bluuebunny/crossref_metadata_2025 huggingface dataset:
One nurse's view of pediatric nurse practitioners
Authors: Ford Loretta C.
Published: December 2021

Involvement in and reflections upon nine years of change in nursing and health care provide the framework for this commentary on the article, "Nurse Practitioners for Children—Past and Future" by McAtee and Silver.1 My earlier association with Silver as a co-director of the first pediatric nurse practitioner project at the University of Colorado makes these comments, hopefully, like conversations and challenges between colleagues. My remarks address those issues concerned with establishing priorities in the preparation of teacher-practitioners, the development of interdisciplinary collaboration, the need for studies of effectiveness of nurse practitioners, and an opinion on the recommendation to prepare "assistant nurse practitioners."
BENJAMIN FRANKLIN'S ACCOUNT OF INOCULATION (VARIOLATION) IN BOSTON
Authors: C. T. E.
Published: December 2021

In a letter written on February 16, 1759 to an English friend, Benjamin Franklin described the practice of inoculation for smallpox in Boston as follows:

Inoculation was first practiced in Boston by Dr. Boylston in 1721 . It was not used before in any part of America, and not in Philadelphia till 1730. Some years since an enquiry was made in Philadelphia of the several Surgeons and Physicians who had practised Inoculation, what numbers had been by each inoculated, and what was the success. The result of this enquiry was that upwards of 800 (I forget the exact number) had been inoculated at different times, and that only four of them had died. If this account was true, as I believe it was, the reason of greater success there than had been found in Boston, when the general loss by Inoculation used to be estimated at about one in 100, may probably be from this circumstance, that in Boston they always keep the distemper out as long as they can, so that when it comes, it finds a greater number of adult subjects than in Philadelphia, where since 1730 it has gone through the town once in four or five years, so that the greatest numbers of subjects for inoculation must be under that age.

Notwithstanding the now uncontroverted success of Inoculation, it does not seem to make that progress among the common people in America, which was at first expected, Scruples of conscience weigh with many, concerning the lawfulness of the practice, and if one parent or near relation is against it, the other does not choose to inoculate a child without free consent of all parties, lest in case of a disastrous event, perpetual blame should follow.
Gypsies: Culture and Child Care
Authors: Mandell Frederick
Published: December 2021

For centuries the Gypsies have sealed their society from the non-Gypsy world. Gypsy families are now seeking crisis medical care in the large centers, and medical personnel are unfamiliar with their fears and defenses. In the midst of American technology, this isolated culture has little understanding of Western medicine and requires more than the standard reassurances. Some limited observations of culture and child care are included so the provider of medical care will understand the unyielding effect of this culture on medical expectations.
INTRODUCTION: Screening in Child Health Care
Authors: North A. Frederick
Published: December 2021

The eight papers in this symposium have been brought together to help practicing pediatricians evaluate the place of screening, and of particular screening procedures, in their own practices and in programs of child health care in which they participate.

Advancing technology is making available an increasing number of tests and observations which might be employed in the early detection of health problems. The Federal government has mandated an Early and Periodic Screening Diagnosis and Treatment (EPSDT) program for all Medicaid eligible children, and California has mandated health screening for school attendance. With this kind of pressure to "screen," how should the pediatrician react? We hope that this symposium will help him decide. The first two papers discuss definitions and criteria, the following five illustrate the application of these criteria in specific areas of current interest and controversy, and the final paper attempts to summarize the current status of screening and to predict some future directions for screening in the health care of children.
Selection of Diseases and Tests in Pediatric Screening
Authors: Frankenburg William K.
Published: December 2021

The availability of a suitable screening test does not justify screening for a disease unless the disease is important, relatively prevalent, and amenable to early treatment. Screening for a disease which has the necessary characteristics cannot be justified unless there is an acceptable, reliable and valid test which can be carried out at reasonable cost.

Screening which is carried out without knowledge and consideration of these criteria is likely to be wasteful of scarce medical resources and may actually do more harm than good.
Tuberculin Testing of Children
Authors: Edwards Phyllis Q.
Published: December 2021

The pediatrician should review and analyze tuberculin test results based on his personal experience. This analysis coupled with knowledge of the tuberculosis situation in the community from which he draws his patients will suggest the degree to which he continues to perform tuberculin tests as a routine procedure. In effect, personal judgment of the pediatrician must determine on an individual basis whether tuberculin testing is necessary.
Otitis Media in the Pathogenesis of Neonatal Meningitis with Group B Beta-Hemolytic Streptococcus
Authors: Ermocilla Rufino , Cassady George , Ceballos Ricardo
Published: December 2021

In this report, a premature black male infant was found at autopsy to have bilateral otitis media, mastoiditis, and suppurative meningitis due to group B beta-hemolytic streptococcus (GB-BHS). The pathogenetic pathway proposed for this early onset meningitis is of importance in late onset meningitis. This patient clearly demonstrates the critical importance of examining middle ear and mastoid, both clinically and at autopsy, in the neonate colonized with this organism.
In Reply: More on Indian Health
Authors: Mortimer Edward A.
Published: December 2021

Dr. Turbeville has added some interesting thoughts, by comparing support for care in the Indian Health Service versus that in the military. I do disagree on one point. There are numbers of critically ill kids who need the attention of a pediatric cardiologist or, as occurred more recently, a neonatologist, but are either not sent in or are sent inappropriately to another unit which is cheaper. In regard to this recent occurrence relating to a newborn baby, our neonatologist accepted the baby for referral to his intensive care unit, but higher-ups in the Indian Health Service were forced to send the baby to another hospital that does not have a neonatologist and, indeed, has an average newborn census of about three.
In Reply: Galactokinase Deficiency in Twins
Authors: Frasier S. Douglas , Olambiwonnu N. O. , Ng Won G. , Donnell George N.
Published: December 2021

We appreciate the opportunity to respond to the comments made by J.A. Monteleone et al. concerning our paper, "Galactokinase deficiency in twins: Clinical and biochemical studies."

It is apparent that Monteleone and his colleagues have not read our paper carefully, since we do not use the term "galactose-free" diet. Rather the term "lactose-free" formula or diet is employed with full recognition that Nutramigen is known to contain a small residual amount of lactose.

The experience in this laboratory with galactokinase deficiency has been only with the two patients described in our paper.
Skin Care of Newborns
Authors: James L. Stanley , Graven Stanley N. , Kay Jacob L. , Korones Sheldon B. , Meyer H. Belton , Muirhead Donald M. , Oliver Thomas K. , Shinefield Henry , Spear Robert L. , Sutherland James M. , Swyer Paul R. , Hasselmeyer Eileen , Knox Eric , Talner Norman S.
Published: December 2021

The recent concern related to bathing newborns with hexachlorophene has led to a redefinition of appropriate skin care for newly born infants in hospital nurseries. Skin manipulations are performed (1) for prevention of infection and (2) for aesthetic and cleansing purposes.

The skin is a protective organ and any break in its integrity affords an opportunity for initiation of infection. In addition, it is clear that protection against invading pathogenic organisms is afforded by skin secretions or contents and the normal skin biota.

Therefore, skin care should involve cleansing with a non-toxic, non-abrasive neutral material.

Consideration of skin care of the newborn is further complicated by the fact that the infant does not have protective skin flora at birth, has at least one and possibly two open surgical wounds, the umbilicus and circumcision site, and is exposed to fomites and personnel that harbor a variety of infectious agents.

Risks and benefits of each skin-care technique in the newly born must be weighed. Is the agent used absorbed and toxic directly or indirectly? What is the effect of the technique on the skin itself? Does the agent predispose to a biota change that is detrimental to the infant?

The currently available data suggest that perhaps the best method for managing infant skin is to minimize manipulation. The recommended technique is referred to as dry skin care. "Dry technique" is recommended for the following reasons: (1) it subjects the infant to less heat loss by exposure; (2) it diminishes skin trauma; (3) it requires less time, and (4) it does not expose the infant to agents with known or unknown side effects.
Enzymatic Alterations in Reye's Syndrome: Prognostic Implications
Authors: Roe C. R. , Schonberger L. B. , Gelbach S. H. , Wies L. A. , Sidbury J. B.
Published: December 2021

Serial studies on serum enzyme and isoenzyme abnormalities in seven cases of Reye's syndrome were found to segregate patients into three categories of organ involvement. The patients with both extensive hepatic and previously unrecognized skeletal muscle involvement died despite therapeutic measures. The other two groups were characterized by enzyme and isoenzyme changes consistent with either predominantly muscular or hepatic involvement. The prognostic value of these abnormalities has been substantiated in subsequent cases of this syndrome. These findings suggest that those patients at greatest risk may be identified early, thus improving evaluation of the efficacy of specific therapeutic interventions in this disease.
Sacral Agenesis
Authors: Lebowitz Robert L.
Published: December 2021

It is important to recognize the patient with sacral agenesis and associated neurogenic bladder dysfunction before irremediable damage to the urinary tract occurs, as stressed by Thompson, Kirk, and Dale.1 It is also true that this entity is often occult. Thus, any clue to the diagnosis, or statistical association with another clinical problem, is of great help in identifying patients with this malformation, aptly termed "the syndrome of caudal regression" by Duhamel.

Thompson, Kirk, and Dale failed to point out the striking incidence of sacral agenesis in infants of diabetic mothers, first noted in this journal by Rusnak and Driscoll.
PEDIATRIC BILL OF RIGHTS
Authors: Andreasen Susan
Published: December 2021

Recently, while attending a course concerned with Humanities in Medicine I had the pleasure of meeting the 10-year-old daughter of one of the participants. The young lady was party to several of our informal discussions on informed consent and children. She was pleased to hear that a Pediatric Bill of Rights existed but she was most displeased when she read the contents. For the Bill of Rights proposed by the National Association of Childrens Hospitals and Related Institutions1 supports the right of minors to obtain medical care without parental consent if a conflict exists. Susan, objected to this being called the "Pediatric" Bill of Rights for it had little to do with what children would propose. Consequently, she composed a true Pediatric Bill of Rights as follows:

1. Any person regardless of age has the right to refuse pedeatric care.

2. Any person regardless of age has the right to pick there own pedeatrision, if there a girl they can pick a girl, if if there a boy they can pick a boy.

3. Any person regardless of age has the right to not take there medicen if they dont want to.

4. Any person regardless of age has the right not to wear those paperthings at the doctors office.

5. Any person regardless of age has the right not to get weighed at the doctors office.
Maternal Thyroid Status and the Incidence of Respiratory Distress Syndrome: Evaluation of a Proposed Relationship
Authors: Cowett Richard M. , Stern Leo
Published: December 2021

In order to establish whether maternal thyroid hormones cross the placenta and produce surfactant in the fetus, possibly reducing the incidence of respiratory distress syndrome (RDS), a retrospective analysis of low-birthweight infants was undertaken. Results indicate that maternal thyroid hormones play a negligible role and that any thyroid mediation would result from fetal thyroid activity.
Dietary Fluoride Intake of Infants
Authors: Wiatrowski Emilie , Kramer Louis , Osis Dace , Spencer Herta
Published: December 2021

The fluoride content of various commercially available food items used in the preparation of the infant diet for the age groups from birth to 6 months has been analyzed and the total daily fluoride intake has been calculated on the basis of these data. The dietary fluoride intake totaled 0.32 mg/day for infants in the age group 1 to 4 weeks, increased in the subsequent months due to increasing food intake, and totaled 1.23 mg for infants 4 to 6 months of age. These fluoride intakes expressed per kilogram of body weight ranged from 0.07 mg/kg in the newborn to 0.16 mg/kg in the 6-month-old infant.
A Critical Look at Oral Decongestants
Authors: Lampert Richard P. , Robinson Donald S. , Soyka Lester F.
Published: December 2021

The use of decongestants for the common cold remains controversial. Topical decongestants appear effective in shrinking the nasal mucosa and relieving symptoms, but the rebound phenomenon and other undesirable side effects, especially with imidazolines, preclude their more common use in children.12 No clearcut evidence exists for the efficacy of oral decongestants and their use in this regard may be more in the nature of a placebo. Based on Miller's study, decongestants may be helpful in maintaining eustachian tube patency in children with chronic serous otitis media, whereas Rubenstein et al.11 found them to be of no help in acute otitis media. Lacking convincing evidence, one cannot presently recommend on a rational basis the routine use of decongestants in upper respiratory infections.
The Misuse of Antibiotics for Treatment of Upper Respiratory Tract Infections in Children
Authors: Soyka Lester F. , Robinson Donald S. , Lachant Neil , Monaco Joseph
Published: December 2021

Antibiotic therapy has been shown to be of no value in the treatment of the URI—either in shortening the course of the acute illness or in preventing the development of secondary bacterial infections. Patient expense, as well as the threat of adverse reactions, should prohibit the present practice by some of routinely prescribing tetracycline, erythromycin, and ampicillin. Indiscriminate antibiotic therapy cannot substitute for proper diagnostic evaluation of the patient who may have either a bacterial or, far more likely, a viral illness.
Reply to Dr. Schain
Authors: Rapoport Judith L. , Quinn Patricia O.
Published: December 2021

The letter by Dr. Schain1 in the October issue of Pediatrics speculates that our reported relationship between minor physical anomalies and hyperactivity2 is mediated by intelligence. Our population had a mean full-scale IQ of 98 (± 13) and there was no significant correlation between the anomaly score and IQ (r = .00, .12, and .07 for WISC verbal, performance, and full-scale IQ, respectively). In a recent study,3 Waldrop has demonstrated a relationship between anomaly score and deviant behavior in girls, which also holds independent of IQ.
Increased Lead Burden and the Energy Crisis
Authors: deCastro F. J. , Lazzara J. , Rolfe U. T. , Engeler E.
Published: December 2021

The present report describes a child with increased lead burden due to inhalation of fumes from lead-base-painted wood burned in an old faulty furnace.

A 5-year-old boy was referred while asymptomatic with a blood lead level of 67µg/100 ml (atomic absorption). He had no history of pica or abnormal behavior. Physical examination revealed a small, alert, thin white boy whose physical and neurological examination were normal Hemoglobin and urinalysis were normal. Radiographs of the abdomen, left knee, and right elbow were normal.
The sudden infant death syndrome: A new theory
Authors: Beckwith J. Bruce
Published: December 2021

Until a generally accepted basis for the sudden infant death syndrome is found, this condition will remain a fertile field for speculation. In a recent review,1 73 theories to account for this condition were enumerated, and since then the list has grown to well over 100. Some of these are the productions of misguided zealots who attach their pet biases like so many leeches to new or poorly understood afflictions of mankind. Generally this is quite a harmless activity, unless such theories are given undue credence by the lay press or by professionals involved in the counseling of SIDS families.
The Application of Acoustic Impedance Measurements to Pediatric Clinical Practice
Authors: Ehrlich Mary A. , Tait Charles A.
Published: December 2021

This article provides background information on acoustic impedance testing and illustrates utilization of test results in pediatric clinical practice. Acoustic impedance measurement devices are presently being used successfully by hearing screening programs and by otorhinolaryngologists in clinical and hospital settings. As a diagnostic tool, the acoustic impedance bridge can have particular applicability in dealing with young children and other difficut-to-test populations. Impedance measurements can provide physicians with objective information about the condition of the middle ear, oftentimes more accurately than either otoscopic examination or standard audiometry. The technique described can assist physicians in diagnosing middleear diseases and in monitoring the effects of otological treatment.
The Absorption of Iron as Supplements in Infant Cereal and Infant Formulas
Authors: Rios Ernesto , Hunter Robert E. , Cook James D. , Smith Nathan J. , Finch Clement A.
Published: December 2021

The absorption of iron was measured from isotopically tagged salts used in supplementing infant cereals and as the iron supplement in cow's milk and soy-based formulas.

Iron as sodium iron pryophosphate and ferric orthophosphate were poorly absorbed from infant cereal (mean, < 1.0%) and thus are not dependable sources of iron to meet the nutritional needs of infants. Reduced iron of very small particle size and ferrous sulfate when added to cereal was absorbed to a greater extent (mean, 4.0% and 2.7% respectively). For technical reasons, these two forms of iron had not been added to commercial cereal products because of discoloration, distribution problems of the iron in the product, and shortened shelf life. Therefore, at the present time, iron supplementation of infant cereals with sodium iron pyrophosphate, ferric orthophosphate, and reduced iron of large particle size does not provide a predictable and available source of iron to meet the needs of infants.

Supplemental iron as ferrous sulfate in milk- and soy-based formulas gave a mean absorption of 3.4% to 5.4%. The iron supplements in these formulas can essentially meet the needs for dietary iron of healthy infants.
Relationship of Maternal and Infant Iron Stores as Assessed by Determination of Plasma Ferritin
Authors: Rios Ernesto , Lipschitz David A. , Cook James D. , Smith Nathan J.
Published: December 2021

Using plasma ferritin derminations, iron stores have been evaluated at the end of pregnancy in 26 women and followed sequentially in their healthy, full-term infants. It has been shown that the iron storage status of the mother does not affect the iron status of the infant. Determinations of plasma ferritin in the infants have demonstrated that by 6 months of age the iron status of the infant reflects the adequacy of the dietary intake of iron, In the absence of effective iron supplementation during the first six months, plasma ferritin levels fall to low levels, indicating the depletion of iron stores in the infant.
Lettrt To The Editor
Authors: Alvord Ellsworth C. , Shuman Robert M. , Leech Richard W.
Published: December 2021

Dr. McCarl has raised 19 objections to our findings of a vacuolar encephalopathy related to hexachlorophene exposure. We reject each of them.

Dr. McCarl begins by challenging the degree to which our sample was representative of the whole pediatric population. He notes that 70% of the second of our three samples in Table I had to be omitted because the brainstem had been discarded in the five years between the autopsy and our study. He ignores the fact that the first sample had the same prevalence of the vacuolar encephalopathy (11% and 9%, as reported on page 692) and no cases were omitted because the specimens were being brought directly to our neuropathology lab two weeks post-mortem and saved thereafter.
Silver Nitrate Ophthalmic Solution and Chemical Conjunctivitis
Authors: Nishida Hiroshi , Risemberg Herman M.
Published: December 2021

The current status of nursery routines of prophylaxis against ophthalmia neonatorum were surveyed by mail questionnaire to 100 leading maternity hospitaLs. More than 20% of the respondents were not using silver nitrate, mainly because of chemical conjunctivitis. The clinical significance and incidence of chemical conjunctivitis were studied in 1,000 newborns whose eyes were handled differently. Rinsing after instillation of silver nitrate does not reduce the conjunctival irritation. Although 90% of the infants had conjunctivitis in the first six hours of life, the majority cleared within 24 hours. Chemical conjunctivitis did not increase secondary infection, neither did it mask bacterial infection. Silver nitrate is effective in vitro against Neisseria gonorrhoeae and Staphylococcus aureus in a concentration of 0.1% and against Escherichia coil in a concentration of 0.01%.
Body Composition at Menarche: The Frisch-Revelle Hypothesis Revisited
Authors: Crawford John D. , Osler David C.
Published: December 2021

Figures for height and weight and derived values for total body water and fat were assembled for groups of girls with a variety of disorders to examine their conformity to the hypothesis of Frisch and Revelle that menarche occurs at a "critical" weight associated with a decline in metabolic rate and achievement of a characteristic body composition. The groups examined included girls with unusually tall stature, central idiopathic precocity, precocity associated with hypothyroidism, girls with hypothyroidism but lacking signs of sexual maturation, one group with gonadal dysgenesis, and another of girls with obesity. Girls with tall stature significantly exceeded the "critical" weight of 47.8 kg before achieving menarche but had onset of menses in accordance with the body composition hypothesis. The body composition of girls with idiopathic sex precocity was altered toward that at menarche of normals although the patients were much smaller and younger. The same trend was exaggerated in girls in whom precocity was associated with hypothyroidism; equally hypothyroid girls showing no signs of adolescent development had body compositions similar to those of age-matched controls. Girls with gonadal dysgenesis showed an alteration in body composition paralleling that of normals between the ages when the latter begin the pubertal growth spurt and achieve menarche. Girls under 8 years of age with simple obesity had an even greater percentage of body fat than normal menarchal girls but showed no signs of puberty. It is concluded that menarche is not necessarily triggered by achievement of a critical body weight or lowering of metabolism. Neither are the rising levels of estrogen in adolescence solely responsible for the characteristic increase in body fat. Only the data on girls with obesity failed to accord with the generalization that, when the ovaries are competent, menarche is highly correlated ated with achievement of a characteristic body composition. The observations, particularly in gonadal dysgenesis, suggest the pituitary gonadotropins may play a role in determining body composition at menarche.
The Effect of Amniotic Fluid Removal on Pulmonary Maturation in Sheep
Authors: Frantz Ivan D. , Adler Saul M. , Thach Bradley T. , Wyszogrodski Issie , Fletcher Barry D. , Taeusch H. William , Avery Mary Ellen
Published: December 2021

Removal of amniotic fluid and the production of oligohydramnios in the pregnant ewe failed to accelerate pulmonary maturation in the fetal lamb. If further human studies confirm that the PROM induces pulmonary maturation, a third event, perhaps release of a mediator that causes both spontaneous PROM and pulmonary maturation, must be postulated.
Effect of β-Adrenoreceptor Stimulants on Exercise-Induced Asthma
Authors: Sly R. Michael
Published: December 2021

Exercise-induced asthma can be prevented or minimized by β-adrenoreceptor stimulating drugs, which may elicit bronchodilation before exercise has begun or may enhance thebronchodilating effect of more prolonged exercise. Recently introduced β-adrenoreceptor stimulants have longer durations of action than isoproterenol, are effective following oral administration, and are selective for β-adrenoreceptors.
Efficacy of Dyphylline (Dihydroxypropyltheophylline) in Exercise-Induced Bronchospasm
Authors: Estelle F. , Simons R. , Blerman C. Warren , Sprenkle Arthur C. , Simons Keith J.
Published: December 2021

The efficacy of dyphylline in prevention of exercise-induced bronchospasm (EIB) was studied in seven subjects. A single 15 mg/kg dose of dyphylline 40 minutes prior to exercise prevented EIB as documented by a significantly smaller mean greatest percent decrease in forced expiratory volume in one second when compared to placebo. Mean serum dyphylline concentrations 40 minutes after a dose of 15 mg/kg were probably in the lower portion of the therapeutic range.
Fucosidosis Type 2
Authors: Kousseff Boris G. , Beratis Nicholas G. , Strauss Lotte , Brill Paula W. , Rosenfield Richard E. , Kaplan Beatrice , Hirschorn Kurt
Published: December 2021

Two siblings, 9 and 4½ years old, had α-L-fucosidase deficiency, angiokeratoma, progressive psychomotor retardation, neurologic signs, coarse facial features, and dysostosis multiplex. It appears that genetic heterogeneity is present in fucosidosis; there are at least two types. In type 1, patients have no vascular lesions, but have rapid psychomotor regression, severe and rapidly progressing neurologic signs, elevated sodium and chloride excretion in the sweat, and fatal outcome before the sixth year. In type 2, patients have angiokeratoma, milder psychomotor retardation and neurologic signs, longer survival, and normal salinity in the sweat.

Quantitative studies on erythrocytes and in saliva disclosed severely increased expressions of Lea and Leb. Biopsies of skin and gingiva showed alterations as seen in angiokeratoma. There was also evidence of lysosomal storage in vascular endothelium, eccrine sweat gland epithelium, and fibroblasts of the skin.
Compliance With Short-Term Antimicrobial Therapy: Some Techniques That Help
Authors: Lima John , Nazarian Lawrence , Charney Evan , Lahti Corinne
Published: December 2021

The effect of two reminder devices on compliance with a ten-day antimicrobial prescription was investigated in a health center population. The reminders, a clock printed on the prescription label with appropriate times circled and a 5 x 7 inch bright red sticker to be posted at home, were compared to a control group. A total of 158 patients were interviewed at home on the ninth or tenth day of therapy, and compliance estimated by measuring the amount of remaining medication. For children, both reminders improved compliance about two-fold over controls. The findings suggest that (1) several simple reminder devices can be effective and (2) the nature of the patient population may be a more important influence on compliance than the relationship to a physician or the type of health care system. In addition, the study demonstrates the influence of the pharmacist on patients' medication-taking behavior.
The Hematology of Bacterial Infections in Premature Infants
Authors: Zipursky A. , Palko J. , Milner R. , Akenzua G. I.
Published: December 2021

A series of premature infants was studied for the presence of bacterial infection. On the basis of clinical evidence and bacteriological studies, they were divided into three groups in which sepsis was considered to be proven, possible, or unlikely. Band neutrophil counts were elevated most frequently in the "sepsis-proven" group and the elevation occurred usually within 24 hours of onset of signs of disease. Qualitative changes in neutrophils (Döhle bodies, toxic granulation, and vacuolization) were more frequent in the sepsis-proven group and, together with the band count, provided valuable techniques for the diagnosis of bacterial infections.

Thrombocytopenia occurred frequently in the sepsis-proven group and seemed to result from increased utilization or destruction of platelets rather than failure of production. In such cases, evidence of intravascular coagulation was minimal and it was concluded that thrombocytopenia had resulted from a direct effect of the bacteria or its products on platelets and/or endothelium.
Delivery of Health Care for Children: Report of an Experiment
Authors: Alpert Joel J. , Robertson Leon S. , Kosa John , Heagarty Margaret C. , Haggerty Robert J.
Published: December 2021

This paper summarizes an experiment evaluating the effectiveness of primary pediatric care delivered to a sample of low-income inner-city families. Primary pediatric care in this study was similar to pediatric group practice. The study findings indicated that the effects of primary care compared with the episodic care received by the control families were appreciable. This included the decreasing of hospitalizations, operations, illness visits, and appointment breaking; increasing of health supervision visits, preventive services, and patient satisfactions; and accomplishing these changes at a lower cost. Patient morbidity was not altered. Medicaid made no difference in the care patterns of the experimental families and apparently benefited only those control families who were white. The controlled clinical trial offers the best opportunity to compare different models of primary care and the data obtained can be used for planning health services for children.
A Question on Throat Cultures
Authors: Abello Victor B.
Published: December 2021

The article by Drs. Katz and Clancy1 on the home throat culture was well received here because of the importance of throat culture and its interpretation.

As a resident, I notice only those patients with positive β-hemolytic Streptococcus sensitive to bacitracin. The authors' statement that treatment should include a subsequent visit to the physician only if the culture is streptococcal-positive seems to bear out this thinking.

Although the majority of sore throat cultures will not yield Streptococcus because they are mostly viral,2 proper clinical screening will increase the yield.3
Why Not Use Topical Penicillin?
Authors: Lerman Stephen J.
Published: December 2021

The article by Nishida and Risemberg1 is a well-conceived and useful study, but I would like to criticize one point in the discussion.

The authors state that "sensitization of infants" is one of the disadvantages of topical penicillin for prophylaxis of gonorrhea ophthalmia neonatorum. Anthoratative sources have previously sounded the same caveat.2,3 All of the reports of hypersensitivity reactions following ocular use of penicillin ointment or drops, however, deal with adults4-7; "sensitization of infants" with topical penicillin has never been reported.
Pediatric Nuclear Medicine
Authors: Grossman Herman , Felman Alvin , Kirkpatrick John , Shopfner Charles E. , Swischuk Leonard E. , Taber Paddy , Conway James J.
Published: December 2021

The subspecialty of pediatric nuclear medicine has rapidly developed since the last discussion1 of the indications for and value of radionuclide imaging in children. New imaging techniques, equipment, and radiopharmaceuticals have stimulated this rapid growth. Bone imaging with the 99mTc phosphate compounds has been applied to evaluate benign as well as malignant processes. Tumor detection and staging have been accomplished with various 99mTc radiopharmaceuticals. Vesicoureteral reflux is more effectively detected with direct radionuclide cystography. A major role in the detection and evaluation of cardiac abnormalities and shunts has been achieved with nuclear techniques.

Recognition of this remarkable growth and development is found in the publication of several books on pediatric nuclear medicine, the presentation of pediatric nuclear in medicine seminars, and formal sessions at the Society of Nuclear Medicine annual meeting.2-6 This brief discussion will hopefully keep the pediatrician aware of the expanding role that radionuclide techniques have in the management of pediatric patients.
Chromosomal Abnormality in Congenital Rubella
Authors: Ansari B. M. , Mason M. K.
Published: December 2021

An infant with congenital rubella was found to have two extra chromosome fragments in most cells examined. This is an unusual finding in congenital rubella and it is suggested that it may be related to the infection.
The Adaptation of Parents: Postpartum Crisis Counseling
Authors: Funderburk Steve , Richardson Karen , Johnson Joan
Published: December 2021

The article by Drotar et al., which appeared in the November 1975 issue of Pediatrics (56:710, 1975), suggests the need for early crisis counseling to maximize parental attachment and adjustment to the child with a congenital malformation. Long-term follow-up of families with retarded children has revealed a rather depressing outcome, with a paucity of healthy coping mechanisms.1 Parents have appeared resistive to gaining insight into their psychological reactions. They often have expended unrealistic material and emotional efforts on the handicapped child, occasionally even to his detriment as well as to that of the normal siblings.
Dr. Serlin Replies
Authors: Serlin Steven
Published: December 2021

Methenamine silver stains failed to reveal Pneumocystis carinii organisms, and no inclusion bodies suggestive of Pneumocystis or viral agents such as adenovirus or cytomegalic virus were seen. As indicated by the case report, we were acutely concerned about bacterial, viral, fungal, or protozoan infection. There was considerable debate about possible etiologies for the continuing respiratory deterioration but no conclusive evidence was obtained until autopsy. It is because of the clinical and radiographic similarity of rheumatic pneumonia to several infectious agents—generally those considered to be opportunistic—and because of the use of large doses of corticosteroids in patients with rheumatic disease that we encourage lung biopsy so a definitive diagnosis can be made and appropriate therapy instituted.
Differentiation of Orbital Cellulitis From Preseptal Cellulitis by Computed Tomography
Authors: Goldberg Frederick , Berne Alfred S. , Oski Frank A.
Published: December 2021

Computed tomography (CT) was used in the management of four patients with periorbital inflammation. These patients were selected for CT scanning because of the difficulty, on clinical examination alone, in determining the degree of orbital disease. The CT scans confirmed the presence and defined the location of an orbital abscess in three patients and eliminated the presence of an abscess in the fourth. On the basis of this experience, CT scanning is recommended in the evaluation of children with periorbital inflammation in whom proptosis, ophthalmoplegia, or loss of visual acuity develops, or in whom severe eyelid edema prevents adequate eye examination.
Treatment of Tall Girls With Estrogen
Authors: Crawford John D.
Published: December 2021

The practice of giving estrogen to normal girls destined to become taller than they wish goes back to the 1940s. The train of thought leading up to the first trials includes two basic observations. First, it was noted that children in whom persistent precocity syndromes develop early in life become short adults and have premature epiphyseal closure. Second, and conversely, in the absence of the gonadal steroids, the epiphyses remain open indefinitely and growth continues beyond the usual age of cessation. While the majority of these cases are complicated by the presence of pituitary disease and the fact that because of their lack of growth hormone the patients are small, the early clinicians bolstered their faith in the converse by their admiration of the enormous size reputed to be attained by the harem eunuchs.

These observations prompted two conclusions. First, gonadal steroids were not only responsible for closing the epiphyses but also for "turning off" secretion of growth hormone. Thus, in the early 1930s, it was reasoned that while children would be well endowed, adults must lack any circulating pituitary growth hormone, save in the rare instance of acromegaly. These were the concepts that led to the treatment of that disorder first with gonadal extracts,1,2 then, when pure steroids became available, with androgens and estrogens.3 The effect of testosterone was disappointing; the beneficial influence of estrogen, however, was so impressive as to be taken as proof of the earlier drawn conclusion that it is the gonadal steroids that normally turn off growth hormone secretion at adolescence.
Tuberculosis Presenting as an Orbital Mass
Authors: Sheridan Philip H. , Edman Joel B. , Starr Stuart E.
Published: December 2021

A 15-year-old male adolescent underwent surgical exploration for a mass lesion of the left orbit. Orbital and pulmonary tuberculosis were postoperatively diagnosed on the basis of radiologic and histopathologic findings, a positive tuberculin skin test reaction, and positive cultures for Mycobacterium tuberculosis. This case emphasizes the point that tuberculosis should be considered in the differential diagnosis of orbital masses.
Letters to the Editor
Authors: Stare Frederick J.
Published: December 2021

associates and I agree with the last sentence of Dr Rapp's letter, also with the quote from our paper "... that this frustrating problem[of hyperactivity] will remain so until we find the cause or causes and develop an effective treatment." We reiterate the last 12 words of our paper. "... appears now that diet plays, at most, a very minor role."
Platelet Number and Function in Diamond-Blackfan Anemia
Authors: Buchanan George R. , Alter Blanche P. , Holtkamp Christine A. , Walsh Elaine G.
Published: December 2021

Congenital red cell aplasia (Diamond-Blackfan anemia) is occasionally associated with hematologic defects other than a deficiency of red blood cell progenitors, but such alterations have not been well studied. The frequency and magnitude of abnormalities in platelet count and platelet function were therefore examined in 38 patients. Thrombocytosis was seen in 21 patients, and 12 had mild thrombocytopenia on at least one occasion. Elevated platelet counts were demonstrated repeatedly in nine children. The three patients with the lowest platelet counts also had leukopenia. Platelet aggregation was normal in all 16 patients in whom it was studied, and bleeding times were within the normal range in 14 of them. Bleeding signs and symptoms were not observed. It is concluded that thrombocytosis or thrombocytopenia often occurs but that platelet function is normal in patients with Diamond-Blackfan anemia.
WAS MATTHEW ARNOLD'S CROOKED LEG CAUSED BY RICKETS?
Authors: C. T. E.
Published: December 2021

Matthew Arnold (1822-1888), poet and critic, the second child (of nine) and oldest son of Thomas and Mary Arnold, had a crooked leg and spent two years of his childhood in heavy iron braces—the family nicknamed him "Crabby" for his shuffling gait.

Park Homan1 in his recently published biography of Matthew Arnold describes the treatment Arnold received for his crooked leg as follows:

Instructing his infants in oarsmanship, the father now took them out on the Trent in the Frolic.... Within a day or two of this time, she [Mrs. Arnold] noticed that something was wrong with Matthew's leg.... But within ten days of leaving the River Trent, the Arnolds consulted Mr. Tothill, back at home, and then a London specialist—with the result that a frightening iron apparatus arrived ... to be fitted to his limbs. His father was not deeply worried: ‘We have had some anxiety about Matt,’ Thomas Arnold wrote to a friend ... ‘from the Effects of a bad habit of crawling before he could walk, and which was greatly bent one of his Legs, so that he has obliged to wear Irons, and must continue to do so for some time.’

At two or three, most children become excitedly aware of themselves in relation to other people, but Matthew found that thick leg-straps and leg-braces of the heaviest iron made him peculiar and decidedly ugly. He found it difficult to move about and reacted very audibly. ‘I also remember,’ he writes at 13, ‘wearing irons and being obstinate and being taken up to London about my crooked legs.’
Kawasaki Disease: Association with Uveitis in Seven Patients
Authors: Lapointe Normand , Chad Zave , Lacroix Jacques , Jacob Jean-Louis , Urbanski Pierre , Polomeno Robert , Kupfert Beverly , Courtecuisse Victor , Décary Francine
Published: December 2021

Seven patients who fulfilled the clinical criteria for Kawasaki disease were found to have anterior uveitis. All cases were transient and resolved with or without treatment. Histocompatibility antigen typing was performed in four patients. All four demonstrated HLA-A1 and three of the four demonstrated HLA-DR5.
A HOME PLAY AND OCCUPATIONAL PROGRAM FOR THE BEDFAST CHILD; THE COUNTERPANE COURSE
Authors: SCHWENTKER FRANCIS F. , EPPERSON ANNE FELTS , HART ARCHIBALD
Published: December 2021

Many children ill at home or in hospitals are denied the advantage of a planned recreational program. A course has been devised which is complete with adequate instruction books and materials suitable for children 7 to 12 years of age.
ACUTE INFANTILE GAUCHER'S DISEASE
Authors: RODGERS CHARLES LAWRENCE , JACKSON SANFORD HUGH
Published: December 2021

A typical case of acute infantile Gaucher's disease is reported in a female infant, in which the initial symptoms were noted at 3½ months of age and death occurred at 9 months.

Clinical analysis of the liver and spleen showed a considerable excess of ceresin, approximately 73% of which was in the form of glucosido-cerebroside.
CONGENITAL VERBAL-AUDITORY AGNOSIA
Authors: KARLIN ISAAC W.
Published: December 2021

The term congenital verbal auditory agnosia is proposed as a name for congenital word deafness in children.

The clinical features that these children present are: (a) lack of speech or limited speech; (b) an ability to hear sounds combined with inability to comprehend words by the auditory route.

The defect is apparently in the audito-psychic area or Wernicke's area.

The unusual case of a child with congenital verbal auditory agnosia is described.
PROGRESS IN THE STUDY OF "MUCOVISCIDOSIS" (PANCREATIC FIBROSIS)
Authors: SHWACHMAN HARRY
Published: December 2021

IN ACCEPTING the first Mead Johnson Award for the year 1949, I should like to thank those who give it and those who have participated with me in the investigation of nutritional disorders, and particularly of the disease pancreatic fibrosis. I should like to acknowledge the assistance received from Dr. Paul R. Patterson who has been associated with me in most of our studies during the past three years.

Dr. May left the Children's Hospital in Boston over three years ago; it is a pleasure to be reunited with him here and to share this honor. Dr. May and I agreed that it would be difficult for us to attempt a presentation which would cover our independent activities. Instead, I should like to thank him for giving me this opportunity to tell you about some of our recent observations at the Children's Hospital. The advantages of working in an institution, in which a vast amount of energy has been expended over a long period of time in the study of pancreatic fibrosis, is quite obvious. The person most responsible for this activity and progress is Dr. Sidney Farber who has clearly presented a theory concerning the nature of the disease which after many years is being generally accepted. In 1941, he was able to refer to an experience of over 150 patients exhibiting the celiac syndrome studied at post mortem over an 18 year period.

Until recently and with rare exceptions all patients with proved pancreatic fibrosis have died. Nevertheless, I should like to suggest that we have much to gain if we discard the prevailing pessimistic attitude toward this disease (pancreatic fibrosis).
RENAL CARBONIC ANHYDRASE IN PREMATURE AND MATURE INFANTS
Authors: DAY RICHARD , FRANKLIN JANE
Published: December 2021

The carbonic anhydrase activity in the kidneys of premature infants was studied because it was thought that if the renal enzyme is as deficient as that in the blood, inefficiency in acidification of urine might result. In contrast with the blood, postmortem specimens of kidneys of premature infants were found to exhibit carbonic anhydrase activity similar to that found in the case of kidneys from older infants and adults.
PROTEIN-BOUND IODINE IN INFANTS FROM BIRTH TO ONE YEAR OF AGE
Authors: DANOWSKI T. S. , JOHNSTON S. Y. , PRICE W. C. , MCKELVY M. , STEVENSON S. S. , MCCLUSKEY E. R.
Published: December 2021

Statistical comparisons indicate that within 12 hours of birth the serum protein-bound iodine of the infant is of the same order of magnitude, on the average, as that present in maternal blood during pregnancy or within a few hours of delivery. During the remainder of the first week of life there occurs a transient statistically significant increase in the mean value of this iodine fraction. During the sixth to twelfth week the concentrations fall below those present neonatally, but at this time or at any subsequent age up to 1 year, they are still on the average above those encountered in euthyroid nonpregnant adults or in older children. The possible relationship of these higher mean values in infancy to increased thyroid function in the rapidly growing infant have been mentioned with emphasis on the elevated concentration of circulating thyroxin.