bluuebunny/crossref_metadata_2025 huggingface dataset:
Water Intoxication
Authors: Moore Eddie S. , Edelmann Chester M.
Published: December 2021

We read with interest the article by Nickman, et al. on "Further Experiences with Water Intoxication," which appeared in Pediatrics (41: 149, 1968). We agree with the authors that both the children they report were suffering from water intoxication. However, the pathophysiology underlying the disturbance in these two infants deserves further comment.

In Case 1, it is apparent that there was not a maximal water diuresis, as evidenced by production of a urine with a specific gravity of 1.006 in the face of overhydration and severe hyponatremia.
Lupus Erythematosus with Nephritis
Authors: Jacobs Jerry C.
Published: December 2021

Hagge, Burke, and Stickler in their recent article "Treatment of Systemic Lupus Erythematosus Complicated by Nephritis in Children"1 conclude, "The retrospective analysis showed a definite trend toward prolonged survival among the patients receiving high doses of steroids, compared to those receiving no or low doses." The evidence in their Figure 1, although not statistically significant, appears to support their thesis. The authors do not mention that the broken line low-dose group represents 23 patients seen between 1945 and 1957 and 4 patients seen between 1959 and 1963, while the solid-line plot includes only patients seen since 1959.2
Letters to the Editor
Authors: Cornblath Marvin , Drash Allan
Published: December 2021

In reply to Dr. Ehrlich's questions, we only wish that life would be as simple as he implied. The association of increased peripheral venous insulin values with islet cell adenoma is by no means universal in adults. In a child with multiple islet cell adenomata (Pediatrics, 39:59, 1967) , fasting plasma insulins as well as those following glucose, tolbutamide, and leucine, were not abnormally elevated. No other studies of peripheral or portal plasma insulin levels in infants or children with islet cell adenoma are known to us.
Letters to the Editor
Authors: Milman Doris H.
Published: December 2021

In the April issue of Pediatrics (41:789, 1968) Drs. Garces, Drash, and Kenny report a case of islet cell adenoma and hypoglycemia in a newborn infant. They state, "only two well documented cases with onset of symptoms in the neonatal period have been reported in the literature." They apparently refer only to recent literature, since they cite no references prior to 1960. In fact, Dr. Harry Sherman1 reported a case of islet cell tumor in the newborn in 1947.
The Disadvantaged Child: Studies on the Social Environment and the Learning Process, by Martin Deutsch and Associates. New York: Basic Books, 1967, 400 pp., $10.00
Authors: Coles Robert
Published: December 2021

I must admit that I have never liked the term "disadvantaged child." One is somehow made to think of those earnest or smiling men and women from our exalted suburbs who organize a car pool once a week in order to go "help" the poor, benighted "slum children"–by taking them to a museum and buying them some cookies. I don't deny what cookies and Rembrandt can mean to a child, any child, nor do I wish to criticize unfairly the desperate efforts on the part of thousands of middle-class people to share what they have with others.
A DISTINGUISHED ENGLISH AND AMERICAN PHYSICIAN ADVOCATE GUMLANCING FOR TEETHING INFANTS: JOHN DARWALL OF BIRMINGHAM IN 1830 AND JOHN LOVETT MORSE OF BOSTON IN 1908
Authors: C. T. E.
Published: December 2021

So far as I know, no present day pediatric textbook recommends gum-lancing to relieve the symptoms caused by the cutting of the infant's teeth. But within the memory of many older practitioners, the value of this procedure was still supported by a number of the leading pediatricians of their day.

One of the most avid proponents of gumlancing was Dr. John Darwall of Birmingham, England, who wrote:

With respect to the gums, the moment they become red and inflamed they should be lanced, nor can any harm result from this practice, if the lancet be clean . . .

An objection has been made, and even by medical men, that should the gums heal over the teeth after they have been lanced, they become harder than they were at first, and consequently that the teeth will have more difficulty in protruding. Unprofessional persons might be excused for making such a remark and drawing such an inference, but in medical men it is utterly disgraceful.

Convulsions, inflammation of the eyes and many other diseases frequently accompany teething; it will be in vain to administer medicines until the gums have been lanced.1

Almost a century later the highly respected John Lovett Morse of Boston advocated gumlancing to relieve the infant's fever, which he considered to be a frequent accompaniment of teething. He cited the following personal experience:

A boy, 17 months old, began to be fussy and a little feverish the night of April 14. The next evening the temperature was 103°F., the next day 100°F. in the evening.
Letters to the Editor
Authors: Lucey Jerold
Published: December 2021

There always has been considerable variation in "opinions" regarding the value of Rh antibody titers during pregnancy. Dr. Zuelzer is an expert in this field, and in his laboratory these titers have proven very reliable. Those of us who are less well situated have, unfortunately, had to live with the problem of wide laboratory variation (state health department, private laboratory, hospital laboratory, and so forth), and we have not developed the faith that he justifiably has in this test.
Tonsils, Adenoids, and Albert Kaiser
Authors: Yankauer Alfred
Published: December 2021

Tonsils and adenoids, like the weather, provide such an inexhaustible fund of discussion that one wonders if they were not invented by doctors for this purpose. Dr. Haggerty's recent discussion in Pediatrics1 and his references to Dr. Albert D. Kaiser impel me to correct a statement which is historically incorrect and to draw attention to the achievements of a rather remarkable pediatrician. My information is based upon conversations with Dr. Kaiser in 1950-1952 when he had become Commissioner of Health in the city of Rochester, the culmination of a long and successful career as pediatric practitioner, medical educator, and researcher.
Letters to the Editor
Authors: Cone Thomas E.
Published: December 2021

Dr. Fleisher's letter calls attention to a factitious cause for an abnormally colored urine. Although this is an uncommon occurrence in the pediatric age group, I recently was asked to see an adolescent boy because his urine was red. In quizzing him further, he admitted adding some red ink to his urine specimen because he thought this would excuse him from taking a school examination for which he had not prepared himself.
GENITAL INFECTION WITH HERPESVIRUS HOMINIS TYPES 1 AND 2 IN CHILDREN
Authors: Nahmias André J. , Dowdle Walter R. , Naib Zuher M. , Josey William E. , Luce Carolyn F.
Published: December 2021

Five cases of genital infections with Herpesvirus hominis (HVH) in 7- to 12-year-old girls and one case in a 3-year-old boy have been observed over a 3-year period. HVH type 1 was isolated from the genital lesions and mouth in both the boy, who had no oral lesions, and in an 8-year-old girl with associated gingivostomatitis. The boy showed serological evidence of a type 1 HVH reinfection and the girl showed evidence of a primary type 1 infection. Laboratory studies on the other four girls confirmed a primary type 2 HVH infection.

On the basis of the virological, serological, and epidemiological information, it appears that genital infections with HVH in children can be either venereally or non-venereally transmitted. The physician should therefore use caution in his judgment as to the way in which a herpetic genital infection was acquired in his patient.
Administration of a Mixture of Fungal Glucosidases to a Patient with Type II Glycogenosis (Pompe's Disease)
Authors: Lauer Ronald M. , Mascarinas Thelma , Racela Antonio S. , Diehl Antoni M. , Brown Barbara Illingworth
Published: December 2021

A case of Type II glycogenosis (Pompe's disease) has been studied by histochemical, electron microscopic, and biochemical techniques. These studies have been made prior to and after the intramuscular administration for 1 week of a mixture of hydrolytic enzymes containing both α-1,4- and α-1,6-glucosidase activities.

Electron photomicrographs of the liver before enzyme administration showed glycogen to be located both within and outside of membrane-limited vacuoles. No change in this distribution could be detected in tissue removed by biopsy after enzyme administration. This impression was confirmed by the determination of glycogen content which was shown to be unchanged. Nevertheless, the liver was found by enzyme assay to contain the administered enzyme. Leucocytes isolated from blood taken 4 hours after the last enzyme injection were also shown to contain the parenterally administered glucosidases.

In skeletal muscle glycogen was present chiefly as extrasaccular deposits which were unchanged in appearance by enzyme administration. No glucosidase activity was demonstrable in the skeletal muscle after such a treatment.

Myocardium sectioned after autopsy had major deposits of glycogen in extrasaccular areas.
Adrenal Insufficiency Mimicking Heart Disease in Infancy
Authors: Sommerville Robert J. , Nora James J. , Clayton George W. , McNamara Dan G.
Published: December 2021

In early infancy congenital adrenal insufficiency in the male may be manifest primarily by a markedly altered electrolyte pattern. The profound toxic effect of the resulting hyperkalemia on the myocardium may clinically suggest the presence of congenital heart disease. Typical changes on the ECG make this a valuable diagnostic tool in hyperkalemia. The dramatic response to specific therapy illustrates the capacity of the myocardium to overcome the transient adverse effects of potassium.
In Reply: Reactions to Booster Doses of Tetanus Vaccine
Authors: Mortimer Edward A.
Published: December 2021

Dr. Perez-Martin's problem regarding reactions to booster doses of tetanus toxoid is one that has concerned many physicians. Excluding those reactions due to pertussis or diphtheria antigens in combined preparations, most appear to fall into one of three patterns: apparent true allergy with urticaria, a severe local reaction (Arthus phenomenon) with or without systemic symptoms, and unpleasant, generalized fever and malaise of several days' duration. The problem has recently been superbly discussed by Edsall and others (J.A.M.A, 202:17, 1967).
Clinical Hematology, ed. 6, by Dr. Maxwell M. Wintrobe. Philadelphia: Lea and Febiger, 1967, 1287 pp., $22.50
Authors: Pearson Howard A.
Published: December 2021

The sixth edition of Wintrobe's Clinical Hematology, as all of the preceding editions, remains the "bible" of this specialty. The book reflects the author's more than 30 years of clinical preeminence and so has great practical value in the management of hematologic diseases. It also presents so definitive an evaluation of the literature that it can serve as a prime reference for the physiologic and pathologic mechanisms underlying hematologic disorders.

Despite its general excellence, there are references from earlier editions which could have been eliminated.
Prolonged Symptomatic Neonatal Hypoglycemia Associated with Maternal Chlorpropamide Therapy
Authors: Zucker Preston , Simon Gilbert
Published: December 2021

Ordinarily, the hypoglycemia of infants of diabetic mothers is brief and asymptomatic.1 It is considered to result from fetal hyperinsulinism secondary to prenatal hyperglycemia. The infant described below had prolonged symptomatic hypoglycemia associated with maternal chlorpropamide (Diabinese) therapy.

Case Report

The patient, a 3,715 gm white male, was the product of a 37-week gestation of a gravida 3, para 2, A positive, 36-year-old mother by repeat cesarean section. The mother, a mild diabetic since age 31, had been receiving 250 mg chlorpropamide twice daily, including the morning of her delivery.

The infant's blood sugar was 20 mg/100 ml at 4 hours of age, and he was then transferred to Babies Hospital for further care.
Etiology of Bacterial Sepsis in Nephrotic Children 1963-1967
Authors: Katz Catherine M. , Katz Samuel L.
Published: December 2021

A retrospective study of 280 nephrotic admissions from 1963 through 1967 at Children's Hospital Medical Center in Boston revealed that gram-negative bacilli have caused the majority of infections in hospitalized nephrotic children. The organisms isolated during this period included pneumococci, E. coli, proteus, klebsiella-enterobacter species, pseudomonas, and Serratia marcescens. This information is recorded to aid physicians in the selection of initial antibiotic therapy in the septic nephrotic patient.
Lymphatics in Hyaline Membrane Disease
Authors: Stowens Daniel
Published: December 2021

The report on "The Pulmonary Lymphatics in Neonatal Hvaline Membrane Disease" by Dr. J. M. Lauweryns and colleagues1 is welcome for the data which are presented and for the emphasis they place upon the pathologic anatomy of the disease, a facet too often overlooked. However, I believe it necessary to point to two portions of the paper which are in error.

That of lesser importance is the statement repeatedly made that this morphologic feature of hyaline membrane disease has been previously unreported.
Hair Dryer for Hip Spica
Authors: Burg Frederic D.
Published: December 2021

Through a recent family problem, a technique for caring for an infant with a hip spica cast has come to my attention. My little girl, who had a congenital dislocation of her left hip, had been in a hip spica for 4 months. A problem which had perplexed us for quite some time was moisture gathering on the inside of the cast and irritating the skin areas covered by the cast. It is very difficult to keep these areas dry.
Sex Errors of the Body: Dilemmas, Education, Counseling, by John Money, Ph.D. Baltimore: The Johns Hopkins Press, 1968, 145 pp., $4.95
Authors: Bongiovanni Alfred M.
Published: December 2021

From his immense storehouse of experience in studying disorders of sex, the author has prepared a succinct manual. Just as the student of rare metabolic disorders employs his discoveries to elucidate normal transactions, Dr. Money describes "the extremes of what can happen in the morphology and function of sex .... to enhance .... to give an appreciation of .... normalcy." Brief descriptions of the many described anomalies of human sex from the chromosomal, hormonal, and through the presumably purely psychologic, serve to present the author's recommendations for management.
Chicago
Authors: Silverman Benj. K.
Published: December 2021

This letter went off today to the Executive Offices of the American Academy of Pediatrics:

"I have written in the past of my opposition to the repeated placing of the Annual Meetings in the depressing atmosphere of the Chicago Loop.

"My feelings are not greatly reinforced by the sordid television pictures of Mayor Daley's vicious handling of American youth at the Democratic convention.

"As pediatricians, we, first of all groups, should take steps to transfer our meetings from Chicago.
Congenital Stenosis of Right Mainstem Bronchus: Another Case
Authors: Litwer Eugene I. , Hubbard Colin P.
Published: December 2021

In reference to the report by Doctors Chang, Hetzler, Gregg, Lofti, and Brough in the April issue of Pediatrics (41:739, 1968) in which they describe the successful resection of a stenotic right mainstem bronchus in a 5-month-old child, we would like to report briefly the case of a 4-year-old child with a similar problem which was treated medically.

A white female was born March 25, 1964 to a hypothyroid mother, birth weight 3 lb, 5 oz, after a full-term pregnancy and normal delivery.
Further Suggestion on Transfer of Medical Information
Authors: Auld William T.
Published: December 2021

Perhaps my "gripe" is universal enough that you will give it some publicity. When a new family comes to town with a child who has a medical problem and I send a request for information to the doctor who has been taking care of him, I find it very annoying to receive photo copies of all his office records with handwriting I cannot read, abbreviations known only to that doctor, and pages of routine information which have no great bearing on the case.
THE RELATIONSHIP BETWEEN VITAMIN D AND THE CRANIOFACIAL AND DENTAL ANOMALIES OF THE SUPRAVALVULAR AORTIC STENOSIS SYNDROME
Authors: Friedman William F. , Mills Loren F.
Published: December 2021

There is evidence that a derangement in vitamin D metabolism on the part of the mother, the fetus, or both may be responsible for supravalvular aortic stenosis, especially when the latter is associated with infantile hypercalcemia. It has been shown that the offspring of rabbits given large amounts of parenteral vitamin D throughout pregnancy may be born with aortic lesions resembling supravalvular aortic stenosis as seen in man. The present study was designed to explore experimentally the relationship between exposure to excessive amounts of vitamin D during pregnancy and the development of the craniofacial complex and dentition because children with the multiple system abnormalities of the supravalvular aortic stenosis syndrome (SASS) share a characteristic craniofacial appearance and exhibit, in common, many abnormalities of dentition. Examination of their jaws and teeth reveals hypoplasia of the mandible, congenital absence of teeth (usually the lateral incisors and second premolars of the maxilla), microdontia, dysgnathia, enamel hypoplasia, and a narrowed occlusal table. In the present study, analogous findings were observed in rabbit offspring whose mothers received large amounts of vitamin D during pregnancy. The most marked functional accompaniment of these abnormalities was severe malocclusion of the teeth. Peculiar facies, premature closure of the cranial bones, strabismus, odd shaped ears, and a low birth weight were additional features of SASS that were noted in many test animals. Buphthalmos was also noted occasionally, probably related to maldevelopment of the bony ocular orbits. Thus, these experimental observations suggest that the cranial, facial, and dental peculiarities as well as the aortic lesion of the supravalvular aortic stenosis syndrome may be related to a derangement in vitamin D metabolism during pregnancy.
Does Imipramine (Tofranil) cause Oral Bleeding?
Authors: Rubell Earl B.
Published: December 2021

In the recent literature describing the use of imipramine hydrochloride (Tofranil) for enuresis in children, I have never seen any reference to gingivitis or bleeding as a side effect to this drug. The Physicians Desk Reference and the package inserts from the manufacturer describe dryness of the mouth but no other side effects referable to the oral mucous membrane. This letter concerns a child in whom I feel that such a side effect occurred. The patient, a 7-year-old female, has been enuretic since birth.
Treatment of Common Acute Poisonings, by Henry Matthew, M.D., F.R.C.P., and Alexander A. H. Lawson, M.B, Ch.B., M.R.C.P. London and Edinburgh: E. and S. Livingstone Ltd., 1967, 151 pp., $5.25. (The Williams and Wilkins Co., Baltimore, exclusive U.S. agents)
Authors: Alpert Joel J.
Published: December 2021

This brief book by an acknowledged expert in the management of poisoning is in the English tradition of making every word count. Included in its 144 pages of text are descriptions of the problem of acute poisoning, diagnosis, identification, basic principles, management of specific poisonings, snake bites, insecticides, plants, basic principles of psychiatric treatment, and prevention. The subjects are handled in a lucid, although abbreviated, manner. The author has a large experience because poison information, treatment, and service is centralized in Scotland and, incidentally, supported by the government.
DOCTOR, PATIENT, AND FAMILY IN COMPREHENSIVE PEDIATRIC CARE
Authors: Fraad Lewis M.
Published: December 2021

There are many definitions of comprehensive pediatric care. Elsewhere in this issue, Bowden and Rothenberg have described one aspect of in-patient comprehensive care which is usually not stressed. The fruitful cooperation of the pediatrician and child psychiatrist can make possible effective care of the sick child which would otherwise be impossible to achieve. In the case described by Bowden and Rothenberg, a strictly medical problem could not be handled without attention to "comprehensive" pediatric care. This called for understanding of the patient disease, attention to and understanding of his socio-psychologic problems, and a knowledge of age-appropriate responses of the patient.
CHILD-RESISTANT CONTAINERS CAN PREVENT POISONING
Authors: Scherz Robert G. , Latham George H. , Stracener Carl E.
Published: December 2021

During the period May 1, 1967, to April 30, 1968, prescription tablet and capsule medications from the pharmacies of Madigan General Hospital and McChord Air Force Base were dispensed in 270,000 child-resistant containers. Poisonings from all prescription medications decreased from 15.8 to 8.2 poisonings per 10,000 pediatric outpatient visits. The most significant change was a 90% decrease in poisonings due to prescription tablets and capsules dispensed in plastic vials originating from Madigan and McChord Air Force Base pharmacies during the test period.

The study suggests that widespread use of the test container would produce a significant reduction in accidental childhood poisonings due to prescription tablets and capsules.
DIAGNOSIS AND TREATMENT: OXYGEN THERAPY AND RETROLENTAL FIBROPLASIA
Authors: Silverman William A.
Published: December 2021

The conference succeeded in emphasizing the current importance of increased understanding of mutual problems by pediatricians and ophthalmologists. Premature infants with major illnesses can be treated adequately only in optimally manned and fully equipped intensive care units. Current support for these facilities is woefully inadequate. Ophthalmologists must examine every premature baby receiving supplemental oxygen, and the eyes of children born prematurely should be examined regularly for the first 2 years of life.

Participants in the conference agreed that revised recommendations for oxygen administration are highly desirable but that currently available data are insufficient to justify a revision of the present cautious recommendations. A vital need exists for extensive research in these areas, along with the accumulation of considerably more clinical data.

Subsequent meetings of this kind are clearly necessary, and it was suggested that the American Academy of Pediatrics should be invited to participate officially in the next meeting.
Neonatal Respiratory Depression Secondary to Maternal Analgesics, Treated by Exchange Transfusion
Authors: Asnes Russell S. , Lamb Johnny M.
Published: December 2021

Drug induced respiratory depression is a constant threat to the neonate whose mother has been sedated during labor. It should always be considered in the differential diagnosis of an altered respiratory pattern in a newborn. When the depression is severe, and there is a strong suggestion that it is drug induced, an exchange transfusion should be considered in an attempt to remove the noxious agents.
THE CLINICIAN'S ART: SOME QUESTIONS FOR OUR TIME
Authors: Green Morris
Published: December 2021

The papers by Kennell, et al. and by Starfield and Borkowf in this issue, and by Korsch et al. in the November 1968 issue provide documentation for the following, seemingly reasonable conclusions: (1) parents of children who have rheumatic fever demonstrate extensive confusion and many unrealistic beliefs about that disorder and its long-term prophylactic treatment; (2) resident physicians are much more likely to record their awareness of complaints related to a body system or function than to behavior problems; and (3) communication barriers between a pediatric resident and the patient parents contribute significantly to patient dissatisfaction.

The importance of these systematic examinations lies in their presentation of data about the clinician's job, a phase of the art of pediatrics not usually regarded as based on cumulative or scientific knowledge.
A COMPLAINT ABOUT MEDIEVAL CHILDREN
Authors: C. T. E.
Published: December 2021

The complaints noted below by Fra Bartholomew Anglicus, an English Franciscan of the thirteenth century, about the children of his time might well be written today.

Some children . . . lead their lives without thought and care. And set their courages only of mirth and liking, and dread no perils more than beating with a rod. .. . When they be praised, or shamed, or blamed, they set little thereby. . . Since all children be tatched [sic] with evil manners, and think only on things that be, and reck [sic] not of things that shall be, they love plays, games, and vanity. . . . And things most worthy they repute least worthy, and least worthy most worthy. .. . And the goodness that is done for them, they let it pass out of mind. They desire all things they see. . . - They love talking and counsel of such children as they be, and void company of old men. They keep no counsel, but they tell all that they hear or see.
VARIABLES AFFECTING SPLITTING OF THE SECOND HEART SOUND IN NORMAL CHILDREN
Authors: Castle Robert F. , Hedden Carol A. , Davis N. Park
Published: December 2021

Phonocardiograms were recorded in a population of normal children and adolescents (116 subjects) in order to evaluate variables which might affect splitting of the second heart sound. Tracings were recorded during normal respiration in supine and sitting positions.

Position was the major variable affecting splitting. Eighty-five percent of this population exhibited greater variation in splitting when sitting than while supine. In the remainder of the subjects, the splitting variation was greater in the supine position.

Heart rate, sex, age, height, and weight had little or no effect on the splitting pattern of the second sound; 15% of the subjects exhibited fixed splitting of the second sound in either, but not both, the supine and upright positions. This was defined as less than 10 msec variation in splitting during normal respiration. This observation indicates the necessity of assessing the second sound in both supine and upright positions before a judgment is made concerning the existence of an abnormal splitting pattern.
CYANOTIC HEART DISEASE AND PSYCHOLOGICAL DEVELOPMENT
Authors: Silbert Annette , Wolff Peter H. , Mayer Barbara , Rosenthal Amnon , Nadas Alexander S.
Published: December 2021

Forty-two children of normal intelligence with congenital heart disease between the ages of 4 and 8 years were tested for general intelligence, perceptual motor function, and gross and fine motor coordination. Three groups of children were tested: (1) those with cyanotic heart disease, (2) those with noncyanotic heart disease and a history of congestive heart failures, and (3) those with noncyanotic heart disease and a benign medical history. The first group had lower I.Q. scores, did less well in perceptual motor tasks, and had poorer gross motor coordination than children in the third group. Children of the second group occupied an intermediate position.
Hypertensive Encephalopathy and Desoxycorticosterone
Authors: Marks James F. , Fink Chester W.
Published: December 2021

Doctor Monteleone reports a patient with congenital adrenal hyperplasia who had permanent severe neurologic sequellae following DOC-induced hypertensive encephalopathy. Since the preparation of our previous manuscript, we have seen three additional children who have suffered from mineralocorticoid-induced hypertension following the implantation of DOC pellets. Our experience would indicate that this complication of mineralocorticoid therapy is much more common than previously recognized.

The administration of some long-acting form of salt-retaining hormone is necessary in the infant with the salt-losing form of adrenal hyper plasia.
The Gynecology OF Childhood and Adolescence, by John W. Huffman, M.D., F.A.C.O.G., F.A.A.P., F.A.C.S. Philadelphia: W. B. Saunders Company, 1968, 574 pp., $19.50
Authors: Yahia Clement
Published: December 2021

This is the first comprehensive textbook on pediatric and adolescent gynecology since the fourth edition of G. C. Schauffler's Pediatric Gynecology appeared in 1958. There have been recent books on the gynecology of adolescence and childhood, notably those by Heald and Jones and Heller, but the latter have concentrated on certain specialized aspects of gynecologic care of the pediatric patient. Huffman's book, on the other hand, encompasses an encyclopedic view of the gynecologic disorders affecting infants, children, and adolescents and draws on the author's vast experience at the Children's Memorial Center in Chicago.
RED CELL METABOLISM IN THE NEWBORN INFANT. IV. TRANSMEMBRANE POTASSIUM FLUX
Authors: Blum Stuart F. , Oski Frank A.
Published: December 2021

Measurements of transmembrane potassium flux in the erythrocytes of newborn infants and normal adults demonstrated an increased net loss of potassium in the infants. This loss appeared to be a consequence of decreased active potassium influx rather than an increased membrane permeability. These studies suggest that the erythrocytes of newborn infants may be more vulnerable to destruction resulting from membrane injury because of their reduced capacity for active transport.
A SAD STORY READ BY CHILDREN IN A POPULAR READER OF THE 1860'S
Authors: C. T. E.
Published: December 2021

Children's readers of a century ago contained lessons far different from those in our contemporary ones. A good example of this difference is the following story in a widely read reader published in 1867.

Please Get It Now, Brother

"Hand me some water, brother, won't you?" said a little sick girl.

"In a minute, Bettie," said Harry, and his little hands went on as busy as ever with the trap he was making. Bettie's fevered cheek was again pressed to the pillow, and Harry soon forgot her request.

"Please get it now, brother," and her voice was very feeble. But Harry heard it and ran for the water, and soon was holding the cup to his sister's lips.

"Not this, please, but some fresh and cold water from the well," and she turned her head languidly away.

"0, don't be so particular! This is fresh; and I am so busy, I can not go to the well now-won't this do?"

Bettie no longer refused, but quietly took the cup which Harry offered her. It was the last time she ever called upon her brother for an act of kindness.

The next day she stood beside the River of Life, and drank of its cool waters. Sickness and death had passed away, and little Bettie would thirst no more.

But Harry could not be comforted. Of all who wept over the little brown coffin, as it lay on the table before the pulpit, there were none who shed more bitter tears than the boy who could not forget that he had refused the last request of his sister.
THE CHILD WITH FREQUENT INFECTIONS: DIAGNOSTIC CONSIDERATIONS
Authors: Johnston Richard B. , Janeway Charles A.
Published: December 2021

The list of syndromes associated with diminished resistance to infection has grown bewilderingly long and complex in recent years. The busy pediatrician finds little consolation in the fact that knowledge gained from study of these specific defects has led to a more comprehensive understanding of normal immune mechanisms. Yet, this new insight has permitted a logical grouping of syndromes which can provide the physician with order and confidence in his diagnostic endeavors. One possible classification of immune deficiencies is offered here, primarily as a basis for some suggestions as to what should make a pediatrician suspect an immune defect and how he can test his suspicions. The reader is encouraged to substantiate the framework presented here with more detailed reviews.1-5

Mechanisms of resistance to infection may be separated into four major systems: physico-anatomical barriers, phagocytosis, humoral factors, and cellular immunity.

PHYSICO-ANATOMICAL BARRIERS

Defects of this "system" are often confined to one anatomical area or, at least, predispose to infections of a localized site. Cystic fibrosis, urethral stenosis, foreign bodies, eczema, skull fracture, and, occasionally, asthma are examples. Sickle cell disease, indwelling intravenous catheters, and prolonged broad-spectrum antibiotic therapy may induce generalized or localized infection. Diagnostic techniques applicable to this group are well known to pediatricians.

PHAGOCYTOSIS

The body clears bacterial invaders largely through the process of phagocytosis. Resistance to infection by fungi and viruses, on the other hand, depends primarily upon the integrity of the small lymphocyte, through a mechanism which is not yet understood. Thus, a patient with an abnormality of phagocytosis has little difficulty with fungal or viral infections if his lymphocytes are normal, but he is threatened by bacteria, especially those not easily killed by other defense mechanisms.
Arterial Pulses Following Percutaneous Catheterization in Children
Authors: Hohn Arno R. , Craenen Jo , Lambert Edward C.
Published: December 2021

Seventy-five patients who had undergone diagnostic arterial catheterization of the femoral artery by a percutaneous technique were examined for diminished pulse pressure by amplified oscillometric blood pressure recordings. Nine of the 75 (12%) had diminished pulse pressure recordings. These data contrast favorably with our previous experience with arteriotomy for catheterization and indicate that percutaneous femoral arterial catheterization in children has less risk of arterial complication than previously suspected.
Cat Scratch Disease: The Larger View
Authors: Carithers Hugh A. , Carithers Cornelia M. , Edwards Ray O.
Published: December 2021

We are indebted to Margilethi for neawakening an interest in a common pediatric problem by reporting 115 persons with cat scratch disease, the first sizable series analyzed in many years.

The conclusion reported in our more recent analysis of 154 cases of cat scratch disease seen in a private pediatric practice is in agreement with that of Margileth in many particulars. However, his series, seen in a hospital setting for the most pant, again contains a high proponlion of relatively severe cases that give a distorted picture of the disease, as have other series reported through the years.
Letters to the Editor
Authors: Marcileth Andrew M.
Published: December 2021

I appreciate and am in full agreement with Dr. Carithers remarks with two exceptions. In a recent review, W. J. Warwick points out that the scratch should be emphasized more than the cat in this syndrome. Reports have indicated that splinters of wood, pins, fish hooks, rabbit claws, thorns, and porcupine quills have acted as inoculating instruments. Therefore, the monkey or dog scratch may well be added to this list. As Dr. Carithers emphasized, it is most important that the physician look for the inoculation site and inquire about a primary lesion that may have healed during the 3 or 4 weeks prior to onset of lymphadenopathy.
Oral Hypoglycemic Agents
Authors: Tibbs Robert C.
Published: December 2021

I noted with interest the article by Drs. Adam and Schwartz, "Should Oral Hypoglycemic Agents Be Used in Pediatric and Pregnant Patients?" (Pediatrics, 42:819, 1968). In regard to juvenile diabetics, his conclusions were an echo of what usually appears in the ped iatric literature, namely, these drugs have no place in the management of any pediatric onset diabetic.

There are no clearly documented reasons for using them in pediatric practice. At best, the oral agents used in this young age group act as symptomatic medicines which require careful supervision and under such conditions, may involve only a small risk.
PULMONARY COMPLICATIONS OF CONGENITAL HEART DISEASE
Authors: R. A. M.
Published: December 2021

Respiratory distress is a very frequent symptom in infants with acyanotic congenital heart disease. Some of the specific physiological and pathological mechanisms involved in this association have been presented in Pediatrics.1 That communication stressed the frequency with which cardiac failure associated with large left-to-right shunts presents with respiratory distress, often misinterpreted as being due to pulmonary disease.

It has, however, also been long recognized that there is a high incidence of pulmonary infection in infants with large left-to-right shunt lesions. The cause of these frequent infections in such patients is not yet evident, but a possible explanation now seems to be suggested from recent observations at autopsy.
EFFECT OF CHRONIC OTITIS MEDIA ON LANGUAGE AND SPEECH DEVELOPMENT
Authors: Holm Vanja A. , Kunze LuVern H.
Published: December 2021

Two groups of children were compared in order to determine the effect on language and speech development of the fluctuating conductive hearing loss which accompanies chronic otitis media. The experimental group consisted of 16 children, aged 5 to 9 years, with chronic otitis media and with hearing fluctuations documented by audiograms. The control group was matched for age, sex, and socioeconomic background. The language performances of the groups were compared by means of the Illinois Test of Psycholinguistic Abilities, the Peabody Picture Vocabulary Test, the Templin-Darley Picture Articulation Screening Test, and the Mecham Verbal Language Development Scale. The result shows that the experimental group was delayed to a statistically significant degree in all language skills requiring the receiving or processing of auditory stimuli or the production of verbal responses. No significant differences were found in tests measuring primarily visual and motor skills. This would suggest that the fluctuating hearing loss accompanying chronic otitis media was the cause of the delay in language development found in the experimental group. Physicians, parents, and educators need to be aware of the implication of this language handicap, as it might affect performance. Further studies are needed to evaluate the influence on permanent language ability by the periodic lack of sensory stimulation experienced during conductive hearing loss due to frequent episodes of otitis media.
JACOB ABBOTT (1803-1879), AUTHOR OF THE MOST FAMOUS BOOK ON CHILD REARING OF THE 1870'S, DISCUSSES CORPORAL PUNISHMENT OF CHILDREN
Authors: C. T. E.
Published: December 2021

Jacob Abbott wrote the most widely read book about child nurture in the decade just after the Civil War. His two principal themes were: the absolute need for parental authority over the child "without violence or anger," and "right development of the child's character . . . in harmony with the structure and characteristics of the juvenile mind." If the child did not bow to parental authority, Abbott advised parents of the need for corporal punishment:

The parental authority must, therefore, be established-by gentle means, if possible-but it must by all means be established, and be firmly maintained. If you cannot govern your child without corporal punishment, it is better to resort to it than not to govern him at all. Taking a wide view of the field, I think there may be several cases in which a resort to the infliction of physical pain as the only available means of establishing authority may be the only alternative. . . . Complete, absolute, unquestioned authority can often be obtained most forcefully by this form of punishment . . . manoeuvre and artifice and reason and affection (are) a sandy foundation for establishing parental authority that came from God and nature.1

As harsh as this advice may seem today, Abbott was convinced that his suggestions about "gentler" controls offered proof and strengthened belief in the child's rationality or tractability.
Letter to the Editor
Authors: Elbualy M. S.
Published: December 2021

I read with interest the article by Dr. R. G. Scherz, et al. (Pediatrics, 43:84, 1969). It is long overdue that child resistant containers (CRC) are made for all drugs and not merely for "baby aspirin." The suggestion that CRC be used for household products is worthy of note.

The statement that the reduction in childhood poisoning was, "due directly to the use of CRC to dispense perscription tablets and capsules" is challenged, because the reduction may have been due to the use of CRC indirectly-inn that the patients may have been more careful since the containers will have reminded them of accidental poisoning.
Letter to the Editor
Authors: Kretchmer Norman
Published: December 2021

I think it is fairly well understood by most people interested in international health that the major underlying problem throughout the world is overpopulation. In my article it was not my intent to emphasize any one particular problem, but rather to give an anecdotal survey of my experience abroad. To think that merely solving the population problem will solve all of the world ills seems to me to be a naive approach. Each section of the world differs ill relation to its basic needs.
NATURAL HISTORY OF "APPARENTLY HEALED" ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS IN CHILDREN
Authors: Treser Gerhard , Ehrenreich Theodore , Ores Richard , Sagel Inge , Wasserman Edward , Lange Kurt
Published: December 2021

Twenty-three children with apparent cure of an acute poststreptococcal glomerulonephritis were followed at monthly intervals for periods up to 10 years. They were considered clinically healed if asymptomatic and if the following were normal: blood pressure, urea clearance, and three consecutive Addis counts. Sequential kidney biopsies were performed and studied by light and electromicroscopy and immunohistology.

Renal biopsies performed between 1 and 3 years after the onset of the acute disease revealed normal glomerular morphology and no evidence of immune reaction only in four patients. The remaining 19 patients had segmental mesangial lesions and varying degrees of immunofluorescence with antihuman gamma-globulin and antihuman complement. Subsequent biopsies on these patients showed further resolution of the glomerular lesions in 16 cases. The remaining three patients had evidence of continuing immune reaction and morphologic progression of glomerular lesions.

No correlation could be found between the duration of symptoms and abnormal laboratory findings at the onset of the disease and the extent or reversibility of the glomerular lesions. In seven patients minimal transient urinary abnormalities reappared after initial clearing. This occurrence need not necessarily carry an ominous prognosis, but it must be interpreted in the light of morphologic and immunologic changes.

Continued presence or diminution of immune activity was the most reliable indicator of the evolution of glomerular damage as evidenced by subsequent biopsies.
Availability, Effectiveness, and Economy of Better Child Health Services
Authors: Holtz Albert I.
Published: December 2021

I would like to add an observation to Dr. Butler's stimulating article, "Availability, Effectiveness and Economy of Child Health Services," Pediatrics, 43:284, 1969.

My practice involves, in part, consultations in a lower socioeconomic area of suburban Los Angeles. By working with general practitioners and local hospitals, I have been able to offer pediatric knowledge to a community of approximately 100,000. The general practitioners, surgeons, and obstetricians refer patients for consultation on an inpatient and outpatient basis.
Family Life and Sex Education
Authors: Faigel Harris C.
Published: December 2021

It appears to me that one of the implications of the Academy's statement on family life and sex education (Pediatrics, 42: 535, 1968) is that such programs are a form of immunization against the social health problems of today's society. If this is truly the feeling of the committees jointly represented, I would like to point out that there is no valid proof of this statement.

In my experience, many practicing physicians, be they family physicians or pediatricians, are totally unprepared and are psychologically unable to effectively serve as the supportive link and catalyst for the instruction of parents and schools the Academy recommends.
Oral Glucose Tolerance Tests in the Newborn
Authors: Schiff David , Stern Leo
Published: December 2021

Pildes, et al. have speculated on the discrepancy observed between umbilical venous and peripheral venous sampling for blood glucose and plasma insulin during oral glucose tolerance tests in the newborn infant. Since the liver is a major source of insulinase activity, it will metabolize, in part, the insulin released by the pancreas. Thus, insulin measured peripherally or post hepatically, will not be the same as that measured in the umbilical vein from a pre-hepatic placement of the catheter tip.
Paediatric Cardiology, edited by Hamish Watson, T.D., M.D., F.R.C.P. (Edin.), M.R.C.P. (Lond.). St. Louis: The C.V. Mosby Company, 1968, 996 pp., $36.50
Authors: Nadas Alexander S.
Published: December 2021

This second multi-authored text on heart disease of children to appear in 1968 certainly is as good as the other (vide infra) , and better than most books on the subject. Dr. Watson's experiment is a very interesting one. He brought together 39 authors, 14 Europeans and 25 Americans, to write individual monographs, in their particular fields of interest, on the problems of heart disease in the young. Although each of the authors and their co-authors write with an individual flavor, Dr. Watson manages very well to give the book homogeneity and consistency.
POSTNATAL FORMATION AND OBLITERATION OF ARTERIAL ANASTOMOSES IN THE HUMAN LUNG
Authors: Robertson Bengt
Published: December 2021

The incidence and structure of arterial bronchopulmonary anastomoses and pulmobronchial arteries were studied by microangiographic and histologic techniques in material from 37 immature, premature, and full-term neonatal infants and 15 infants and children varying in age from 3 weeks to 4 years, 7 months. The number of arterial bronchopulmonary anastomoses was found to increase with postnatal age. The opposite was true for the pulmobronchial arteries, and some anastomoses were probably formed from pulmobronchial arteries which established precapillary communication with adjacent branches of true bronchial arteries. From the age of 2½ months, many anastomoses are narrowed by intimal smooth muscle cells; and, from the age of 7 months, some anastomoses are completely obliterated by smooth muscle cells and fibrous tissue. The majority of the arterial bronchopulmonary anastomoses probably become obliterated as the individual approaches adulthood.
Normal Intelligence in the Lesch-Nyhan Syndrome
Authors: Scherzer Alfred L. , Ilson Jerome B.
Published: December 2021

A case of Lesch-Nyhan syndrome is presented in which psychological evaluation revealed normal, intellectual potential. It is suggested that formal psychological testing, using a variety of modified instruments, may uncover other patients with essentially normal, intellectual potential. Such testing is essential in order to realistically plan programs of pediatric rehabilitation and to adequately study the effects of various treatment regimes.
Purpura Fulminans Associated with Neisseria catarrhalis Septicemia and Meningitis
Authors: Feigin Ralph D. , Joaquin Venusto San , Middelkamp J. Neal
Published: December 2021

Purpura fulminans in association with N. catarrhalis septicemia and meningitis was found in a 6-month-old male infant. The small number of cases in the literature of meningitis due to saprophytic neisseria may understate the incidence of infection with this ordinarily nonpathogenic organism and has served to mask the apparent predilection of N. catarrhalis producing meningitis and septicemia for the young child.

The association of purpura fulminans with N. catarrhalis septicemia merely serves to emphasize that this life-threatening complication may accompany almost any infectious disease of childhood.