an abnormal prothrombin time and thromboplastin generation test. The authors report these tests to be within normal limits. Also, a platelet adhesiveness of 74% is hardly "slightly reduced" by most published normal values which range from 20 to 80%. In addition, if "A.P.T.T." means "a partial thromboplastin time," then this test should also be abnormal.
Epidermolysis Bullosa: A Clinical, Genetic, and Epidemiological Study, by Tobias Gedde-Dahl, Jr. Baltimore: The Johns Hopkins Press, 1971, 180 pp., $20.00
Authors: Freedberg Irwin M.
Published: December 2021

The Norwegian population register and the closely-knit Norwegian medical community have been utilized in the past to conduct several detailed evaluations of specific disease entities. Dr. Tobias Gedde-Dahl, Jr. has utilized these same facilities to produce this extensive review of epidermolysis bullosa. The volume contains a wealth of data and a complete bibliography concerning the several entities which have as their common attributes cutaneous bulla formation and evidence of genetic transmission.

The book is written in a thesis-type format with extensive documentation and much detail.
Minimal Brain Dysfunction in Children, by Paul H. Wender, M.D. New York: Wiley-Interscience, A Division of John Wiley & Sons, Inc., 1971, 242 pp., $10.50
Authors: MacKeith Ronald C.
Published: December 2021

Every medical student, physician, and scientist should read the story of the Emperor's new clothes and identify with the child who, unimpressed by the weight of authoritative opinion, cried "But the Emperor has no clothes." Leon Eisenberg is a children's psychiatrist whom I respect enormously. But although I am glad to have read this book, I can't accept his unqualified recommendation of it.

Not all the blame lies with the author, for the publisher's assessors have not done their job.
PHYSIOLOGICAL EVIDENCE OF HYPERMETABOLISM IN OSTEOGENESIS IMPERFECTA
Authors: Cropp Gerd J. A. , Myers David N.
Published: December 2021

Observations on 30 prepubertal patients with osteogenesis imperfecta have shown abnormally low bodyweights and elevations in metabolic rates, serum thyroxine levels, oral temperatures, heart and respiratory rates. The findings suggest that these patients are in a chronic hypermetabolic and hyperkinetic circulatory state, possibly related to abnormal thyroid function. Since excess thyroid hormone can uncouple oxidative phosphorylation, part of the energy which normally is captured by the synthesis of ATP is lost as heat, and is thus not available for tissue anabolism. It is postulated that this waste of energy is the cause of the hyperthermia, the physical underdevelopment and the abnormal bone structure in children with osteogenesis imperfecta.

After the onset of puberty, metabolic rates normalized in our patients and the clinical progression of the disease became arrested. This study suggests that osteogenesis imperfecta is a disease caused by abnormalities in metabolic processes in many tissues, and it does not seem to be a disease which affects connective tissue alone.
AGE LIMITS OF PEDIATRICS
Authors: Jennison M. Harr , Coleman Allan B. , Feiertag Richard B. , Kugel Robert B. , Forsyth William B. , Rinker Andrew , Hazard Sprague W. , Ellis Effie O. , Knutti Sarah H.
Published: December 2021

In 1938 the American Academy of Pediatrics took formal action and defined the age limits of pediatric practice as follows (Journal of Pediatrics, 13:127 and 13:266, 1938):

The practice of pediatrics begins at birth and extends well into adolescence and in most cases it will terminate between the sixteenth and eighteenth year of life.

In 1969, the Council on Pediatric Practice asked the Executive Board to up date this statement, and the Executive Board referred it to the Council on Child Health. After extensive review of several statements proposed by the Committee on Youth, the Council on Child Health recommended the following statement, which has been approved by the Executive Committee of the Academy for publication as official policy of the American Academy of Pediatrics.

PEDIATRICS

The purview of pediatrics includes the growth, development, and health of the child and therefore begins in the period prior to birth when conception is apparent. It continues through childhood and adolescence when the growth and developmental processes are generally completed. The responsibility of pediatrics may therefore begin during pregnancy and usually terminates by 21 years of age.
Continuous Positive Airway Pressure
Authors: Auld Peter A. M. , Krauss Alfred N. , Klain David B.
Published: December 2021

The recent enthusiastic report of the use of continuous positive airway pressure (CPAP) prompts us to report our own experience with this method of therapy in infants with severe hyaline membrane disease. In 1968, four severely affected infants with hyaline membrane disease were treated with CPAP. The therapy was undertaken in infants whose clinical course was deteriorating under intermittent positive pressure breathing. The CPAP was applied by a negative pressure chamber that enclosed a child's chest, abdomen, and lower extremities.
Letter to the Editor
Authors: Chernick V. , Vidyasagar D.
Published: December 2021

We have used continuous negative pressure (CNP) in 49 infants with severe hyaline membrane disease.1 Fourteen of the 26 patients who did not have adequate spontaneous alveolar ventilation (severe apneic spells or Paco2 > 70 mm Hg) eventually died. Patients 2, 3, and 4 of Auld, et al. would fall into this category and the poor prognosis fits our own experience. Of 23 severely ill patients in whom spontaneous alveolar ventilation was adequate, there was uniform survival despite initial Pao2 values that were less than 50 mm Hg while breathing > 80% oxygen.
Acute and Chronic Childhood Lead Poisoning: Criticism of the Statement
Authors: Lin-Fu Jane S.
Published: December 2021

I read the AAP's recent statement, "Acute and Chronic Childhood Lead Poisoning,"1 with disappointment verging on alarm.

The statement recommends that "the major emphasis . . . be placed on the testing of dwellings for lead-pigment paints . . . in order to identify high-risk areas." Yet many such areas, or "lead belts," have long been so correctly identified that 20 to 40% of young children screened from these areas have been shown to have blood lead values of 40 µg/100 ml or more.2
Letter to the Editor
Authors: Steeg Carl N. , Bigger J. Thomas , Gelband Henry
Published: December 2021

Thank you for the opportunity of replying to Dr. Fareau. I gather from his letter that he disagrees with our diagnosis of ventricular tachycardia (VT).

Dr. Fareau is absolutely correct in his analsis of the ventricular rate in our Figure 1. Indeed, the rate is 300, and not 150 as noted. In actuality, ventricular rates varied from 125 to 300 with varying degrees of exit block from the parasystolic focus. A rate of 300 does not exclude VT.
Growth Diagrams 1965 Netherlands: Second National Survey on 0-24-Year-Olds, by J. C. Van Wieringen, F. Wafelbakker, H. P. Verbrugge, J. H. DeHaas. Groningen: Wolters-Noordhoff Publishing, 1971, 68 pp., no price given
Authors: Frisch Rose E.
Published: December 2021

This excellently organized small book presents the results of the second national, cross-sectional growth survey held in the Netherlands in 1964 to 1966. Height and weight measurements of more than 54,000 children and young adults, 6 to 24 years of age, are clearly presented in tables and diagrams. Sex maturation characteristics were also surveyed for more than 6,500 adolescent boys and girls. Color photographs of the criteria are given. The graphs which combine growth curves and sexual maturation stages for girls and boys are especially illuminating.
The Neurological Examination of the Child with Minor Nervous Dysfunction (Clinics in Developmental Medicine No. 38), by Bert C. L. Touwen and Heinz F. R. Prechtl. Philadelphia: J. B. Lippincott, 1970, 105 pp., no price given
Authors: Byers Randolph K.
Published: December 2021

This carefully written description of the neurological examination of children for the elucidation of minor neurologic dysfunction is timely. It is increasingly evident that the management of behavioral and academic disabilities in children with such dysfunction varies to some extent from that useful in children not so afflicted. The tardiness of this recognition is in large measure a function of lack of agreement as to methods of examination. Most neurologists working from such a background have developed a variety of "soft signs" which in their own minds arouse the suspicion of mild neurologic deficit in children, but which are still "soft" because they do not deviate sufficiently from the neurologic findings in adults to warrant certainty.
EFFECTIVENESS OF PEDIATRIC CARE: THE RELATIONSHIP BETWEEN PROCESSES AND OUTCOME
Authors: Starfield Barbara , Scheff David
Published: December 2021

The effectiveness of patient care was assessed by determining the adequacy of various steps in the care process and relating them to its outcome. Fifty-three children attending either of two university hospital clinics and having newly discovered low hemoglobins were randomly chosen. Review of medical records and home interviews showed that only 14 of the 53 low hemoglobin values were recognized, diagnosed, treated, and followed-up. In 39 children, the low hemoglobin value was unrecognized in 24, recognized but undiagnosed in six, diagnosed but untreated in one, and treated but not scheduled for follow-up in four; for four children the follow-up appointment was not kept. Mothers of 7 of the 22 children for whom treatment was prescribed denied receiving any therapy. Outcome in terms of eventual hemoglobin level was significantly related to the adequacy of the processes of care and especially to whether or not the patient received therapy. Major problems with record keeping also were apparent. The model used here is useful in evaluating the effectiveness of medical care because it relates specific activities of physicians, other health workers, and patients to outcome.
"NEW" SYNDROME OF CONGENITAL CONTRACTURAL ARACHNODACTYLY ORIGINALLY DESCRIBED BY MARFAN IN 1896
Authors: Hecht Frederick , Beals Rodney K.
Published: December 2021

Congenital contractural arachnodactyly (CCA) is a newly delineated disease. Several CCA families are described. Key features of CCA are multiple congenital joint contractures, arachnodactyly, "crumpled" ears, and kyphoscoliosis. The joint contractures are maximal at the knees and usually improve spontaneously, whereas the kyphoscoliosis usually worsens with age. There is no ocular or cardiovascular involvement. Transmission is as an autosomal dominant trait.

Historically CCA is of interest, because it was confused with Marfan's syndrome. Reports of patients with what appears to be CCA were encountered from various parts of the world dating from every decade since 1900. We believe the earliest description to be by Marfan in 1896. We conclude that Marfan's original patient had CCA and not what is known today as Marfan's syndrome.
FAREWELL THE ROTUND EPONYM
Authors: Gardner Lytt I.
Published: December 2021

Time was, to greet a new syndrome A rich, resounding eponym was born.

Perhaps a rumbling Prussian name Like cannon on a darkling plain. What better phrase could we command For bleeding than: "von Willebrand"?

Or hear the fine French filigree Of purple prose at last set free To dance a blushing minuet For Seigneur Gilles de Ia Tourette.

Oú sont les grands noms du temps jadis? Oh where are the syndromes of memory?

The virologists have done away With euphonious Guillain-Barré. What robot twist may soon delete Mauriceau-Levret-Smellie-Viet?

Good-by our Latin triple-play: de Toni—Fanconi—Debré.

Instead computers' tapes will store That special circum-Alpine lore.

Bonnevie—Ullrich—Turner may be Reduced to new simplicity. Now only cryptic letters show Upon that magic crest: "XO."

Oú sont les syndromes d'antan? Where are the great names of days gone by?

Hail to the fresh atonal day—The abstract chords no hands can play—These scratchy, skinny sounds now free, Born of the stark cacophony.

Farewell the gold Victorian tone Of well-upholstered surnames grown. Into an eponymic hymn—A polyphonic requiem.

Oú sont les grands noms du temps jadis? Oh where are the syndromes of memory?
Lead Levels in Cord Blood
Authors: Harris Paul , Holley Marshall R.
Published: December 2021

Blood lead levels were determined on 24 mothers during labor and on the blood of their newborn offspring.

The mean value for the mother's blood lead was 13.2 µg/100 gm (range 10 to 20) and for the cord blood 12.3 (range 10 to 20) µg/100 gm whole blood.

These levels are lower than "normal" blood lead standards usually accepted in the diagnosis and treatment of childhood lead poisoning.
Mist Tents, Fever, Croup
Authors: Turner Edward James
Published: December 2021

I read with great interest, the article on mist tent therapy in the October issue. A mist tent has in recent years become somewhat of a symbol for "up to the minute" medical therapy. I have never really been impressed by the results of mist tent therapy in patients suffering from cystic fibrosis. I always felt that the effort of propelling particles of water of 5 microns or under into an already saturated bronchial system was doomed to failure.
Letter to the Editor
Authors: Hartley Robert D.
Published: December 2021

In the study by Honikman and Massell on the diagnosis of streptococcal infections, no mention was ever made as to the amount of growth of streptococcus on the culture plate.

By not stating it, did they imply that the significance and treatment is the same whether there is a pure culture of streptococcus versus only a few colonies mixed in with otherwise "normal flora" of the throat?