bluuebunny/crossref_metadata_2025 huggingface dataset:
THE MALABSORPTION ASSOCIATED WITH CHRONIC LIVER DISEASE IN CHILDREN
Authors: Weber Andrée , Roy Claude C.
Published: December 2021

The malabsorption associated with chronic liver disease was studied in 23 children, all except two of whom had evidence of cirrhosis. There were 14 patients with extrahepatic biliary atresia, four with "paucity of intrahepatic bile ducts," and five with post-hepatitic cirrhosis. Steatorrhea (> 5 gm /24 hr) was documented in the 14 patients tested while on a normal diet. No evidence of pancreatic or small bowel mucosal disease could be found.

While basal duodenal bile salt concentrations were found to be below the critical micellar concentration (CMC) in only two of the four cases of post-hepatitic cirrhosis tested, a poor response to pancreozymin clearly separated all the four from normal control subjects. The 10 children with end stage cirrhosis excreted significantly (P < .001) more fat (21.4 ± 6.6) in their stools than did the others (10.9 ± 2.1). Even though a medium chain triglyceride (MCT) supplemented low fat diet was associated with a drop in fecal fat, it had no effect on the severe malnutrition of decompensated extrahepatic biliary atresia; whereas, in conjunction with cholestyramine, it led to a resumption of weight gain and a concomitant amelioration of liver function in patients with "paucity of intrahepatic bile ducts" and in those with post-hepatitic cirrhosis.
ON THE DIFFICULT BREEDING OF THE TEETH
Authors: C. T. E.
Published: December 2021

In 1764 Dr. John Theobald of London wrote a book containing "everything necessary to be known relative to the nursing of children, from the time of their birth to the age of 7 years; together with a plain and full account of every disorder to which infants are subject, and a collection of efficacious remedies, suited to every disease."

Theobald had this to say about teething.

DIFFICULT BREEDING THE TEETH

Amongst the disorders to which children are subject, there are none as Hippocrates observes, which occasion such grievous symptoms, as difficult dentition. There is great reason to expect the breeding of teeth will be difficult, if the child is continually crying, thrusts its fingers into its mouth, and bites the nurses (sic) nipples; if unequal swellings are perceived in the gums, where the teeth are expected to appear, if the mouth and whole body are very hot, and the child starts much in its sleep, slavering much, and a looseness are no bad signs, when a child is cutting its teeth. The bad and dangerous disorders arising from difficult dentition, are restlessness, gripes, costiveness, green stools, thrush, fevers, suffocating coughs, convulsions, and epilepsies, which often end in death.

The cure must begin by applying a leach (sic) behind each ear, and when the swelling of the gum shows it is time to cut it, which is known by a white speck appearing on the swelling, it should be cut quite down to the tooth, with a penknife, instead of a lancet, to prevent its uniting too soon, and forming a hard cicatrix.
Mumps as a Cause of Hydrocephalus
Authors: Hower J. , Clar H. E. , Düchting M.
Published: December 2021

We read Dr. Bray's communication with great interest. With actually three cases of aqueductal stenosis after mumps being recorded we cannot doubt that the experimental findings of Johnson and Johnson have a bearing on human pathology.

Our patient, a 6½-year-old boy, underwent evaluation of his megacephalus five months before the onset of mumps. At that time a pneumoencephalogram could be obtained by lumbar filling. Cerebrospinal fluid flow was considered marginally adequate. Three months after mumps meningoencephalitis the patient presented with symptoms of increased intracranial pressure (papilledema, sudden increase in head circumference, and widening of the coronar suture).
The Mothers' Medical Encyclopedia, by Virginia E. Pomeranz, M.D. and Dodi Schultz. New York: New American Library, Inc., 1972, 403 pp., $1.50 (paper-back)
Authors: Cone Thomas E.
Published: December 2021

Dr. Virginia E. Pomeranz, the senior author of this book is a practicing pediatrician in New York City and a Fellow of the American Academy of Pediatrics. She and Miss Dodi Schultz, a professional writer, have combined their talents to offer mothers a paperback of about 400 pages which is a combination dictionary, encyclopedia, first-aid manual, and day-to-day medical guide. Almost 1,400 topics are discussed, all in alphabetical order and skillfully cross-referenced. The topics ranging from abdomen to zoonoses are succinctly and forth-rightly described. A good example is this:
THE EFFECT OF PREMATURITY AND HYALINE MEMBRANE DISEASE ON OXYGEN EXCHANGE IN THE LUNG
Authors: Woodrum David E. , Oliver T. K. , Hodson W. Alan
Published: December 2021

The alveolar-arterial oxygen gradient (AaDO2) measured while breathing 100% oxygen was utilized as an estimate of the right-to-left shunt in 34 premature infants. Seventeen of these infants were free from clinical or radiologic evidence of hyaline membrane disease (Group 1) and 17 had hyaline membrane disease (Group 2). The initial AaDO2 in Group 2 (557 mm Hg) was significantly larger than that in Group 1 (358 mm Hg). There was little or no change in the AaDO2 in the infants serially studied within either group throughout the first four days of life. The magnitude of the AaDO2 and the arterial pH of the infants in both Groups 1 and 2 were only weakly correlated. There was a significant correlation between AaDO2 and gestational age in the group 1 infants studied throughout the first 72 hours of life. Our data lead us to speculate that most of the right-to-left shunt in both groups occurred within the lung, and that the AaDO2 in the infants without hyaline membrane disease reflects immature lung development.
VENEREAL DISEASE AND THE PEDIATRICIAN
Authors: Hazard Sprague W. , Allen V. Robert , Eisner Victor , Garell Dale C. , Hammar S. L. , Shaffer Thomas E. , Shen Jerome T. Y. , Tanner Natalia M. , Welty John Allen
Published: December 2021

As a result of the sharp rise in venereal disease during the past decade, which seriously threatens the health of our young people, pediatricians must become actively involved:

1. in the prompt identification, treatment, and epidemiologic control of venereal disease in young people and newborn infants;

2. in developing and promoting social legislation related to the treatment of minors;

3. in encouraging and participating in effective educational programs for youth on venereal disease.

A heightened alertness to the possibility of venereal disease is required by every physician.
Letter to the Editor
Authors: Pless I. B.
Published: December 2021

We appreciate Dr. Mofenson's comments regarding our report on the Prevention of Injuries to Children in Automobiles. At the time this paper was submitted for publication, the Committee's notice had not been published, nor had the PAS pamphlet been distributed. But this is water under the bridge—better late than never.

The Accident Prevention Committee's suggestion regarding the necessity for more legislation in this area is an excellent one. Unfortunately, the pessimism revealed by Dr. Mofenson's comments about the effectiveness of health education may influence the pediatrician adversely.
HUMAN FETAL GROWTH RETARDATION: I. CLINICAL FEATURES OF SAMPLE WITH INTRAUTERINE GROWTH RETARDATION
Authors: Urrusti J. , Yoshida P. , Velasco L. , Frenk S. , Rosado A. , Sosa A. , Morales M. , Yoshida T. , Metcoff J.
Published: December 2021

Intrauterine growth was assessed in a series of 128 cases. Thirty-six infants were small for gestational age, and showed the usual signs of intrauterine growth retardation (IUM). The head circumference of these infants was small, with reference to normal term babies (FT) and comparable to premature infants, appropriately sized for a gestational age (ACA) five weeks less than that of the IUM's. There were 12 neonatal deaths, three among IUM infants within 24 hours and nine in the low birth weight AGA group within 72 hours. The mothers of these three groups of infants were similar with respect to age, weight, height, nutritional patterns, and prior pregnancy histories.
THE ROLE OF THE CHILD CARE WORKER IN THE TREATMENT OF SEVERELY BURNED CHILDREN
Authors: Bezzeg Elizabeth Diaz , Fratianne Richard B. , Karnasiewicz Sally Q. , Plank Emma N.
Published: December 2021

Experience with 57 children suggests that the physical and psychological rehabilitation of severely burned children is promoted in a positive and child-oriented environment. It has also suggested that the child care worker, functioning as an integral member of the burn team, can help establish a more peaceful relationship between the child and his environment and insulate him, by means of repeated positive encounters, from the threatening and often seemingly hostile world around him, while preparing him eventually to meet it. Thus, the child care worker can offer to the child the critical support and understanding needed throughout the long period of hospitalization by helping create a more normal and child-centered environment.
EVALUATION OF A TEN-YEAR EXPERIENCE IN A COMPREHENSIVE CARE PROGRAM FOR HANDICAPPED CHILDREN
Authors: Perrin Jane C. S. , Rusch Edna L. , Pray Janet L. , Wright Gregg F. , Bartlett Glen S.
Published: December 2021

Chronically disabled patients under care of a multidisciplinary hospital program were scored for functional changes by retrospective chart review. Family functions were also assessed. Professional input time was measured as the number of clinic visits (physician) or years of social worker involvement. Correlation coefficients calculated between a number of variables did not show significant zero-order correlations between professional quantitative input and improvement of patient-family functions.
Translocation Trisomy D Syndrome 46, XX, D-, t(Dq Dq)+: Report of a Case With a Note on the Cold-Instability of Hb Gower-2
Authors: Bethlenfalvay N. C. , Louro Jose M. , Greer Harry A.
Published: December 2021

The existence of two distinct embryonic hemoglobins (Hb Gower-1 and Hb Gower-2) in young fetuses up to 85 mm crown-rump length has been well established. Persistence of Hb Gower-2 to (and for a short period after) birth associated with the trisomy D1 syndrome has been well documented. With rare exceptions, however, electrophoretic documentation of this hemoprotein was not accomplished in the majority of subsequently reported cases. Marked instability of Hb Gower-2, especially on cold storage has received but one mention in the literature. The purpose of this paper is to report a case of D/D translocation trisomy in which the demonstration of Hb Gower-2 would not have been possible without this knowledge.
THE UNHAPPY CONSEQUENCES OF CONSULTING A SURGEON ABOUT THE TURN OF A CHILD'S SHAPE, ACCORDING TO MRS. SEYMOUR, WRITING IN 1754
Authors: C. T. E.
Published: December 2021

A caveat meant for parents, and often mentioned in eighteenth century books written by lay authors about child rearing practices, was to shun physicians, especially surgeons. The following is an excellent example of this distrust of surgeons:

We see Persons with high Hips, and Persons who have high Shoulders; some are large boned, and some have them small, and all this yet with Regularity, while in an Infant these Things are often visible; and to a judicious Person they would only shew (sic), that such or such would be the general Tur of the Person's Shape when grown up, being in themselves nothing tending to Distortion, and being unalterable. If the Mother thinks no more of these, or if she thinks nothing of them at all, some ignorant Female Friend, who sees the child undressed, takes Notice of them: It is a sweet Baby, says she, it is a Pity any thing should grow out of Shape; and if it were her Case she would have Advice in time. This Opinion of Advice in time, is the Destruction of half the Shapes in the World. I am so much the Friend of Physicians, that I think, in Diseases, Advice cannot be sought too soon; but here the only Safety is not to seek it at all: The first Step is the Beginning of Destruction. The Town is over-run with Surgeons, and they must live: If the mother should send for a Physician it is out of his Province; and it is fifty to one that he is not Anatomist enough to know whether there may be any Fault or not.
Bone Marrow And Bone Tissue: Color Atlas of Clinical Histopathology, by Rolf Burkhardt. New York/Heidelberg/Berlin: Springer-Verlag, 1971, 115 pp., $77.30
Authors: Fetterman George H.
Published: December 2021

An atlas should present excellent illustrations and should project an authoritative air. This one qualifies on both counts.

Those hematologists and pathologists who rely on "histobiopsies" of bone marrow will be highly pleased with this volume. Those who are usually content with examination of smears of marrow aspirates may be somewhat less enthusiastic.

Burkhardt begins by describing his myelotomy method, which is hardly simple, and certainly more incapacitating to the patient than the more commonly used techniques, either of histobiopsy or marrow aspiration.
British Medical Bulletin, Vol.20, No.1, Research in Diseases of the Tropics. London: The British Council, Medical Department, 1972, 102 pp., $6.50
Authors: Weller Thomas H.
Published: December 2021

It is appropriate to call this collection of excellent reviews of current research on tropical diseases to the attention of pediatricians. The majority of the children of the world live in poorly sanitated tropical and subtropical regions. More often than not such children are developmentally scarred by the repetitive synergistic insults of malnutrition and infectious disease and are doomed to an abbreviated life of misery.

In this collection of 16 essays, edited by Dr. C. E. Gordon Smith, Dean of the London School of Hygiene and Tropical Medicine, the magnitude of the unsolved problems surfaces as the dominant theme.
THE TROUBLE WITH THE RISING GENERATION LIVING IN NEW ENGLAND IN 1657
Authors: C. T. E.
Published: December 2021

The modernity of Ezekial Rogers' remarks, although written in 1657, may surprise present day readers. In a letter to Cotton Mather, Rogers had this to say about young people:

. . . I find greatest trouble and grief about the rising generation. Young people are little stirred here; but they strengthen one another in evil, by example, by counsel. Much ado have with my own family; hard to get a servant that is glad of catechising or family-duties: I had a rare blessing of servants in Yorkshire; and those that I brought over were a blessing: but the young brood doth much afflict me. Even the children of the godly here and elsewhere, make a woful (sic) proof! So that, I tremble to think, what will become of this glorious work that we have begun, when the ancient shall be gathered unto their fathers. I fear grace and blessing will die with them, if the Lord do not also show more signs of displeasure, even in our days. We grow worldly every where; methinks I see little godliness, but all in a hurry about the world; every one for himself, little care of public or common good.

It hath been God's way, not to send sweeping judgments when the chief magistrates are godly and grow more so. I beseech all the Bayministers to call earnestly upon magistrates (that are often among them) tell them that their godliness will be our protection: if they fail, I shall fear some sweeping judgment shortly. The clouds seem to be gathering.1
SIR PERCIVAL POTT'S CURE FOR CURVATURE OF THE SPINE
Authors: C. T. E.
Published: December 2021

One of the popular late eighteenth century books written by physicians for lay audiences contains the following description of Percival Pott's (1714-1788) treatment of curvature of the spine.

Mr. Pott has ordered a large opening to be made on each side of the spine by means of caustics and the discharge to be preserved by the introduction of a kidney bean and (when the bottom of the sore is become clean by suppuration) to sprinkle every third or fourth day a small quantity of Spanish flies on them finely powdered. I have experienced this method to be very beneficial, and sometimes wholly to cure the patient.1
The Pastoral Fallacy: An Editorial Fallacy?
Authors: Rothenberg Michael B.
Published: December 2021

I am astounded by your choice of "The Pastoral Fallacy" as a filler on page 589 of the October issue of Pediatrics!1 Why you have chosen to reprint a 1967 comment by Dornhorst and Hunter which reveals a total lack of understanding of our current concepts of comprehensive care in pediatrics is beyond my comprehension. It seems to me to be the gravest disservice to the development of comprehensive care programs (the systematic inclusion of psychosocial dynamics and personality development in the practice of pediatrics in a longitudinal fashion and on a community basis) to reprint the conception of two men who can only see comprehensive care as a reaction ". . . by those no longer able to keep abreast, to the technical complexities of modern medicine," and who feel that it is only the "more trivial disorders" which have an "inter-relation with emotional factors."
The Natural History and Progress in Treatment of Congenital Heart Defects, edited by B. S. Langford Kidd, M.D., F.R.C.P.(E)., F.A.C.C., and John D. Keith, M.D., F.R.C.P.(C)., F.A.C.C. Springfield, Illinois: Charles C Thomas, 1971, 346 pp. $19.75
Authors: Gersony Welton M.
Published: December 2021

This volume evolved from a 1969 international symposium of the same title sponsored by the Ontario Heart Foundation in cooperation with the Hospital for Sick Children and the University of Toronto. The participants were outstanding cardiologists, surgeons, and pathologists from throughout the world, and the resulting publication is a multiauthored compendium which explores the current areas of interest concerning the major congenital heart lesions.

This book is certainly one of the best of its type yet published; the material is extremely well organized and nicely edited.
CONCURRENT EPIDEMICS OF STAPHLOCOCCUS AUREUS AND GROUP A STEPTOCOCCUS DISEASE IN A NEWBORN NURSERY—CONTROL WITH PENICILLIN G AND HEXACHLOROPHENE BATHING
Authors: Gezon Horace M. , Schaberg Monica J. , Klein Jerome O.
Published: December 2021

During an 8-week period beginning February 11, 1972, 33 infants, born at the Boston City hospital, developed disease due to Group A, type 28, Steptococcus pyogenes. The administration of parenteral benzathin penicillin G to full term infants and oral penicillin V to low birth weight infants was effective in preventing subsequent infection and diesease. Concurrently, bacteriologic surveys indicated extensive colonization of newborn infants with Staphylococcus aureus. A double blind study of hexachlorophene compared with detergent base bathing in the prevention of staphylococcal infection and disease of the newborn infants was instituted. The diaper area including the umbilical stump was washed. The bathing procedure was instituted soon after delivery and once each day during the hospitalization and at home to complete a 3-week course. A surveillance system, including home visits during the third week of life, was established. Although a few infants with staphylococcal disease were diagnosed in the nursery, most infants with pustules, omphalitis, and conjunctivitis were identified through the home visit. Colonization rates of Staphylococcus aureus were similar in the two groups. Staphylococcal disease was significantly decreased in the hexachlorophene-bathed infants during the first 11 weeks of the study.
THE ALLEGED DELETERIOUS EFFECTS ATTENDANCE AT VASSAR COLLEGE HAD ON A YOUNG GIRL'S HEALTH A CENTURY AGO
Authors: C. T. E.
Published: December 2021

Many nineteenth century physicians believed that a girl's health would be adversely affected if she were to devote as much time at college to scholarly pursuits as was required of boys. The passage below, written in 1873 by a wellknown Boston physician, is an excellent example of this opinion.1

Miss D— entered Vassar College at the age of fourteen. Up to that age, she had been a healthy girl, judged by the standard of American girls. Her parents were apparently strong enough to yield her a fair dower of force. The catamenial function first showed signs of activity in her Sophomore Year, when she was fifteen years old. Its appearance at this age is confirmatory evidence of the normal state of her health at that period of her college career. Its commencement was normal, without pain or excess. She performed all her college duties regularly and steadily. She studied, recited, stood at the blackboard, walked, and went through her gymnastic exercises, from the beginning to the end of the term, just as boys do. Her account of her regimen there was so nearly that of a boy's regimen, that it would puzzle a physiologist to determine, from the account alone, whether the subject of it was male or female. She was an average scholar, who maintained a fair position in her class, not one of the anxious sort, that are ambitious of leading all the rest. Her first warning was fainting away, while exercising in the gymnasium, at a time when she should have been comparatively quiet, both mentally and physically.
ANIMAL FEEDLOTS—A POLICY STATEMENT WITH BACKGROUND
Authors: Wehrle Paul F. , Brendel William , Brent Robert L. , Chisolm J. Julian , Doyle John L. , Fagan Emmett L. , Finberg Laurence , Miller Robert W. , Nahmias Andre J. , Thompson G. D. Carylyle , Horton Robert J. M.
Published: December 2021

The Committee on Environmental Health of the Indiana Chapter of the American Academy of Pediatrics sought the assistance of the Academy's Committee on Environmental Hazards regarding a developing health risk to children in Indiana. A cattle feedlot was developed along the shores of a creek which empties into a lake where recreational use included an area specifically designated for swimming.

The Environmental Protection Agency estimates that the wastes produced by farm animals in the United States are equivalent to the wastes of 2 billion people, more than half the world population of 3.7 billion people. It has further estimated that more than half of these wastes are produced in feedlots.

Feedlots for livestock and poultry are a relatively new industry that has developed since World War II in various parts of the United States. Significant changes are occurring in the increased demand for meats and in the manner of feeding, processing, and marketing livestock. Feedlots are now being established closer to market areas throughout the nation. With the increasing number of animals and the increasing use of feedlots, it is necessary that some wastes management system be required to protect the human population from a number of infectious diseases. Animal wastes from feedlots are more infectious than wastes from grazing farm animals because of naturally occurring epizootics within such confined feeding facilities. Chemical pollution by animal wastes or chemical changes incident to microbiologic or chemical pollution are also a concern.

In the interest of our domestic water supply and the safe use of recreational waters, both vital to the health of children, the Committee has approved the following statement:
NOSOCOMIAL INFECTION WITH ECHOVIRUS TYPE II IN HANDICAPPED AND PREMATURE INFANTS
Authors: Cramblett Henry G. , Haynes Ralph E. , Azimi Parvin H. , Hilty Milo D. , Wilder Michael H.
Published: December 2021

This report describes an outbreak of nosocomial infections due to echovirus type 11 among premature and/or handicapped infants in an intensive care unit. Four patients became ill within a short period of time and echovirus 11 was recovered from several of their specimens. The illnesses were clinically suggestive of bacterial sepsis and/or bacterial meningitis. Each of the four infants who became ill was in an isolette for a period of from 20 to 54 days before onset of illness. Three of the four patients became ill within 24 hours of one another which suggested a common exposure at nearly the same time. No index case could be identified, but it appears that this outbreak of enteroviral infections was due to inadequate hand washing by personnel. The outbreak was halted by removing the infants to an infectious disease unit and by closing the involved unit to new admissions for seven days.
THIAMINE DERIVATIVES IN SUBACUTE NECROTIZING ENCEPHALOMYELOPATHY
Authors: Pincus Jonathan H. , Cooper Jack R. , Murphy Jerome V. , Rabe Edward F. , Lonsdale Derrick , Dunn Henry G.
Published: December 2021

Twenty-one patients in whom the diagnosis of subacute necrotizing encephalomyelopathy (SNE, Leigh's disease) was made, have been treated with large doses of thiamine hydrochloride, thiamine propyldisulfide (TPD) or thiamine tetrafurfuryldisulfide (TTFD). In 12, the diagnosis is secure and in 9 it is presumptive. The incidence and quality of remissions in patients in both categories exceeded those described in the literature in 84 untreated patients with this disease. In general, remissions correlated well with high thiamine levels in the cerebrospinal fluid and exacerbations with the reverse. The ultimate failure of vitamin therapy in several patients who initially did well seemed to correlate with the tendency of CSF thiamine levels to fall during the course of continuous therapy. Preliminary results indicate that substituted thiamine derivatives (TPD and TTFD) were more efficacious in raising CSF thiamine levels than thiamine. TTFD has the further advantage of imparting little odor to treated patients. In the one case in which a comparative study was done, the intravenous route was more effective than the oral one in raising blood and CSF levels but in high dosage therapy raised CSF levels satisfactorily at least in the early days and weeks of treatment of many cases.

While thiamine and its derivatives appear to be of benefit, a permanent solution to the therapeutic problem will probably come from another source.
PEDIATRIC CARDIOLOGY REVISITED
Authors: Nadas Alexander S.
Published: December 2021

The paper on manpower and training requirements in pediatric cardiology by Adams and his colleagues1 raises a number of issues which are very topical at this writing, February 1973. The Sub-board of Pediatric Cardiology, of the American Board of Pediatrics, was established in 1960 with the avowed purpose of improving the care of infants and children with heart disease in the United States. This goal was to be obtained by certification, through appropriate testing, of physicians capable of rendering optimal care for these patients and by identifying programs offering satisfactory training to obtain certification. A commentary on the sub-board has appeared in this journal about ten years ago.2
Letters to the Editor
Authors: Haggerty Robert J.
Published: December 2021

The use of physicians' offices and other extramural hospital practices is an excellent idea. The Case Western Reserve students' experience in the first two years of medical school sounds good. What is needed now is to set clear, achievable, and measurable goals for these experiences, and evaluate how successful they are in reaching them. It would be repeating history's mistakes to switch all teaching to these settings and then after 10 or 20 years know no more than we do now about hospital OPD teaching.
Preventing Reading Failure: Prediction, Diagnosis, Intervention, by Jeannette Jansky and Katrina deHirsch. New York/Evanston/San Francisco/London: Harper & Row, 1972, 207 pp., $8.95
Authors: Cavanaugh James J. A.
Published: December 2021

As a sequel to a previous work,1 Jansky and deHirsh present in Preventing Reading Failure the results of a study of 347 New York City school children who were examined prior to entering kindergarten and at the end of the second grade in that city's public school system to ascertain the feasibility of predicting, by a group of tests, who was likely to fail to learn to read during the intervening three years despite a traditional education.
ABSORPTIVE DEFECTS IN YOUNG PEOPLE WITH REGIONAL ENTERITIS
Authors: Beeken W. L.
Published: December 2021

Eleven patients with Crohn's disease between 8 and 21 years of age were evaluated to document the incidence and severity of correctable nutritional deficiencies in young people with this disorder. Studies included common hematological and electrolyte determinations, complete gastrointestinal barium studies, assessment of d-xylose, vitamin B12 and fat absorption, and quantification of intestinal protein loss. A variety of abnormalities was found. Subnormal weight, diffuse disease radiologically, anemia, low serum iron, and excessive protein loss occurred in eight patients. Vitamin B12 malabsorption and hypoproteinemia occurred in six, and steatorrhea and hypocalcemia were detected less often. The frequent occurrence of these abnormalities warrants careful monitoring of children with Crohn's disease for absorptive defects which are amenable to corrective or palliative treatment.
FAMILIAL OCCURRENCE OF ENDOCARDIAL FIBROELASTOSIS IN THREE SIBLINGS, INCLUDING IDENTICAL TWINS
Authors: Lee Moo H. , Liebman Jerome , Steinberg Arthur G. , Perrin Eugene V. , Whitman Victor
Published: December 2021

A family is presented in which twins and one other of the total of four siblings were affected with endocardial fibroelastosis. A genetic study suggested that the twins were identical and that the mode of transmission in this family was consistent with autosomal recessive inheritance.

A series of standard electrocardiograms beginning 24 hours of age was studied in all three children, as well as Frank system vectorcardiogram in case 1 and both Frank and McFee-Parungao system vectorcardiograms in the twins. From the clinical examinations and the electrocardiographic and vectorcardiographic studies, it can be concluded that, at least in this family, there was no evidence of abnormality in the newborn period, but that the electrocardiographic changes in all three affected siblings apparently occurred by 3 to 4 months of age.
HEALTH CARE FOR JUVENILE DELINQUENTS
Authors: Eisner Victor , Sholtz Robert I.
Published: December 2021

Pediatricians have long interested themselves in the health of juvenile delinquents. The Academy first appointed a Committee on Juvenile Delinquency in 1955. Although this Committee has changed its title to the Committee on Youth and has expanded its role to include other problems and concerns of young people, it still concerns itself with the health supervision of youth in detention facilities. It has now developed, with the endorsement of the National Council of Juvenile Court Judges, written standards for health care provided in juvenile court institutions.1

Juvenile delinquents come largely from low income families, and often from families with serious social problems.
MISS HARRIET MARTINEAU ON THE MANNERS OF AMERICAN CHILDREN
Authors: C. T. E.
Published: December 2021

Harriet Martineau (1802-1876), an English reformer and author, traveled widely in the United States between 1834 and 1836. As a result of her travels she wrote Society in America, published in 1837, which soon became a classic account of American society of the 1830's. Miss Martineau had this to say about the manners of American children:

For my own part, I delight in the American children; in those who are not overlaid with religious instruction. There are instances, as there are everywhere, of spoiled, pert, and selfish children. Parents' hearts are pierced there, as elsewhere. But the independence and fearlessness of children were a perpetual charm in my eyes. To go no deeper, it is a constant amusement to see how the speculations of young minds issue, when they take their own way of thinking, and naturally say all they think. Some admirable specimens of active little minds were laid open to me at a juvenile ball at Baltimore. I could not have got at so much in a year in England. If I had at home gone in among eighty or a hundred little people, between the ages of eight and sixteen, I should have extracted little more than "Yes, ma'm," and "No, ma'am." At Baltimore, a dozen boys and girls at a time crowded round me, questioning, discussing, speculating, revealing in a way which enchanted me. In private houses, the comments slipped in at table by the children were often the most memorable, and generally the most amusing part of the conversation.
To Tap, or Not to Tap, in the Febrile Convulsion
Authors: Kafka H. L.
Published: December 2021

"Lumbar puncture has become nearly routine in the evaluation of the child who has just experienced his first febrile convulsion."1 This rather categoric statement may apply to patients seen in a teaching hospital or in an outpatient department of a university clinic. It would be interesting to take a poll from private pediatricians. I strongly believe that even the most arduous of the private pediatricians are far from doing spinal taps in their offices. It would, therefore, mean that every child appearing in a private pediatricians' office with a febrile convulsion would have to be transferred to a hospital.
Hypothyroidism After Growth Hormone Therapy
Authors: Sack Joseph , DeLamater Paul
Published: December 2021

Porter et al.1 have confirmed the observation that some growth hormone-deficient patients demonstrate hypothyroidism after initiation of growth hormone therapy.2 They further demonstrated that "TSH response to TRH is diminished following GH administration." The two possible mechanisms they suggested for this diminished TSH response were (1) direct inhibition of the response of the thyrotropin to TRH, or (2) GH potentiation of the effect of T4.

We should add still another possible mechanism. Burgus et al.3 and Brazeau et al.4
Single Umbilical Artery
Authors: Van Leeuwen Gerry
Published: December 2021

Dr. Gellis, in 1971 Pediatric Yearbook, indicated that nothing very new was being learned about the missing umbilical artery and decided to say no more about it.1

In the July 1973 issue of Pedaitrics, there is an article and a commentary on single umbilical artery.2 I would like to make a couple of comments relevant to the report of nearly 40,000 infants reported in the collaborative study. In the Journal of Pediatrics in 1967 and 1968,3,4 we reported, in mixed black and white infants, an incidence of 0.3% single umbilical artery.
A TRIBUTE TO DR. CLEMENT A. SMITH
Authors: Lucey Jerold , Haggerty Robert
Published: December 2021

Clement Smith's stature is preeminent for his contributions to the development of the field of neonatology. He has capped his career by more than a decade of superb editorship of Pediatrics. As editor, he has maintained standards of excellence and good taste in the contents of the journal and has attracted scholarly research articles of future importance to clinical work as well as ones of practical use in pediatricians' care of children today. He has had the gentleness to soften the blows of rejection to writers. He has also maintained toughness and high standards in order to obtain the needed revisions of accepted articles.
Routine Chest Radiography in Children
Authors: Thomas H. P. , Schiller Ruth P. , Girone Joseph A. C. , Rothstein Edward P. , Schlackman Neill
Published: December 2021

Brill et al., in a recent report, suggested that chest radiography is not indicated as a screening procedure in healthy children. Their conclusion seems justified, since the study included 1,000 healthy children. Most important, however, was the qualification that these children had no abnormality on physical examination, presumably performed by experienced physicians.

We have recently been involved with two cases in which unsuspected conditions were unmasked by "routine" chest x-rays done before the physical examination.
A Pediatric Nurse-Practitioner for the Neonate
Authors: Slovis Thomas L. , Comerci George D.
Published: December 2021

We have been impressed with the relative laxity in the care of newborns between delivery and first observation by a pediatrician. Especially during this critical period of transition, careful monitoring is required.

A program for the training of a neonatal nurse practitioner (NNP), therefore, was developed at a regional Air Force hospital and 14 registered nurses and one licensed practical nurse have since been trained. Formal instruction consisted of 24 hours of cribside activity including presentation of factual material, demonstration of physical findings and discussion of pathophysiology.
Intrauterine Infections (Ciba Foundation Symposium 10, new series). Amsterdam/London/New York: Associated Scientific Publishers, 1973, 219 pp., $10.50
Authors: Steigman Alex J.
Published: December 2021

This interesting volume is the result of a proper symposium rather than a collection of submitted reports. The authoritative findings are sprinkled generously with a free flowing discussion which brings sharply into focus what remains to be learned and how to go about it. The 22 well-qualified participants include 17 from Great Britain, 4 from the European continent, and 1 from the United States. Wisely included are the observations of a veterinarian-scientist; lessons learned from studies made primarily to prevent economic losses in animals may become useful to clinicians.
Perspectives in Pediatric Pathology, Vol. I, edited by Harvey S. Rosenberg, M.D., and Robert P. Bolande, M.D. Chicago: Year Book Medical Publishers, Inc., 1973, 406 pp., $27.50
Authors: Vawter Gordon F.
Published: December 2021

This volume announces a projected series aimed at thorough analysis of various areas of interest to students of diseases affecting children, including both pediatricians and pathologists. There is no question of the valuable role such a series can fulfill. For example, three articles cover aspects of hereditary, acquired and neoplastic renal disease; three deal with normal and aberrant bodily defense; three are discussions of particular areas of malformation (and include a most provocative discussion of tracheobronchial abnormalities, itself worth the price of admission).
Questions That Worry Children with Exstrophy
Authors: Feinberg Todd , Lattimer John K. , Jeter Katherine , Langford William , Beck Leah
Published: December 2021

It was apparent in the work with patients and their families that children who have exstrophy and epispadias have many more psychologic problems, particularly during adolescence, than the average child. The chief areas of conflict centered around wetness and concern for sexual adequacy. The anxieties of the children were also reflected in the parental attitudes.

In our opinion, there should be an ongoing guidance team which becomes involved with the family at the birth of the infant with this abnormality and which extends its services into young adulthood. The focus of the work should be to help these patients and their parents understand the nature of the problems. Guidance should be at many levels, from the care of the stoma to the inevitable emotional conflicts (Table IV).

At the Babies Hospital on the Columbia University Pediatric Urology Service, one of us (K.J. and family) has instituted a program of writing booklets for the information of the parent and the patient as to the best way to care for a stoma or a urine collection device. Booklets of advice and counsel for the parents are also being developed. Discussion groups are being set up with our nurses under one of us (L.B.) who is a child psychiatrist, to help parents and children ventilate their feelings and fantasies and to help them resolve some of their conflicts as to allow for maximal growth on the part of the child. In addition, in these groups counselling can take very concrete forms as to hobbies and activities for the children and even the best device for collecting the urine. The group tends to be very supportive of and helpful to its individual members.
Grasshopper Allergy
Authors: Schnitzker William F.
Published: December 2021

Allergic reactions to insects may occur from saliva or injected toxins, patient sensitization to body protein of the insect, sensitization to the emanation, scale, or powder of the insect, or allergy to pollen carried by the insect.

Generalized urticaria, angioedema, anaphylaxis and death may occur in sensitized persons following sting by: Hymenoptera—bees, wasps, hornets, and ants; and Diptera—mosquitoes.

Eczema or urticaria may occur from contact with insects. Allergic rhinitis and asthma may result from inhalation of insects or their products. Mites are contributary factors to house dust allergy. The May and Caddis fly can cause epidemic respiratory allergy by inhalation.
Toxic Effects of Anticonvulsants: General Principles
Authors: Hooshmand H.
Published: December 2021

Any drug, regardless of how benign and well tolerated, is potentially toxic. The toxicity may be due to (1) dosage; (2) the size of the patient; (3) drug interaction; (4) drug specificity for the disease; (5) the nature of the disease for which the drug is used; and (6) the mode and frequency of medication.

DOSE OF ANTICONVULSANT

Dose of anficonvulsant is very important (Table I). Any anticonvulsant in higher than therapeutic doses has toxic potential. It is well known that anticonvulsants in large enough doses can act as convulsants. This is especially true for diphenylhydantoin, benzodiazepines, and lidocaine.

THE SIZE OF THE PATIENT

The size of the patient should be considered in dosage. It is safer and more accurate to adjust dosage to body surface than to weight (Table I). As the child grows, there may be a need to gradually increase the dose of anticonvulsants if seizure control is poor, or if the serum level of the anticonvulsant starts to decline.

DRUG INTERACTION

The relationship. of multiple drug therapy and its toxic effects on the brain is quite complicated, and many forms of toxicity can result.

Toxicity may be the result of a combination of pharmacologically similar drugs. Such a combination may enhance the side effects of drowsiness and ataxia. The patient may suffer from these side effects without attaining therapeutic levels of individual anticonvulsants in the blood. In other words, a combination of drugs such as phenobarbital and primidone may result in severe ataxia and drowsiness.
Radiology of the Newborn and Young Infant, by Leonard E. Swischuk, M.D. Baltimore: The Williams & Wilkins Company, 1973, 602 pp., $36.50
Authors: Silverman Frederic N.
Published: December 2021

This volume is concerned primarily with radiologic diagnosis in the neonate and young infant up to 6 to 8 weeks, but occasional overlaps into the older infant are found because of "personal interests" on the part of the author. The greatest emphasis in this volume is on the common and ordinary situations for which radiographic examination is indicated. Some rare conditions are included. Because the author has attempted to be comprehensive, many of the subjects are treated in a very brief fashion; however, for practically every subject, references are available for those who wish to pursue it further.
Letter to the Editor
Authors: Kattwinkel John
Published: December 2021

I certainly agree with Drs. Harris, Stevens, and Nugent that the most efficient nasal CPAP delivery system would be the one which offers the least resistance to flow. Since such resistance is dependent not only on the diameter of the tubing, but also on tubing length, we feel that the short Silastic cannulae described in our article offer advantages over previous systems which have involved cannulation of the nares to the postetior pharynx.

Regarding the accuracy of pressures obtainable by the nasal technique, we have not found the mouth leak to be significant until a system pressure of approximately 10 to 12 cm of H2O is achieved.
Encephalopathy Following CNS Prophylaxis in Childhood Lymphoblastic Leukemia
Authors: Muriel Federico Sackmann
Published: December 2021

Common acute toxicities from intrathecal methotrexate are well known. The paper by McIntosh et al.1 is important because it emphasizes an intrathecal methotrexate (and radiation) toxicity which is more often observed than reported (we believe that in clinical practice of chemotherapy the common toxicity is overlooked and underreported).

In a recent publication, Aur et al.2 stated: "Five to eight weeks following irradiation approximately 10% of the children experienced fever and somnolence, sometimes accompanied by dizziness or spinal fluid pleocytosis, which lasted 1-2 wk.
THE CASE OF A MALE CHILD BORN WITHOUT AN ANUS (C. 1745)
Authors: C. T. E.
Published: December 2021

The case history below written by a Scottish surgeon is a good example of the linguistic style of mid-eighteenth century clinical presentations in the English language.

Paul of Aegina, a seventh century Byzantine physician, is usually credited with having successfully incised the perineum of an infant without an anus1

The first recorded American operation was performed in Flemingsburg, Kentucky, in 1800 by Dr. J. P. Campbell.2 The defect was an anorectal atresia without fistula, and the child was living three months after operation.

Mr. James Jamieson of Kelso, Scotland gave this description of his unsuccessfully treated patient:

Some years ago Mrs. Hannah, midwife in this Town was called to one Mrs. Stevenson in Plowland five miles distant from this Place, whom she delivered of Twins, the one Female, the other Male; and discovering in the later no Appearance of an Anus, came home and sent me to see the Child, whom I found otherwise sprightly, and seemingly in perfect Health, but not the least Vestige of an Anus to be seen or felt, but equally firm and solid from the Coccix (sic) to the Scrotum: whereupon I told the Grandmother, who only was acquainted therewith by the midwife, that it was preternatural, and that though I had twice seen the Anus covered by a membrane, which was easily cured, I could not propose to do the like in this; but if she pleased, I should try to reach the Gut by Incision which she, with the mother's Consent fondly agreed to: whereupon I made an incision pretty deep in the most reasonable Part, then introduced my little Finger into the Wound, to find the Gut, but in vain.
Infant Mortality and Water Hardness in the United States
Authors: Spiers Philip S. , Wright Stephen G. , Siegel Daniel G.
Published: December 2021

Because of a negative association found between infant mortality and water hardness in Great Britain, evidence for a similar relationship was sought in 81 cities of the United States. With infant mortality rate as the dependent variable, its relationships with five water indices and seven other environmental variables were examined. The results of multiple regression analyses found no evidence for a negative association between water hardness and infant mortality. The only independent variables significantly associated with the dependent variable were percent low income and a measure of industrialization.
Double-Blind Study of the Effectiveness of a Broad Spectrum Antibiotic in Status Asthmaticus
Authors: Shapiro Gail G. , Eggleston Peyton A. , Pierson William E. , Ray C. George , Bierman C. Warren
Published: December 2021

The dosage of 1:1,000 aqueous epinephrine is incorrectly given in the article by Shapiro et al. in the June issue (Pediatrics, 53:867, 1974). The cor- rect dosage is 0.01 cc/kilo instead of 0.1 cc/kilo as given.

The patient's serum IgE level in the article by Albrecht et al. in the June issue (Pediatrics, 53:907, 1974) is incorrect. It should be given as 205 nanograms per milliliter instead of 205 mg/ml.