bluuebunny/crossref_metadata_2025 huggingface dataset:
Mortality Reporting for Childhood Leukemia
Authors: George Stephen L.
Published: December 2021

The continuing discussion on the current prognosis for children with acute leukemia1-6 has raised at least two general points concerning the analysis and reporting of survival data. Because these points are of fundamental importance to the discussion, they require further clarification.

The first point concerns the common practice of overtly or covertly excluding a particular type of patient from the analysis.4 Patients excluded typically have unfavorable prognoses so that results extrapolated to the general population of patients often seem overly optimistic.
Gangrene of the Newborn, and its Management
Authors: Siegel L. K. , Gross Robert
Published: December 2021

An infant with peripheral gangrene was recently born at Harrisburg (Pa.) Polyclinic Hospital. This rare entity was most recently reported in 1971.1 Our patient was an approximately 28-week gestation infant of a 21-year-old primigravida without prenatal care, whose membranes had ruptured spontaneously 5 days prior to admission. On initial examination two presenting parts were felt. The delivery was spontaneous after 5 hours of active labor. The infant cried spontaneously, had an Apgar score of 7, required no resuscitation, and weighed 2 lbs. 6 oz. The head was badly battered and markedly molded.
YOUTH, PERMISSIVENESS, AND CHILD DEVELOPMENT
Authors: Philips Irving
Published: December 2021

As unrest grows in our social scene, as institutions undergo change, as innovations revolutionize everyday living, there is among many a longing to return to affirmations of older and simpler virtues. Their discontent often is expressed in a condemnation of youthful rebellion and, by extension, of youth and child care practices. It tends to focus upon "permissiveness" as the main cause of youthful lawlessness and laxity of behavior.

In American society the elaboration of methods of child rearing to bewildered parents by specialists in behavior, medical and nonmedical, is not new. nonmedical, is not new. In the early twenties character formation, according to the behavioristic psychology of Watson, was thought to be best achieved by a firm and rigid schedule, early developed, rigorously obeyed, and meticulously followed.
ORAL EXAMINATIONS OF THE AMERICAN BOARD OF PEDIATRICS
Authors:   The American Board of Pediatrics, Inc.
Published: December 2021

It is hoped that this description of the pattern and content of oral examinations given by the American Board of Pediatrics may be helpful to candidates—particularly to those who may be understandably apprehensive as they prepare to pass through this "final portal" leading to certification and official recognition as a qualified specialist.
Letter to the Editor
Authors: Outerbridge Eugene W. , Roloff Dietrich W. , Stern Leo
Published: December 2021

The paper by Doctors Vidyasagar and Chernick on the achievement of continuous positive transpulmonary pressure using continuous negative chest wall pressure contains a suggestion for modification of the Air-Shields Isolette-Respirator to permit its use in this fashion. They suggest the insertion of a switch into the electrical circuit to activate the solenoid valve and thereby permit continuous evacuation of air from the body compartment. While this modification is effective, it is not necessary to do so in order to achieve continuous negative pressure (CNP).
Radiant Heaters and Other Hazards in the Delivery Room
Authors: Sweet Avron Y.
Published: December 2021

In the May issue of Pediatrics, Dr. Alex Robertson pointed out the unhappy fact that no effective radiant warmer now available meets standards of safety sufficient for use in delivery rooms where flammable anesthetics are administered. His unhappiness had to do with the manufacturers. Dr. T. K. Oliver responded on behalf of the Committee on Fetus and Newborn to the effect that it is important to provide neonates with a suitable environment in the delivery room and suggested that the problem of unacceptable heating devices vis-a-vis flammable anesthetics can be obviated by discontinuing the use of flammable anesthetics or permanently mounting the heating units at a height of 60 in. or more.
Letter to the Editor
Authors: Oliver Thomas K.
Published: December 2021

Dr. Sweet's suggested action as delineated in the last sentence of his letter is wise and has the support of the Committee on the Fetus and Newborn. As he well knows joint meetings take time. In the meanwhile the suggestions outlined in the reply to Dr. Robertson should not be delayed. In contrast to Dr. Sweet's skepticism, I believe action by individual hospital staffs can be effective and is surely appropriate.
The Adoption of Black Children
Authors: Shearer William T. , Shearer Mary I.
Published: December 2021

The American Academy of Pediatrics is to be commended for issuing a statement on the need for adoptive homes for black children (Pediatrics, 48:325, 1971). Although tardy, the Academy's Committee on Adoptions and Dependent Care addressed itself to a pressing problem of child care and welfare.

It is indeed unfortunate that the statement is incomplete and misleading. It suffers from a lack of information. In some instances, the lack of information is not the fault of the Committee but should certainly be a concern of the Committee.
AN EPIDEMIC OF BULLOUS IMPETIGO ARISING FROM A CENTRAL ADMISSION-OBSERVATION NURSERY
Authors: Light Irwin J. , Brackvogel Virginia , Walton R. Lee , Sutherland James M.
Published: December 2021

An epidemic of discrete exfoliative skin lesions associated with group II staphylococci was recognized in infants recently discharged from a newborn nursery unit. Bacteriologic surveillance of infants discharged from the nursery indicated a recent increase in colonization of infants with this organism. Nasal cultures from personnel and environmental cultures failed to reveal the source of the epidemic. Isolation of the organism from two infants discharged home directly from the admission-observation nursery suggested that the epidemic was being perpetuated by a reservoir of infection among infants in this central nursery. Following a change in the location of this nursery, with physical separation of all new admissions from previously colonized infants, there was an immediate and significant decrease in colonization with the epidemic strain of staphylococcus. Closing of the entire admitting nursery and converting to a cohort system was associated with a total disappearance of the epidemic strain.
Therapy of Reye's Syndrome
Authors: Eskes Philip W. H.
Published: December 2021

Recently, Brown and Madge published their rationale of treatment for Reye's Syndrome in this journal in a letter to the Editor. We would like to add another case to the one they treated, with successful outcome following their insulin-glucose routine:

A 4-year-old Caucasian male was admitted to Huntington Hospital following a 24-hour history of severe vomiting. Initially he demonstrated few abnormalities on physical exam, but within 24 hours he alternated periods of hyperagitation with periods of stupor, developed cortical blindness, sluggish pupillary reflexes, hyperactive KTR's, and positive Babinski's bilaterally.
Diminished People: Problems and Care of the Mentally Retarded, by fifteen authors, edited by Norman R. Bernstein, M.D. Boston: Little, Brown & Company, 1970, 340 pp., $15.50
Authors: Crocker Allen C.
Published: December 2021

I have the feeling that probably no one can put together a book on the subject of mental retardation which will satisfy many other people. An author in this field invariably reveals his own personal bias in his writing and editorship, and this inevitably clashes in some measure with the emotion-laden special attitudes of many of the more experienced of his potential readers. It should also be pointed out that as an area of professional interest, mental retardation has an unsatisfactory nomenclature, imperfect standards, a set of uneven disciplinary alliances, and a massively unfulfilled mission.
HYPERCALCEMIA ASSOCIATED WITH HYPERTENSION DUE TO PROLONGED IMMOBILIZATION (AN UNUSUAL COMPLICATION OF EXTENSIVE BURNS)
Authors: Berliner Benjamin C. , Shenker I. Ronald , Weinstock Michael S.
Published: December 2021

An 11-year-old boy developed hypercalcemia, hyposthenuria, hypertension, and hypertensive encephalopathy after being immobilized because of severe third degree burns. Complete recovery took place when his serum calcium returned to normal levels. The possible mechanisms involved in the development of these little recognized complications of hypercalcemia are discussed.

Although these phenomena are well documented in the medical literature, there has been little attention given to this association in pediatric publications.

Pediatricians have long been aware of the hypertensive problems encountered in burns, as well as other situations of immobilization. They have also recognized hypercalcemia under these circumstances, but the mutual relationship has been rarely commented upon.
LISTERIA MONOCYTOGENES AND QUEEN ANNE
Authors: Saxbe W. B.
Published: December 2021

Despite 17 pregnancies, Queen Anne left no surviving children. The unfortunate results of her pregnancies are consistent with listeriosis in four of its manifestations: habitual abortion, stillbirth, neonatal death, and postnatal meningitis with residual hydrocephalus. Because Anne was childless, the Crown passed to the House of Hanover. Parliament made use of this situation to assume the initiative in government which it has maintained to the present.
Idiopathic Dilatation of the Superior Vena Cava (Superior Vena Cava Dilatation)
Authors: Franken Edmund A.
Published: December 2021

A case is reported of an 8-year-old male who presented with mediastinal widening secondary to idiopathic dilatation of the superior vena cava. Roentgen signs of superior vena cava dilatation include a right, anterior, and superior location in the mediastinum, lack of tracheal deviation, and increased size on supine roentgenograms. Contrast studies to define the venous nature of such a mass can obviate thoracotomy.
Has the Nitroblue Tetrazolium Test Proved Itself?
Authors: Abello Victor B.
Published: December 2021

I followed with interest the use of the nitroblue tetrazolium (NBT) reduction test in the differential diagnosis of viral and bacterial infections.1-3 My enthusiasm, however, has been slowly dampened. With more work being done, there has been increasing awareness of the different false-positive and false-negative results.2-5 Consequently, I believe its clinical value is waning even before the test has been generally made available to practitioners. The NBT test will probably fall in the category of WBC and differential in its use in differentiating viral from bacterial infections, which similarly has numerous false-positive and false-negative results and has to be correlated clinically.
Letter to the Editor
Authors: Brickman Anthony
Published: December 2021

The mumps neutralizing antibody titration as performed in our laboratory accurately predicts susceptibility to mumps. No patient with a titer of 1:2 or greater has subsequently become infected. When a group of children was exposed to mumps on a long-stay hospital ward, every seronegative individual subsequently excreted virus, developed parotitis, or both.1 On the other hand we know of numerous skin test positive individuals who went on to develop mumps. The results of our study indicate that placebo reactions cannot account for all of the discrepancies in the mumps skin test.
Planning Buildings for Handicapped Children, by Ivan Nellist, A.R.I.B.A. Springfield, Illinois: Charles C Thomas, 1970, 120 pp., $12.75
Authors: Mackeith Ronald C.
Published: December 2021

The author is a British architect who clearly feels for handicapped children and has given deep thought to his subject. The book deals primarily with mentally handicapped children with a brief chapter on the additional problems of those who also have physical handicaps. In general he describes what is necessary for older children including those in wheelchairs, with little very specific reference to those who, because they are younger or more severely handicapped, are not at all mobile. The parts on play areas, observation and recording facilities will be particularly valuable.
PLACENTAL TRANSFUSION AND HYPERBILIRUBINEMIA IN THE PREMATURE
Authors: Saigal Saroj , O'Neill Allison , Surainder Yeldandi , Chua Le-Beng , Usher Robert
Published: December 2021

Placental transfusion has been compared in premature and full-term infants. Blood volume measurements showed that the 5-minute transfusion was similar in full-term and premature infants (47% and 50% increase in blood volume from birth). A larger proportion of the 5-minute transfusion occurred by 1 minute in full-term (76%) than in premature infants (56%). Placental transfusion, by increasing red cell volume, greatly enhanced the severity of neonatal hyperbilirubinemia. Bilirubin concentrations of 15 mg/100 ml developed in only 6% of premature infants when cord clamping was immediate, in 14% when cord clamping was delayed 1 minute, and in 38% after a 5-minute delay in cord clamping.
WHAT AMERICAN PARENTS READ ABOUT COLIC IN 1860
Authors: C. T. E.
Published: December 2021

As every pediatrician knows, there is little really known about the causes of a type of abdominal pain in infants which every mother calls colic. Among the etiologic factors mentioned are: hunger and underfeeding, overfeeding and flatulence, hyperactivity, allergy, family tensions, and immaturity of the gastrointestinal tract. Treatment still remains largely a matter of trial and error and is generally unsatisfactory.

Dr. Henry S. Taylor writing in 1860 had this to say about colic.

The period when children are most liable to colic is from the age of one or two weeks till they have cut their first teeth. It shows itself by the tension or enlargement of the stomach, a drawing up of the knees toward the stomach, as if in pain, and an emission of wind from the stomach, which usually for a short time affords relief. It is frequently attended with costiveness and sometimes by vomiting. It arises usually from wet feet, or from the use of improper food, and is almost invariably attended with indigestion. Taken in its earliest stages, it is seldom difficult to cure, but is exceedingly debilitating, and if neglected becomes dangerous. We have known bilious colic to remove by death even an adult in five or six hours. Convulsions in children are not unfrequently caused by neglect of the colic.

Not unfrequent it has been found that the colic of the infant has arisen from the state of its mother system. In all such cases the health of the mother and her diet should be promptly attended to.
Isolated Phrenic Nerve Palsy in the Newborn
Authors: Smith Barry T.
Published: December 2021

A case of isolated phrenic nerve palsy in a newborn infant following a difficult forceps delivery is described. Treatment was supportive and complete clinical and radiological recovery occurred between the tenth and eighteenth days of life.

Phrenic nerve palsy should be considered in the differential diagnosis of respiratory distress in the newborn period, especially if there is a history of traumatic delivery or if a brachial palsy is present.
Letter to the Editor
Authors: Gluck Louis
Published: December 2021

Dr. Roux is correct; the procedure he outlines and executes which is his own modification is neither valid nor reliable.

We use Silica Gel H containing (NH4)2SO4 (Dr. Roux did not) which gives a different chromatographic separation from his. His statements about Eastman chromatogram sheets No. 6061 do not apply; these cannot be charred. His application of a large overload of phospholipids (0.5 mg) gives poor separation on TLC; we use about 30 µg. We long ago advised Dr. Roux that we stopped spraying with H2SO4 since this chars less uniformly than does the heated (NH4)2SO4-Silica Gel H plate.
Letter to the Editor
Authors: Reynolds John W.
Published: December 2021

It is surprising that there has been no published report concerning the effect of high dose glucocorticoid therapy in hyaline membrane disease (HMD). This therapy has been used empirically in many disorders with a much lower mortality rate than HMD. If clinical trials with either glucocorticoid or estrogen therapy are to be conducted, it is imperative that the severity of the disease in each case be assessed by objective criteria, that there be a concurrent control group matched for clinical severity and gestational age, and that currently used methods of neonatal intensive care be applied to both groups.
Lumbar Puncture in the Newborn
Authors: Healy C. E.
Published: December 2021

Concerning the discussion of the letter to the Editor in Pediatrics about the use of scalp vein needles to perform lumbar punctures on young infants: There is no doubt that the procedure is performed much more easily using a scalp vein needle for the reasons which have been outlined. The reasons for using an obturator and the spinal tap needle have been outlined also. In addition to possibly introducing infection into the central nervous system space, the possibility of introducing viable epithelial cells into this space is also a theoretical hazard.
Letter to the Editor
Authors: Greensher Joseph , Mofenson Howard C. , Borofsky Leatrice G.
Published: December 2021

The letter in Pediatrics,1 on "Improved Methods of Lumbar Puncture in the Newborn and Small Infant" and the comments by Dr. Byers was of special interest to us.

In our recently published article, "Lumbar Puncture in the Neonate: A Simplified Technique,"2 a "Butterfly-21 Infusion Set Needle" was used by us with excellent results. The possibility of coring out a fragment of skin tissue by using a hollow needle was considered. In an experimental series demonstrating this phenomena, Gibson and Norris3 felt that these fragments would cause plugging of the needle or flow outward with the fluid.
PLASMA PRESSORS IN THE NORMAL AND STRESSED NEWBORN INFANT
Authors: Holden Kenton R. , Young Reuben B. , Piland Jethro H. , Hurt W. Glenn
Published: December 2021

Plasma pressor activity (PPA) was measured in umbilical plasma of 29 full-term newborn infants and two sets of twins using a modified in vitro bioassay which reflects primarily plasma levels of epinephrine and norepinephrine. Full-term newborn infants with asphyxia neonatorum demonstrated significant hypercapnia, acidemia, lower Apgar scores, and elevated PPA as compared to normal.

Eight newborn infants born to mothers with mild preeclampsia as well as the second born of twins showed similar trends. Pooled data on all newborn infants revealed a highly significant correlation between umbilical artery PPA and Paco2, pHa, as well as Apgar scores at 1 and 5 minutes.
IMMUNOCHEMICAL EFFECTS OF INJECTION THERAPY WITH ALLERGENS BY CUSTOMARY AND INTENSIVE DOSAGE REGIMENS IN CHILDREN
Authors: May C. D. , Lyman M. , Alberto R. , Aduna N.
Published: December 2021

Evaluation of dosage regimens for injection therapy with allergen extracts was undertaken by determination of immunochemical responses. Antigenic release of histamine was used as a means of measuring leukocyte sensitivity to allergens and antigen-neutralizing capacity of serum or "blocking" antibody. Customary dosage regimens providing 190,000 to 265,000 Protein Nitrogen Units of allergen in 2 years, and intensive dosage regimens providing these amounts or more in a few weeks were evaluated in 46 allergic children by frequent measurement of luekocyte sensitivity and antigen-neutralizing capacity of serum. Uninjected subjects were studied simultaneously. With 32 children receiving customary dosage regimens for injection of an allergen extract (Alternaria, ragweed, house dust), increases and decreases in leukocyte sensitivity in those children receiving injections did not differ significantly from others without injections. Modest increases in antigen-neutralizing capacity of serum occurred with injections. With 14 children receiving intensive dosage regimens for injection of the same allergens, much higher titers of antigen-neutralizing capacity in the serum could be achieved, but little net change in leukocyte sensitivity was observed, except for one case in which leukocytes became desensitized. In no case did intradermal skin tests with the allergens become negative, meaning the children were not desensitized. The dosage regimens used for injection of the allergens tested did not evoke immunochemical responses which encourage one to undertake extensive clinical trials.
AVOIDING PEDIATRIC PATHOGENESIS IN THE MANAGEMENT OF ACUTE MINOR ILLNESS
Authors: Carey William B. , Sibinga Maarten S.
Published: December 2021

The management of acute minor illnesses constitutes a major portion of a physician's work. The impact of such illness on the child's development and the physician's positive or negative influence on the child's and the parents' emotional adjustment are considered here. Very few data are available in the literature. Suggestions for management and research are presented.

Diagnosis and therapy of acute minor illness are far from uniform or agreed upon. Accurate diagnosis and reasonable treatment are the pediatrician's first responsibility. Over-, under-, and misdiagnosing and treating are to be avoided. Secondly, he should nurture the sick child by reducing stress and by promoting his adjustment to the illness situation. The child's emotional health suffers from the pediatrician's neglect, over-involvement with or mismanagement of his feelings during illness. Thirdly, the pediatrician should support the parents by helping them to deal with the specific illness and by promoting their capacity to cope with illness in general. If, instead, the pediatrician is overly dominant or submissive, neglectful or punitive in handling the parents' needs, they may become frightened, dependent, demanding, confused, or angry. Their feelings of incompetence in handling illnesses affect their general child-rearing abilities.
CAN NASAL BACTERIAL FLORA BE PREDICTED FROM CLINICAL FINDINGS?
Authors: Hays Gerald C. , Mullard Janice E.
Published: December 2021

In a clinical study involving 229 control subjects and 285 patients with abnormal nasal or paranasal findings which extended over a 2-year period, patients with crusting below the nares, on the edges of the alae nasi, or redness of the skin below the nares had a significant increase in the growth of beta hemolytic streptococcus in their nasal cultures.

Patients with a nasal discharge had a higher incidence of beta hemolytic streptococci, Hemophilus influenzae, and pneumococci than the controls.

Color, thickness, and duration of nasal discharge were poor predictors of nasal bacterial flora.

Blistering distal dactylitis was found in two symptomatic patients, both of whom grew beta streptococci from their noses and the pus from the blisters.
PEDIATRIC PROBLEMS RELATED TO DETERIORATED HOUSING
Authors: Wehrle Paul F. , Brent Robert L. , Chisolm J. Julian , Doyle John L. , Fagan Emmett L. , Finberg Laurence , Miller Robert W. , Nahmias Andre J. , Thompson G. D. Carlyle , Farr Lee E. , Horton Robert J. M.
Published: December 2021

There has been increasing concern by several groups about the plight of children whose lives are harmed by their housing environment, which results in an increased risk of accidents, infectious diseases, and in particular, lead poisoning. The Committee on Environmental Hazards has also been vitally concerned with these problems, and several of its members have served as expert witnesses in congressional hearings on related bills. However, efforts up to the present have been insufficient to alleviate illnesses which, though ill-defined, are clearly preventable.

The Committee on Environmental Hazards recommends that the Academy encourage national and local governments to support, at the economic and law enforcement levels (including health departments), those measures necessary to alleviate the problems of childhood lead poisoning. Deteriorated housing is an essential feature of lead poisoning, and it is related to the increased risk of accidents and the incidence of infectious diseases. Action is needed to urge landlords, by whatever means possible, to improve those housing conditions which are a danger to the health of children. It may be economically unfeasible for landlords of deteriorated housing in inner cities to improve their buildings, and both legislative action and financial commitment from government may be necessary to bring about required action.
Growth Charts for Black Children Now Available
Authors: Scott Roland B.
Published: December 2021

In view of the relative dearth of readily available growth data on black children, readers of Pediatrics may be interested in obtaining copies of growth charts currently being used in the Department of Pediatrics and Child Health of Howard University College of Medicine and Freedmen's Hospital.

Graphic charts (8½ x 11 in.) depicting data for head circumference, length, and weight (metric system) in children under 17 years of age are available. Data for boys and girls are plotted on separate charts.
Corticosteroids in Croup: Further Testimony
Authors: Vann Harold , Smith E. Ross , Atkinson E. R.
Published: December 2021

Like Doctor Coffin, whose letter you printed in the September issue, we have practiced for 10 plus years in a three-man group which has together treated all of the croup cases in a very busy practice. The difference is we do not use corticosteroids in croup. There have been no fatalities and the only tracheostomies have been in cases of epiglottitis (possibly three).
The Patient, His Family, the Pediatrician, and the Pediatric Allergist
Authors: Rapaport Howard G.
Published: December 2021

The recent statement by the Section Committee on Allergy on the relationship between pediatrician and allergist presents the point of view of the pediatrician, for the most part ignoring or minimizing that of the allergist. I believe that both sides of this question should be aired.

The statement is particularly disturbing because its basic premise—that the pediatrician, assisted by a cooperative allergist, will be able to treat most allergic problems—has been disproven by the experience of at least 20 years.
Possible Influence of Geographic Location and Colony Counts on Guidelines for Diagnosis of Streptococcal Infections in Rheumatic Fever
Authors: Lewak Norman
Published: December 2021

In their "Guidelines for the Diagnosis of Streptococcal Infection" (Pediatrics, 48:573, 1971), Honikman and Massell did not specify whether the guidelines should vary by geographic location. Taking into consideration the economic factors mentioned by the authors, should the same guidelines apply to different areas of the country which have markedly different incidences of rheumatic fever?

We are all aware that the public is (rightfully) taking a close look at the quality of medical practice. Practice audits appear to be a certainty in the future.
Letter to the Editor
Authors: Massell Benedict F. , Honikman Larry H.
Published: December 2021

Dr. Lewak's question about geographic locations is important, but present knowledge does not allow for an accurate answer. In some areas where it had been thought that there was very little rheumatic fever, it was later found that there was an appreciable incidence of the disease—especially among individuals living under crowded conditions. Thus, socioeconomic factors may very well influence incidence to a greater extent than geographic factors. Furthermore, there is no evidence so far that either symptomatology or rheumatogenicity of streptococcal infection is influenced by geography.
Letter to the Editor
Authors: Tefft Melvin
Published: December 2021

The use of echo cardiography is still another modality available for the evaluation of pencardial effusion as differentiated from myocardial enlargement. However, it is still a relatively new technique, not necessarily replacing either radioisotope scanning or CO2 insufflation. Moreover, it may not be readily available, both in terms of instrumentation and experienced individuals for proper interpretation.

Possibly, at this time, one should consider all techniques available and should choose the one readily available to his own institution where most accurate diagnosis can be obtained.
Article
Authors: Gil David G.
Published: December 2021

Dr. Newberger's review of Violence Against Children misrepresents my studies. My research methodology dismayed him, but he failed to mention that I discussed limitations of a survey of legally reported child abuse and warned explicitly against automatically extrapolating findings beyond the 13,000 children from all over the country studied in my surveys. In spite of limitations, my study samples were far more representative than small samples drawn from hospitals or welfare agencies in one locality which were used in most earlier studies of child abuse.
DOES BREAST-FEEDING INCREASE THE CHILD'S RISK OF BREAST CANCER?
Authors: Miller Robert W. , Fraumeni Joseph F.
Published: December 2021

Wide publicity has been given to the recommendation by an experimental scientist that mothers with a family history of breast cancer should not nurse their daughters for fear of increasing the child's risk of developing breast cancer.1 Because 5% of U.S. women develop this neoplasm,2 a substantial proportion of families have a member with breast cancer, and would be affected by the recommendation. The experimental basis for the advice against breast-feeding should be weighed against the epidemiological evidence concerning transmission of mammary cancer from mother to daughter. In particular, the risk of transmitting breast cancer to the child should be evaluated against the benefits derived from breast-feeding.
Vomiting In Utero with Intestinal Atresia
Authors: Shrand H.
Published: December 2021

The fetus with high intestinal obstruction may vomit bile in utero. A green amniotic fluid with failure to pass meconium clinches the diagnosis.

Case Report

After an uncomplicated pregnancy, labor progressed with no signs of fetal distress—yet when the membranes were ruptured excessive amounts of green amniotic fluid appeared. The obstetcian diagnosed hydramnios with "meconium stained liquor." The fetal heart then dropped to 80 beats a minute and the infant (2.7 kg) was immediately delivered by low forceps. The cord was wrapped around the neck producing a face purple with ecchymoses.

After unwrapping the cord greenish fluid was suctioned from the mouth and pharynx and over 30 cc from the stomach.
FILLED MILKS, IMITATION MILKS, AND COFFEE WHITENERS
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

Certain fluid milk-like products packaged in the same type of container as fresh fluid milk are marketed in grocery stores in many states. These products may be mistaken for fresh fluid milk and skim milk; therefore, the Committee on Nutrition is concerned about the nutritive value of such products if they are used in the diets of infants and children.

These milk-like products are classsified as filled milks and imitation milk. According to the provisions of the Filled Milk Act, Public Law No. 513, a filled milk is defined as any milk, cream, or skim milk to which any fat or oil other than milk fat has been added so the resulting product is in semblance to or imitation of a milk product. More simply stated, any mixture of milk solids with fats other than milk fat is called a "filled" product. However, imitation milk resembles milk but contains no skim milk or nonfat milk solids. Filled milks are and have been marketed in many states, whereas imitation milks have only recently been offered to the public in several areas, notably New York, Arizona, and California.

Most imitation milks on the market are totally unsuitable for infant feeding and constitute a public health risk, even though these products are presently marketed in just a few areas. However, it appears advisable to inform physicians about the nutritional values of milk-like products because they could become more widely available.

This statement does not deal with proprietary infant formulas, which are specifically exempted under the provisions of the Filled Milk Act1 and which are covered by Food and Drug Administration regulations on Special Dietary Foods.
In Reply: Evaluating Effectiveness of Care: Some Questions
Authors: Sommers Peter , Sussman Sidney J.
Published: December 2021

In the November, 1971 issue of Pediatrics, Gordis and Markowitz1 report on a study designed to evaluate the effectiveness of two different models of health care. One must seriously question whether the authors' conclusions are justified in light of the crude measures utilized. It is certainly tempting to select such easily quantifiable indicators as mortality rates, immunization status, or height/weight measurements. However, it is doubtful whether results expressed in these oversimplified terms can lead one to make any decent conclusions about the effectiveness of a particular health program.
In Reply: IgA in Meconium, and Cystic Fibrosis
Authors: Rule Allyn H. , Hyslop Newton E.
Published: December 2021

The antisera to secretory IgA and secretory component used in our studies reported in Pediatrics were prepared in goats as previously described1 with washed immune precipitates of salivary IgA isolated from saliva by method of Tomasi2 and precipitated by goat anti-IgA antisera. These goat antisera contained antibodies to α-chain and secretory component, as defined by appropriate patterns in immunodiffusion reactions with agammaglobulinemic, IgA-deficient and normal salivas and a pure sample of normal human colostral IgA kindly provided by Dr. T. B. Tomasi.1
Radionuclide Brain Scans in Convulsive Disorders?
Authors: Golden Gerald S. , Erenberg Gerald
Published: December 2021

In a recent article, Tefft1 has stated that radioactive brain scans must be used to evaluate each child with a convulsive disorder, including those with a normal neurological examination and a normal or nonspecific electroencephalogram. He states that this should be done to rule out the presence of a low grade intracranial neoplasm or arteriovenous malformation. We would like to present three objections to this blanket policy.

First, the yield would be extremely low. Follow up of children with epilepsy detected gliomas in 23 of 10,450 children (0.3%) in the study by Page, et al.2 and in 3 of 1,518 (0.2%) studied by Livingston.3
In Reply: Hypoglycemia and Leukemia
Authors: Jaffe Norman , Kim Byung Soo
Published: December 2021

We indicated that the cause of hypoglycemia was not entirely resolved. Certainly, among the possibilities we cited, an abnormality in glucose metabolism due to reduced liver glucose-6-phosphatase should also be considered. We regret its omission. Indeed, all causes of hypoglycemia should receive consideration. We were most impressed with the leukemic infiltration of the organs and tissues noted at autopsy. Report by other workers suggesting that this could be an etiological factor1-3 and particularly the correlation between a reduction in the size of the spleen and an increase in blood sugar,4 prompted us to infer that the leukemic mass probably played a major role in the pathogenesis.
PHYSIOLOGIE UND PATHOLOGIE DER NEUGEBO-RENENPERIODE: Handbuch der Kinderheilkunde (H. Opitz and F. Schmid, editors), vol. I/2 edited by J. R. Bierich, R. Grüttner and K.-H. Schäfer. Berlin/Heidelberg/New York: Springer-Verlag, 1971, 538 pp., $69.30
Authors: Riegel Klaus P.
Published: December 2021

This volume numbered I/2 is the last to appear of 12 tomes completing a pediatric encyclopedia of 12,500 pages and 4,500 figures worked out by 550 authors. According to the editors, this handbook is to date the most representative of all works on Pediatrics, and probably will be so for a long while. It was intended, in the tradition of the great Pfaundler-Schlossmann Handbuch (founded in 1906), to present a critical and condensed evaluation of material based upon the literature of fact rather than that of theory.
INFANTILE AUTISM (Proceedings of the Indiana University Colloquium), edited by Don W. Churchill, M.D., Gerald D. Alpern, Ph.D., and Marian K. DeMyer, M.D. Springfield, Illinois: Charles C Thomas, 1971, 340 pp., $15.50
Authors: Leonard Martha F.
Published: December 2021

Since infantile autism is a puzzling and challenging condition, or group of conditions, with causes uncertain or complex and treatment often unsatisfactory, one approaches a new book on the subject with eagerness and a hope of finding some new answers or clarification. Infantile Autism is a compilation of invited papers and discussions by 26 English and American workers in the field of autism, who participated in a colloquium at Indiana University in 1968. The colloquium focussed on some central questions: Is infantile autism a clinical entity?
GENETIC DISORDER OF THE ENDOCRINE GLANDS, by David L. Rimoin, M.D., Ph.D., R. Neil Schimke, M.D. St. Louis: The C. V. Mosby Company, 1971, 383 pp., $32.50
Authors: Frasier S. Douglas
Published: December 2021

The authors present this book as an attempt to catalogue the known genetic disorders of the endocrine glands. They have succeeded admirably.

Each chapter begins with a brief description of the embryology and physiology of the gland under discussion. If there are weaknesses in this presentation, they are excusable in the light of the authors' main purpose. Embryology and physiology are followed by a catalogue of genetic disorders which are associated with altered function of that gland.
HEMOLYTIC CRISES OF FAVISM IN SICILIAN FEMALES HETEROZYGOUS FOR G-6-PD DEFICIENCY
Authors: Russo Giuseppe , Mollica Florindo , Pavone Lorenzo , Schilirò Gino
Published: December 2021

Five female children who suffered hemolytic crises of favism were studied 10 to 20 months after crisis. Spectrophotometric assay of erythrocytic glucose-6-PD (G-6-PD) activity, methemoglobin reduction test, and three cytochemical methods of enzyme demonstration in individual erythrocytes were performed. The parents were also studied in the same way.

Four girls were certainly heterozygotes for G-6-PD deficiency, and one was very probably a heterozygote. A relationship was found between severity of hemolytic crisis and degree of enzyme deficiency and percentage of enzyme devoid red cells. The G-6-PD levels during crisis were higher than out of crisis.

Assumption of a selective lysis of enzymopenic red cells during crisis would seem justified. Heterozygotes with low percentages of enzymopenic red cells probably experience hemolytic processes without or with minimal clinical signs. Hence favism in females is probably more frequent than generally thought.
HOW PATIENTS SPEND THEIR TIME AT THE PEDIATRICIAN'S OFFICE
Authors: Wegenke John , Wilson Mary , Reeb Kenneth G. , Hansen Marc F.
Published: December 2021

A time-motion study of patient visits to three pediatric clinics—a medical school "model clinic" for teaching health services delivery in a primary care setting, and two private pediatric practices—is presented. Results characterize the temporal aspects of the patient care process and highlight differences and similarities in this process between these clinics. Wasted patient time is demonstrated and possibilities for correcting the inefficiencies are discussed. This technique is readily adaptable to most clinical settings and is proposed as a useful and practical tool for physicians interested in improving the efficiency of patient care.
Letter to the Editor
Authors: Katz Samuel L.
Published: December 2021

Dr. Kempe having recently commented on the end of smallpox vaccination in the United States (Pediatrics, 49:489, 1972), we asked Dr. Samuel Katz to answer these two letters. He writes:

In response to the five questions raised by Dr. Edward B. Shaw, I have prepared the following answers. They are arranged in the sequence he has used.

(1) The decision was not a sudden, frivolous, or unexpected one on the part of the Committee. The WHO Smallpox Eradication Program began in 1966 and showed its striking results first in 1968.
Allied Health Workers in Pediatrics
Authors: Matlin Arnold H.
Published: December 2021

I strongly disagree with the opinions of Dr. Pick in regard to the appropriate role of allied health workers.

Dr. Pick is concerned with the private practice of pediatrics, while to me the more important issue is the overall health care of children. In view of the worsening crisis in health care delivery, we can no longer afford the luxury of letting highly trained health professionals perform functions that can be equally well performed by less highly trained personnel.
Letter to the Editor
Authors: Bean Margaret A.
Published: December 2021

Dr. Pick's thinking is fuzzy. What does he mean by "pediatric judgment?" If he means judgment made by a pediatrician, then his last paragraph doesn't make sense. If, as I suspect, however, he means making decisions about care and treatment of children and giving advice, counseling, and teaching that many parents need in rearing healthy children and caring for them in illness—what makes him think that pediatricians have a corner in this market?

Judgment is judgment.
Diazepam (Valium) for Neonatal Narcotic Withdrawal: A Question of Safety
Authors: Schiff David , Chan George , Stern Leo
Published: December 2021

While we do not dispute the efficacy of diazepam (Valium) in the management of the neonatal narcotic withdrawal syndrome, we cannot agree with the statement made by the authors regarding the safety of the injectable preparation of diazepam. Like caffeine sodium benzoate, the injectable preparation of diazepam is capable of displacing bilirubin from its albumin-binding site, a property which in the case of sulfisoxazole, has resulted in the occurrence of kernicterus at low serum levels of bilirubin. This property lies not with the therapeutically active diazepam component, but with the buffer preservative which contains sodium benzoate.
Päediatrische Unfallfibel, vol. 95, by H. Moll and J. H. Ries. Berlin, Heidelberg, New York: Springer-Verlag, 1971, 86 pp., $4.30
Authors: Eichenwald Heinz F.
Published: December 2021

The German word "fibel" means primer; the title of this volume therefore suggests that it was the authors' intention to produce an elementary text on accidents in children. This is exactly what they have done by describing in a volume of some 80 pages most of the various misadventures that might befall a child. Obviously, such space limitation means that subjects can only be covered sketchily. Thus, fractures are discussed in nine pages, eye injuries in two, and poisoning in 20.
CLINICAL OBSERVATIONS ON THE USE OF AUREOMYCIN IN VARICELLA
Authors: MAZURSKY MILTON M. , WRIGHT LYDIA , WEICHSEL MANFRED
Published: December 2021

Eighty-two patients with varicella between the ages of 6 months and 12 years whose rash was of less than 24 hours' duration and none of whose lesions were in the crust or scab stage were seen on admission and followed daily for six days. Forty-one of these patients received aureomycin orally (50 mg./kg. body weight the first 24 hours; 25 mg./kg. body weight the next 48). Forty-one cases served as controls.

Aureomycin had no effect on the cases treated.

Two patients developed epidemic parotitis despite the administration of aureomycin early in their incubation periods.
CONGENITAL ANOMALIES
Authors: MILLER HERBERT C.
Published: December 2021

The purpose of this Symposium is to survey an area of human existence that has interested laymen as well as physicians for centuries, but one in which very few facts have been assembled until modern times. It is only recently that the power of "the foul fiend Flibbertigibbet, who squints the eye and makes the harelip," has diminished and that "the craft and subtlety of the Devil" in the production of monsters has waned. So much progress has been made within the past decade that we now can begin to discuss the problem of the congenitally defective infant in terms of prevention and not just of theoretic eugenics.

While the title of this Symposium is "Congenital Anomalies," it would be remiss to limit our attention solely to anatomic abnormalities. It is becoming increasingly clear that the latter are but one aspect of a much larger problem, namely, the general health of the fetus. The etiologic agents which are responsible for anatomic malformations apparently are capable of producing other types of injury in the fetus. For instance, congenital toxoplasmosis is sometimes associated with microphthalmia, an easily recognized anatomic malformation, as well as encephalitis, chorioretinitis and uveitis in the same individual. It is also apparent that a single anomaly can result from any one of several prenatal factors. Microphthalmia can result from congenital toxoplasmosis, maternal rubella or a genetic factor. Microcephaly is the result of such diverse factors as maternal rubella, excessive exposure to X-rays or a genetic factor. It is evident that a multiplicity of prenatal factors are associated with various morbid states in the fetus, of which congenital malformation is only one.
PLACE OF ORAL FEEDING IN INFANTILE DIARRHEA
Authors: CHUNG ARTHUR W. , HOLT L. EMMETT
Published: December 2021

Early oral feeding is recommended in infantile diarrhea not as a substitute but as a supplement to needed parenteral therapy. An analysis of pertinent data indicates the safety and value of this procedure.
In Memoriam
Authors: SHAW E. B.
Published: December 2021

JOHN TOOMEY died January 1, 1950. Born May 25, 1889, his preliminary education was in law, in which he received the degree of LL.B. and he practiced law for one year. Forsaking law for medicine, he entered medical school and received his medical degree from Western Reserve University in 1919. His entire professional career was devoted to the service of his Alma Mater where, beginning in a minor capacity, he had steadily increasing responsibilities to be finally Professor of Clinical Pediatrics and Contagious Diseases, Western Reserve University School of Medicine, and Associate Director of Pediatrics and Contagious Diseases and Associate Director in the Department of Pediatrics, Out Patient Department, City Hospital of Cleveland.
CASE FATALITY IN INFANTS AND CHILDREN WITH PERTUSSIS, 1942-1946
Authors: KOHN JEROME L. , FISCHER ALFRED E. , MARKS HERBERT H.
Published: December 2021

Analysis of data on patients with pertussis during 1942-1946 obtained by means of a questionnaire from communicable disease hospitals and from health officers in a number of cities in the United States and Canada showed these results:

Case fatality rates of patients admitted to hospitals for treatment have declined substantially in the period under review. This decline is general, both among infants under one year of age and among older children. In 1946, the case fatality rate of the infants hospitalized for the disease was 5.0% in those cities for which data for at least four years were available. This may be compared with the rate of 7.8% in 1942 and 11.1% in 1943. At ages one year and over, the rate was only 1.3% in 1946, as compared with 1.7% in 1942 and 3.7% in 1943.

The rates in the hospitals with larger experiences were generally more favorable than in hospitals with smaller experiences.

Despite the incomplete reporting of pertussis, which results in exaggerating the case fatality rate for the general population, the level of these rates in the community as a whole was lower than for hospitalized cases. This reflects the higher proportion of the severer cases in the hospitalized group. Indications are that in many places hospitalization is limited more and more to severe cases.

Progress in the management of pertussis, especially of the severer cases admitted to hospitals, is believed to be the chief factor in the decline in case fatality of pertussis.

A request contained in the questionnaire for an opinion on the severity of pertussis during the period studied elicited few replies, and these replies showed a division of opinion on the matter. It appears unlikely that there has been much of any change in the severity of the disease.
FAVISM IN TWO CHILDREN IN CALIFORNIA
Authors: JACOBS ALVIN H.
Published: December 2021

The first two instances of favism recognized in the western United States are reported. Attention is called to the widespread use of fava beans in this area and the possibility of favism as a cause of unexplained cases of acute hemolytic anemia or jaundice.