bluuebunny/crossref_metadata_2025 huggingface dataset:
REDUCING THE LITERAL AND HUMAN COST OF CHILD ABUSE: IMPACT OF A NEW HOSPITAL MANAGEMENT SYSTEM
Authors: Newberger Eli H. , Hagenbuch John J. , Ebeling Nancy B. , Colligan Elizabeth Pivchik , Sheehan Jane S. , McVeigh Susan H.
Published: December 2021

Social service personnel from one public and two voluntary agencies were integrated into a consultation group in an academic pediatric hospital, leading to a reduction in the actual cost of medical services and the risk of reinjury subsequent to the diagnosis of child abuse. In the 1969-1970 hospital year, 62 cases of child abuse were seen, of which 39 were hospitalized. The average hospital stay was 29 days; the average hospital cost $3,000. Total hospital costs for the 39 cases were $123,000, of which bed costs made up $95,000. There were at least three subsequent incidents of child abuse in these 39 cases, and there was one subsequent death; the reinjury rate was 10% for hospitalized cases.

In September 1970 the Trauma X Group, an interdisciplinary, interagency consultation unit based in the hospital, was formed. With formal consultation and continued surveillance after discharge by the Trauma X Group, the following data were obtained from the 1970-1971 hospital year. Of 86 cases, 60 were hospitalized. The average hospital stay was 17 days; the average hospital cost $2,500. Total hospital costs for the 60 cases was $150,000, of which bed costs made up $101,000. There was one incident of reinjury and no deaths subsequent to diagnosis in these 60 cases; the reinjury rate was 1.7%. The risk of reinjury calculated from a modified life table was reduced from 8% in the year previous to the formation of the group to 7% and 2%, respectively, in the subsequent year and six-month periods, supporting the dollar-cost impression of effectiveness. Foster placement, furthermore, was infrequent and does not explain the differential impact of the Trauma X Group in the intervals under study.
PEDIATRIC NEPHROLOGY E. Mead Johnson Award Address 1972
Authors: Edelmann C. M.
Published: December 2021

The first printed book devoted to pediatrics was entitled The Little Book of the Diseases of Children, written by an Italian, and published in 1472. However, it was not until the 20th century that pediatrics formally emerged as a discipline. The impact of this modern development on the health and welfare of children is reflected in the change in morbidity and mortality statistics of the past 50 years, notably in the areas of infectious diseases and nutritional disturbances.

Now, 500 years after the appearance of The Little Book of the Diseases of Children, advances in our understanding of the biologic base upon which pediatrics is built have made further specialization and subspecialization imperative. No longer is a division into surgical and medical practice adequate. No longer does the separation into pediatric and adult medicine serve to keep the field totally within the grasp of one specialist. As pediatrics was born of internal medicine and obstetrics, so now pediatrics has given birth to new specialties. These offspring, based on organ systems, at first developed parthenogenetically. More recently it has been recognized that fertilization of pediatrics by internal medicine may lead to more viable progeny. Thus, when we speak of the pediatric subspecialties we must recognize that they cannot be exclusively pediatric if they are to be truly system based and take advantage of all the scientific advances within that system. In our own division of pediatric nephrology, we welcome the input of our colleagues from internal medicine, recognizing that they have much to offer to the nephrology half of our title, and much to learn from the pediatric half!
Improvement of Hospital Pediatric Clinics
Authors: Kendall Colin
Published: December 2021

Your reviewers echo Dr. Duff in lamenting teaching clinics' shortcomings.1 Perhaps the pediatric risorgimento is at hand!

Crowding, noise, lack of interest, divided responsibility, and impecuniosity are everywhere and at their glaring worst in certain provincial clinics.

Patients and physicians are bound to agree that "services and teaching are . . . confused and inadequate."

The authors conclude, bleakly, that clinics cannot improve until society changes. Must we then wait for the millennium?

I know no remedy for society's ills (except that money is not the solution) but can offer three modest proposals for hospital clinics:
Letters to the Editor
Authors: Duff R. S. , Rowe D. S. , Anderson F. P.
Published: December 2021

Regarding letters concerning our article (Pediatrics, 50:839, 1972) we respond as follows:

The experiences described by Orenstein and Dietrich no doubt are very instructive. We suspect that learning through observation is a promising and perhaps neglected pedagogic technique. But since students surely retard the work of the observed practitioners, one must ask what is a just compensation. We suggest the customary "prestige" payment (a university appointment) is unsatisfactory.

The sequences of learning and the continuity of care described by Kafka seem reasonable to us.
DIAGNOSIS OF SINUSITIS IN INFANTS AND CHILDREN
Authors: Kogutt Marvin S. , Swischuk Leonard E.
Published: December 2021

A study was undertaken to evaluate sinusitis in infants and children and to correlate the clinical and radiographic findings. Symptoms were often minimal, even in the face of marked sinus involvement, and persistent rhinorrhea, cough, and otitis media were the most common findings. Symptoms such as fever, localized tenderness, and pain were much less frequently encountered, and indeed, were conspicuous by their absence.

Radiographic examination was found to be valuable both in assessing the initial extent of involvement and in following the response to therapy, but probably is not necessary in every case.
The Demonstration of Insulinopenia in Familial Dysautonomia
Authors: Cole Harold S.
Published: December 2021

Children with familial dysautonomia have a marked retardation in height and weight. Nine children with familial dysautonomia and seven control children were studied by means of rapid IVGTTs. The KG and serum levels in insulin and GH were obtained to determine the existence of abnormalities in any of these parameters which might be responsible for growth failure.

There were no significant differences in the KG or GH values between the groups. The insulin values of the dysautonomic children were lower than those of the control children at all the sampling times during the 1-hour test and were statistically significantly lower when the total insulin areas were compared.

These lower levels of serum insulin growth might reduce its effectiveness as an anabolic agent and result in the growth failure of dysautonomic children.
Letters to the Editor
Authors: Costin Gertrude , Kogut Maurice D.
Published: December 2021

Drs. Costin and Kogut comment as follows:

We were pleased to read Dr. Comas' letter in which he describes a 12-4/12-year-old girl whose clinical data suggest that she may be an example of the syndrome that we reported. The evidence for this was the occurrence of menstruation, pubic hair, and breast development when the patient was hypothyroid and disappearance of menstruation following treatment with thyroid hormone. It is not clear why Dr. Comas' patient had an increase in pubic hair and appearance of axillary hair following treatment at a time when her menstrual periods ceased; in all the reported female patients regression of the secondary sexual characteristics was noted following adequate therapy.
Human Pituitary Growth Hormone, by Allen W. Root, M.D. Springfield, Illinois: Charles C Thomas, 1972, 259 pp. $10.50
Authors: Kaplan Selna L.
Published: December 2021

This book, divided into four sections, provides a comprehensive review of the biochemical effects of growth hormone as well as the clinical syndromes associated with abnormalities of its secretion and metabolism.

The book opens with a historical résumé of the "discovery" of this hormone, identification of its varied biologic actions, and isolation from the pituitary gland. The second part discusses the development of radioimmunoassay for measurement of growth hormone by Roth and associates and the subsequent surge in studies of the control mechanisms for the secretion of growth hormone.
EFFECTIVE PULMONARY BLOOD FLOW IN PRETERM INFANTS WITH AND WITHOUT RESPIRATORY DISTRESS: A SIMPLE BEDSIDE METHOD USING NITROUS OXIDE
Authors: Orme Richard L'E , Featherby Elizabeth A. , Rigatto Henrique , Cervantes Francisco J. , Brady June P.
Published: December 2021

We have devised a method of measuring pulmonary capillary blood flow (Qpc eff) suitable for infants with idiopathic respiratory distress syndrome (IRDS). The uptake of nitrous oxide is measured during a 40-second period of rebreathing 40% nitrous oxide in oxygen from a 40- to 80-ml bag. The rate of uptake of nitrous oxide is divided by the solubility in cord blood and the mean alveolar concentration to give Qpc eff.

We studied 14 preterm infants, 7 hours to 14 days of age, on 73 occasions; nine had classical IRDS and five were healthy preterm infants (controls). During the first five days of life Qpc eff was significantly lower in infants with IRDS than in the control infants, 106 ml/kg/min compared with 177 ml/kg/min (P < 0.001). Qpc eff was not related to arterial Po2, Pco2, or pH but was inversely related to the inspired oxygen concentration needed to keep the arterial Po2 within normal limits (P < 0.02). Qpc eff showed a highly significant increase with age in infants with IRDS (P < 0.001). This method provides a reasonably rapid, safe and noninvasive technique for estimating effective pulmonary blood flow in sick infants.
LACK OF CHROMOSOMAL BREAKAGE IN CONGENITAL RUBELLA
Authors: Wolman Sandra R. , McMorrow Lydia E. , Ziring Phillip R. , Cooper Louis Z.
Published: December 2021

We recently examined lymphocyte cultures from 24 children with laboratory-confirmed congenital rubella. Seventy percent of these children were under 1 year of age and thirty percent were virus excretors. The mean percentage of gaps plus breaks in children with congenital rubella was 11.2% versus 8.7% in age-matched controls.

This was not statistically significant. The mitotic response to phytohemagglutinin was not depressed. The apparent discrepancies between these results and those of previous investigations are probably best explained by the broad spectrum of clinical severity in congenital rubella and the fact that a small, but variable, minority of fetal cells become infected in utero.
THE TAY-SACHS DISEASE FIBROBLAST MODEL: FAILURE TO RESPOND TO EXOGENOUS HEXOSAMINIDASE A
Authors: Schneck Larry , Amsterdam Daniel , Brooks Steven E. , Rosenthal Arthur L. , Volk Bruno W.
Published: December 2021

In vitro studies with Tay-Sachs disease (TSD) fibroblast cultures treated with β-D-N-acetylhexosaminidase A (Hex A) did not reveal any detectable incorporation of the enzyme into cultured cells as measured by activity against the fluorogenic substrate or intracellular radioactivity of the 125I-labeled enzyme.

Futhermore, there was no demonstrable alteration of 14C-labeled GM2 (TSD) ganglioside in treated cells. It was concluded that parenteral administration of this enzyme to affected infants is not clinically justifiable.
YOUNG BENJAMIN FRANKLIN DECIDES TO BECOME A VEGETARIAN
Authors: C. T. E.
Published: December 2021

When Franklin (1706-1790) was about 16 years old he read a book by Thomas Tryon (1634-1703) extolling the health benefits of a vegetable diet. Although Franklin did not adhere to such a diet for prolonged periods of time, he periodically would become a vegetarian because it "promoted clearness of ideas and quickness of thought."

"At the time Franklin wrote the passage below he was serving as a printer's apprentice to his older brother, James.

When about 15 years of age I happened to meet with a book written by one Tryon,1 recommending a vegetable diet, I determined to go into it. My brother, being yet unmarried, did not keep house, but boarded himself and his apprentices in another family. My refusing to eat flesh occasioned an inconveniency, and I was frequently chid for my singularity, I made myself acquainted with Tryon's manner of preparing some of his dishes, such as boiling potatoes or rice, making hasty pudding, and few others, and then proposed to my brother, that if he would give me, weekly, half the money he paid for my board, I would board myself. This was an additional fund for buying books, but I had another advantage in it. My brother and the rest going from the printinghouse to their meals, I remained there alone, and, despatching presently my light repast, which often was no more than a brisket of a slice of bread, a handful of raisins or a tart from the pastry-cook's, and a glass of water, had the rest of the time till their return for study, in which I made the greater progress, from that greater clearness of head and quicker apprehension which usually attend temperence in eating and drinking."2
"CHILD HEALTH SUPERVISION–IS IT WORTH IT?" A RESPONSE
Authors: Heavenrich Robert M.
Published: December 2021

Dr. Yankauer's statement that "the methods of child health supervision deserve to be based upon scientific study of their effectiveness and efficiency rather than on outmoded traditions and current fashionable methods"1 is indisputable. Such a study, though difficult to design, is possible. Of necessity the study would be longitudinal, continuing, and costly. Hopefully, conclusions drawn from it could justify the effort.

Others have challenged the sacrosanct methods of child health supervision. The unpublished Schedule for Preventive Health Care (Child Health Supervision) for Children and Youth promulgated by the Committee on Standards of Child Health Care of the American Academy of Pediatrics2 suggests fewer visits to physicians' offices or clinics than have any previous schedules.
GONORRHEAL OPHTHALMIA NEONATORUM
Authors: Shaw Edward B.
Published: December 2021

A national epidemic of gonococcal infection accounts for nearly 50,000 cases monthly, as reported by the U.S. Public Health Services. Admittedly many are unreported. This may include most of those in pediatric patients, like that in an unusual site1 and the other in a more commonly recognized focus,2 described in this issue of Pediatrics. Gonorrheal ophthalmia in the newborn has not occurred very frequently in recent years, although it was previously the most frequent cause of blindness. It might be anticipated that the adult incidence of gonorrhea would cause a corresponding increase in ophthalmia neonatorum.

This neonatal form of infection is not reported in national statistics but in California, where it is reported, there is an average of 8,000 adult cases each month but only two or three newborn cases.
Letters to the Editor
Authors: Chisolm J. Julian
Published: December 2021

I am glad to have the opportunity to respond to Dr. Metcalf's letter to you concerning erythrocyte protoporphyrin tests. A clear distinction should be made between blood lead measurements and measurements such as erythrocyte protoporphyrin tests. Whole blood lead concentration primarily reflects current and recent absorption of lead, but is not a measure of toxicity, per se. Protoporphyrin is one of the heme metabolites which accumulates when heme synthesis is inhibited by lead and so provides a sensitive index of increasing adverse metabolic effect, as the concentration of lead in the tissues increases.
Perinatal vs. Neonatal Mortality
Authors: Houck Peter W.
Published: December 2021

The annual summary of vital statistics for 1971 was noted in the December 1972 issue. I am confused as to the method of reporting newborn deaths. The recently revised Standards and Recommendations, Hospital Care of Newborn Infants handbook recommends reporting a perinatal death rate for international comparability. Stillbirths after 28 weeks and neonatal deaths under seven days* are used as a more relative means of assessing conditions surrounding birth. The following formula is used to calculate the perinatal death rate:
Stillfibel: The Basis of Natural Breast-Feeding (in German), by Dr. med. Henry Otto and Dr. med. Hedda-Maria Otto. Leipzig: Georg Thieme Publisher, 1972, 116 pp., no price given
Authors: Eichenwald Heinz F.
Published: December 2021

This small paperback book on breast-feeding was published in the East German Republic to fill a need for a guide for physicians requiring accurate scientific information. The authors, despite their obvious bias in favor of breast-feeding, approach the matter fairly and completely: beginning with the anatomy of the breast and the physiology of milk secretion, they discuss the pathological physiology of lactation, various diseases and conditions which affect milk secretion and quality, methods of suppressing lactation, and finally, how breast-feeding should be carried out, what the mother (and the father) should be told, what precautions the mother should take, her nutrition during lactation, and what arrangements society should make to encourage breast-feeding since, according to the authors, this is obviously a socially desirable goal.
The Parents' Guide to Drugs, by Matthew Andrews, Garden City, New York: Doubleday & Company, 1972, 186 pp., $2.50
Authors: Faigel Harris C.
Published: December 2021

I have always opened a new book with a sense of adventure promising satisfaction on the one hand and risking disappointment on the other. Generally, I enjoy books; I dislike disappointments. This one is disappointing.

Written in 1971 and published in 1972, it contains nothing about the changing patterns of alcohol, heroin, barbiturate, or soporific abuse of the last two years and is curiously out of date in 1973.

Despite the author's assertions to the contrary, youngsters do use barbiturates and amphetamines for euphoria right from the start.
THE PEDIATRICIAN AND FAMILY RELATIONSHIPS
Authors: Smith Clement A.
Published: December 2021

Among all the specialists, pediatricians should be second only to psychiatrists in their concern with family relationships. And of all family relationships, those involving the mother (as almost every family matter sooner or later does) particularly touch the pediatrician. Until the baby's second or third year, the mother is not only an essential participant in almost all pediatrician-patient encounters, but she necessarily speaks for the patient, often telling how the baby feels, and thus feeling it herself, too. To some extent, as we all know, she is the patient, so central is her involvement. Some of the same relationship continues, gradually modified with the growth of the child's individuality and independence, yet capable of arising at times in all its former intensity.
ANTICHOLINERGIC POISONING: TREATMENT WITH PHYSOSTIGMINE
Authors: Rumack Barry H.
Published: December 2021

The increased incidence of poisoning by overdoses of commonly used drugs with anticholinergic properties (Table I) and the general lack of knowledge concerning a specific treatment for these poisons warrants a summary of the problem at this time. Some plants containing anticholinergic alkaloids are also included in this group as they may also be taken intentionally or accidentally.

Drugs with anticholinergic properties primanly antagonize acetylcholine competitively at the neuroreceptor site. Cardiac muscle, exocrine glands, and smooth muscle are most markedly affected.1 Action of the inhibitors is overcome by increasing the level of acetylcholine naturally generated in the body through inhibiting the enzyme (choline esterase) which normally prevents accumulation of excess acetylcholine. It does this by hydrolyzing that compound to inactive acetic acid and choline. Agents which inhibit this enzyme, so that acetylcholine accumulates at the neuroreceptor sites, are called anticholine esterases.

Physostigmine, one of the anticholine esterases which is a tertiary amine, crosses into the central nervous system and can reverse both central and peripheral anticholinergic actions2. Neostigmine and pyridostigmine are also anticholine esterases but they are quaternary amines and are capable of acting only outside the central nervous system because of solubility and ionization characteristics.

The anticholinergic syndrome has both central and peripheral signs and symptoms. Central toxic effects include anxiety, delirium, disorientation, hallucinations, hyperactivity, and seizures.2 Severe poisoning may produce coma, medullary paralysis, and death. Peripheral taxicity is characterized by tachycardia, hyperpyrexia, mydriasis, vasodilatation, urinary retention, diminution of gastrointestinal motility, decrease of secretion in salivary and sweat glands, and loss of secretions in the pharynx, bronchi, and nasal passages.
Letters to the Editor
Authors: Mofenson Howard C.
Published: December 2021

Each year 1,000 children under the age of 5 are killed riding in automobiles and another 60,000 suffer disabling injuries.

Crash protection does not mean holding a child on the lap of the parent. If an automobile strikes a solid object or comes to a sudden stop the unrestrained passenger continues forward at the rate of speed of the car until stopped by a surface within the vehicle or ejected through the windshield. The geometric increase of the child's weight would not allow the parent's arms to restrain the child.
Health Education: The Other Side of the Coin
Authors: Lagozzino Daniel A.
Published: December 2021

Although I am currently a member in good standing of the AAP School Health Committee and have been for the past four years, your readers may be surprised to find my name missing from the list endorsing the School Health Committee's Statement on Health Education which appears on page 458 in this issue of Pediatrics. Also, the Executive Committee turned down my request to publish a Minority Report. Therefore, this opportunity to describe the other side of the coin is sincerely appreciated.
Letters to the Editor
Authors: Piomelli Sergio , Davidow Bernard , Guinee Vincent F.
Published: December 2021

Dr. Steinfeld's recommendations recognized that in 1970 "the determination of blood Pb level, with all its pitfalls," was generally considered "the most reliable of the many biological tests of indicators of lead exposure and absorption" available at the time. In New York City, the Bureau of Lead Poisoning Control has screened hundreds of thousands of children in high risk areas and detected thousands of children with an elevated blood lead. No administrative decision has been made (and none mentioned in our paper) to replace the blood Pb screening program with the FEP test.
EFFECTS OF MATERNAL NUTRITION ON THE HUMAN FETUS
Authors: Naeye Richard L. , Blanc William , Paul Cheryl
Published: December 2021

In a study of 467 gestations maternal stature had little correlation with fetal growth but mother's pregravid body weight as well as weight gain and low-calorie diets during pregnancy did have such a correlation. Maternal undernutrition before the third trimester had little or no influence on fetal body, organ, and cellular growth while such effects were pronounced in late gestation. Fetal body and organ growth improved with successive pregnancies except in the most poorly nourished mothers, whose successive neonates became more growth retarded.
How "Regular" (and What?) Is the "Regular Source of Medical Care?"
Authors: Mindlin Rowland L. , Lobach Katherine S.
Published: December 2021

The paper by Starfield et al.1 presents useful and interesting data about medical care utilization in a sample of Baltimore children, but it fails to address itself to the question posed in its title.

The paper examines several important attributes (type of provider, accessibility, and financial requirement) of the patients' regular sources of care. It also includes data about the regularity with which those sources are actually used. However, there are no data or tables which specifically show the relationship between regularity of use and the other attributes studies.
In Reply: To Tap, or Not to Tap, in the Febrile Convulsion
Authors: Menkes John H.
Published: December 2021

Rules are made to be broken; the only question is who may safely break them. I would never dispute Dr. Kafka, whose years of pediatric practice support his clinical intuition, if he were to discharge an infant who had just experienced his first febrile convulsion without performing a lumbar puncture. But this shortcut is not reserved for those physicians who have not yet acquired the "feel" for a seriously ill child. After all, a delayed diagnosis of meningitis may well be disastrous.
In Reply: Hypothyroidism After Growth Hormone Therapy
Authors: Rosenfield Robert L. , Refetoff Samuel , DeGroot Leslie J.
Published: December 2021

Drs. Sack and DeLamater quote our paper as confirming the observation that hypothyroidism develops in growth hormone (GH)-deficient patients upon the institution of GH therapy. This statement is incorrect since no significant change in thyroid function was observed during several months of GH therapy. In fact, our data may be interpreted as indicating that some GH-deficient patients have a state of hypothyroidism undetectable by measurement of serum total and free thyroxine levels prior to the institution of GH replacement.
The Therapeutic Choice in Paediatrics, edited by W. L. Burland and B. M. Laurance. Baltimore: The Williams & Wilkins Company, 1972, 228 pp., $16.00
Authors: Shirkey Harry C.
Published: December 2021

This is a fine little book. It is small in size, both in the number of pages and the size of the page, but is loaded with excellent information. While it is oriented from the British point of view it is certainly pertinent to all children except for minor differences in regulatory procedures. The book should be especially valuable for the American audience since a therapeutic crisis has been identified by the then Commissioner of Food and Drugs, Charles Edwards, at the Annual Meeting of the American Academy of Pediatrics, 1972.
DISORDERS OF GONADAL DEVELOPMENT
Authors: Stempfel Robert S.
Published: December 2021

In 1947, Professor Alfred Jost completed a series of classical experiments with the fetal rabbit from which it was shown that early castration in utero resulted in phenotypic femaleness, regardless of genetic sex.1 These observations indicated that masculine differentiation of the internal ducts and of the primordia from which the external genitalia evolve depends solely upon the presence of the fetal testis. It followed also that the fetal ovary is not a determinant of feminine organogenesis, while the testis blocks feminization and induces masculinization.

At about the seventh gestational week, both female (Müllerian) and male (Wolffian) ducts are present in the fetus.
CALIFORNIA ARBOVIRUS (LA CROSSE) INFECTIONS
Authors: Balfour Henry H. , Siem Robert A. , Bauer Henry , Quie Paul G.
Published: December 2021

California encephalitis (CE) has been a significant cause of morbidity in Minnesota, accounting for 6.4% of all laboratory-documented cases of meningoencephalitis during the summers of 1967 through 1972. CE occurred in 66 children aged 6 months to 17 years. All patients were from rural or suburban areas. A mild and a severe clinical form of CE were defined with the severe form becoming more prevalent during the last two years. Focal neurologic findings were present in 16% of patients and localized abnormalities were seen in 40% of EEGs and brain scans. All patients survived but 15% had sequelae. Comparative neutralization and immunodlifusion tests indicated that La Crosse was the subtype responsible for CE in all patients appropriately studied. Since the diagnosis of CE depends on serology, antibody responses in patients during the acute illness and for two years thereafter are described. The clinical features of CE are contrasted with those of herpesvirus, mumps, and enteroviral meningoencephalitis.
LYDIA MARIA CHILD ON THE MANAGEMENT OF GIRLS DURING THEIR TEENS
Authors: C. T. E.
Published: December 2021

Lydia Child (1802-1880), an American author and reformer, was one of the most prominent women of her day. Her advice to mothers on the management of their teen-age daughters would be exceedingly difficult for contemporary mothers to follow. She wrote:

The period from twelve to sixteen years of age is extremely critical in the formation of character, particularly with regard to daughters. The imagination is then all alive, and the affections are in full vigor, while the judgment is unstrengthened by observation, and enthusiasm has never learned moderation of experience. During this important period, a mother cannot be too watchful. As much as possible, she should keep a daughter under her own eye; and, above all things, she should encourage entire confidence towardr herself. This can be done by a ready sympathy with youthful feelings, and by avoiding all unnecessary restraint and harshness. I believe it is extremely natural to choose a mother in preference to all other friends and confidants; but if a daughter, by harshness, indifference, or an unwillingness to make allowance for youthful feeling, is driven from the holy resting place, which nature has provided for her security, the greatest danger is to be apprehended. Nevertheless, I would not have mothers too indulgent, for fear of warning the affections of children. This is not the way to gain the perfect love of young people; a judicious parent is always better beloved, and more respected, than a foolishly indulgent one. The real secret is, for a mother never to sanction the slightest error, or imprudence, but at the same time to keep her heart warm and fresh, ready to sympathize with all the innocent gaiety and enthusiasm of youth.
MIXED GONADAL DYSGENESIS
Authors: Davidoff Frank , Federman Daniel D.
Published: December 2021

The syndrome of mixed gonadal dysgenesis (MGD) is characterized by a unilateral testis, usually intra-abdominal, a streak gonad on the contralateral side, and persistent Mullerian structures. The external genitalia are always masculinized to some extent, on occasion achieveing a normal male phenotype: the somatic signs of Turner's syndrome are frequently present. These patients are always chromatin-negative, and appear to represent the commonest expression of the mosaicism of XO and XY cells, probably resulting from a cytogenetic era very early in embryogenesis. Patients with Turner's syndrome who are slightly masculinized because of "hilus cells" in their streak gonads appear on the one hand to represent a clinical and cytogenetic stage intermediate between MGD and XO Turner's syndrome; while on the other, certain male pseudohermaphrodites with bilateral dysgenetic testes are probably intermediate between MGD and the normal XY male. Testicular androgenic function appears to be quantitatively and qualitatively normal at puberty in MGD, despite complete lack of germ-cell proliferation. The discrepancy between normal Leydigcell function at puberty and the evidence of incomplete genital masculinization during fetal life may possibly be explained by delayed and asynchronous fetal testicular development. Although patients with unilateral gonadoblastoma and contralateral streak gonad were included in the original description of the syndrome of MGD, most such patients differ clinically and cytogenetically from patients with a testis and probably should be considered more akin to patients with the syndrome of pure gonadal dysgenesis, than to MGD.
The Pediatrician, the Epidemic, and the Community
Authors: Seifert Milton H.
Published: December 2021

Sometimes it takes an epidemic to make a practicing physician feel a deep sense of community–not only with his home town but with the resources of his state and nation.

An encephalitis epidemic1 is capable of causing him plenty of discomfort, too. When your neighbor describes some worrisome symptoms over the telephone; when the house call on the daughter of a close friend gives you evidence of CNS involvement; when you are attempting to manage choking and convulsions in the middle of the night–you know these are part of the job of being a family physician, but you also know the ignorance, the fear, and the sense of loneliness.
THE URINARY MANIFESTATIONS OF ANXIETY IN CHILD
Authors: Galdston Richard , Perlmutter Alan D.
Published: December 2021

This report comprises concurrent studies of the urologic and psychiatric manifestations of intrapsychic conflict among a group of children who had been admitted to the surgical wards of The Children's Hospital Medical Center, Boston, between 1965 to 1970 for complaints of disordered urination.

Experience with these children indicates that anxiety can alter the frequency and disturb the adequacy of voiding to a degree sufficient to dispose the child to urinary tract infection. This effect of anxiety can occur both in the presence or absence of a demonstrable anatomic lesion. It suggests that an assessment of the degree and nature of the child's anxiety should be an integral part of the pediatric urologic examination.
Letters to the Editor
Authors: Froehlich Luz A.
Published: December 2021

Dr. Froehlich commented as follows:

With regard to the method of examination of the cord, we wish to reassure Dr. Van Leeuwen that all the examinations were done by pathologists. Based on the "name of examiner" indicated on the standard protocol, it can be clearly stated that the examinations were done in the vast majority of instances by the project pathologist himself or under his supervision. In addition, the protocol required that when a single umbilical artery was initially noted on bisecting the mid-portion of the cord, the rest of the umbilical cord throughout its length was to be examined at one-inch intervals.
Helping the Battered Child and His Family, by C. Henry Kempe, M.D., and Ray E. Helfer, M.D. Philadelphia: J. B. Lippincott, 1972, 313 pp., $8.50 cloth, $4.75 paper
Authors: Newberger Eli H. , Hagenbuch John J.
Published: December 2021

The present literature on child abuse is rife with contradictions. In part this stems from an inadequate base of knowledge about the problem; protective activities on behalf of children are frequently unable to sustain or improve the competence of disorganized families to nurture their offspring. Medical and social work practitioners, not to say health and social planners, who would develop enlightened alternatives to prevailing clinical practice, are obliged to navigate a sea of speculations and substantial theories about child abuse, derived from poorly conceived case series and, not infrequently, from little data at all.
A Simple Method for Changing an Umbilical Artery Catheter
Authors: Heymann Michael A.
Published: December 2021

Umbilical arterial catheterization has become common in the management of sick new-born infants. In addition, the umbilical artery is often used during diagnostic cardiac catheterization for retrograde arterial studies and for monitoring arterial blood pressure and blood gases during the procedure. Many infants with congenital heart disease referred for cardiac catheterization, already have an umbilical arterial catheter in place. The catheter tip may be placed in a variety of positions, usually in the lower aorta below the renal arteries, and cannot be advanced up the aorta as the portion of catheter outside the abdominal wall is not sterile. The catheter can simply be withdrawn and replaced by a new catheter using standard aseptic techniques.
CARDIORESPIRATORY STATUS OF ERYTHROBLASTOTIC NEWBORN INFANTS: II. BLOOD VOLUME, HEMATOCRIT, AND SERUM ALBUMIN CONCENTRATION IN RELATION TO HYDROPS FETALIS
Authors: Phibbs R. H. , Johnson P. , Tooley W. H. , Johnson B. Bradley , Sudman D. , Schlueter M.
Published: December 2021

We measured hematocrit and serum albumin concentration at birth and red blood cell and plasma volume soon after birth in prematurely born infants with erythroblastosis fetalis of varying severity and examined the realtionships between these variables and the presence and severity of hydrops fetalis.

Blood volumes in most of these infants were similar to the established normals for newborn infants without erythroblastosis. There was no simple association between blood volume and the presence of hydrops. Nonhydropic and severely hydropic infants had, on the average, similar and normal blood volumes, while mildly hydropic infants had low blood volumes. Anemia correlated fairly well with severity of hydrops but almost a quarter of the infants with severe hydrops were only mildly anemic. Red blood cell volume decreased and plasma volume increased proportionally with the degree of anemia at birth. Thus, hydropic infants with severe anemia had large plasma volumes while those with milder anemia did not. On the other hand, hypoalbuminemia was common and correlated closely with severity of hydrops.

We suggest that hydrops results at least in part from low plasma colloid osmotic pressure due to hypoalbuminemia.
Diagnostische und Therapeutische Techniken in der Pädiatrie, by Dr. med. Roland Gädeke. Berlin/Heidelberg/New York: Springer-Verlag, 1972, 184 pp., $12.10 (in German)
Authors: Eichenwald Heinz F.
Published: December 2021

What a shame that this small soft-cover volume is not available in English, since it contains a mountain of practical information — tricks of the trade that most of us accumulate only through many years of experience and occasionally more by error than trial!

What Dr. Gädeke has done is to concern himself with the handicraft ("handwerk") of pediatrics: techniques of measurement, diagnosis, therapy, restraint, bandaging, the collection of biological fluids, minor surgical procedures, etc., which the pediatrician and pediatric nurse use in the hospital, in the office, and for parent instruction.
RESPIRATORY DISTRESS AS THE INITIAL MANIFESTATION OF WERDNIG-HOFFMANN DISEASE
Authors: Mellins Robert B. , Hays Arthur P. , Gold Arnold P. , Berdon Walter E. , Bowdler J. Denby
Published: December 2021

Two infants with Werdnig-Hoffmann disease presented with respiratory distress after an initial asymptomatic interval of one to two months. In both patients the finding of bilateral eventration of the diaphragm prior to the loss of deep tendon reflexes or other evidence of muscle weakness led to surgical repair in an attempt to ameliorate the respiratory difficulty. The underlying progressive neuromuscular disease did not become apparent until 3 to 4 months of age and was confirmed in each instance by muscle biopsy and by postmortem examination. We speculate that other infants presenting early in life with fatal respiratory distress of unknown etiology may also have this unusual variant of Werdnig-Hoffmann disease.
Increased Lead Absorption: Paint Is Not the Only Problem
Authors: Mitchell Douglas G.
Published: December 2021

In the first half of fiscal 1972, over 65,000 children in the United States were screened for undue absorption of lead as part of 47 federally funded lead-poisoning control programs. Many state, county, city and citizens groups are carrying out similar programs reaching at least another 65,000 children. This screening is concentrated in decaying urban areas, where many children are exposed to paint chips containing up to 20% lead. Primary emphasis is placed upon detecting children with undue lead absorption and then physically separating them from the lead source: chipped and peeling paint on walls, windows, and skirting boards.

There is little doubt that ingestion of leaded pigmented paint is the prime cause of overt lead poisoning.
Comments
Authors: Sarett Herbert P.
Published: December 2021

Lamm and Rosen's paper in this issue compares levels of lead they reported for processed infant formulas in 1971 with those they found in 1972-1973.

Their comparison is not valid, since an entirely different method of analysis was used in the present report and the levels cannot be compared. The first levels of lead reported in formulas by Lamm et al. were erroneously high; much lower levels were found at that time by the FDA, by the New York City Department of Health, and by manufacturers of infant formulas. Differences in methods of analysis can give wide discrepancies between findings in various laboratories, especially when only "traces" of a substance are measured.
A FEW BELIEFS ABOUT CHILDREN IN THE MEDICAL FOLKLORE OF THE PENNSYLVANIA GERMANS
Authors: C. T. E.
Published: December 2021

The medical folklore of the Pennsylvania Germans is rich with suggestions for the care of children. Although modem medicine continues to supplant folk beliefs of disease and folkways of diagnosis and cure in the lives of the Pennsylvania Germans, nonetheless folk beliefs still linger on.

A few former beliefs about the care of children are these1:

A fretful baby longs for some certain food for which its mother wished in vain during pregnancy. The only remedy is to discover the nature of the food and to give the child a taste of it. To forestall such fretfulness a husband will do all in his power to gratify the fitful desires of his wife.

A child will cease to grow if it is stepped over; if it crawls through an open window, or between the legs of a chair or table; however if it crawls back the same way its growth will not be interrupted.

A cat left alone with a sleeping baby will endeavor to rob it of its breath. An aged person sleeping with a young child will absorb its vitality.

A child will have lofty thoughts if a louse is placed on its head and it is carried to the upper story of the house before it is nine months old.

A fretful unbaptized child cries for a name; a child that cries during baptism is displeased with its name; will become a great singer or preacher; a face washed with baptismal water will become very beautiful.1
Care of the Seriously Ill Neonate With Hyaline Membrane Disease and With Sepsis (Sclerema Neonatorum)
Authors: Prod'hom L. S. , Choffat J.-M. , Frenck N. , Mazoumi M. , Relier J.-P. , Torrado A.
Published: December 2021

1. Intensive treatment of 595 infants with hyaline membrane disease has increased the survival rate from 46% in the years 1966 to 1968 to 68% in the years 1971 to 1972. This improvement is seen in infants with a gestational age of 28 weeks and more in both sexes, not only in the milder form of the disease, but also in the more severely affected infants, whether in the asphyxiated or in the nonasphyxiated group. Mechanical ventilation seems to be a valuable therapeutic tool, particularly in the most severely affected infants.

2. Postmortem examinations have shown the prevalence of three major disturbances other than those of respiration: ventricular and subarachnoidal hemorrhage, infections, and iatrogenic lesions.

3. Among the 355 survivors, the overall frequency of late somatic and neurological sequellae has been found to be 6.5%.

4. It seems justified to stop all reanimation practices in the presence of a ventricular hemorrhage, since this neonatal complication has led always to severe brain damage in the survivors.

5. Exchange transfusion can be effective in the clinical management of septicemia associated with sclerema neonatorum, when given repeatedly.
Cholestyramine Therapy for Intractable Diarrhea
Authors: Tamer M. Akram , Santora T. Richard , Sandberg Douglas H.
Published: December 2021

Seven infants with persistent diarrhea have been successfully treated with a brief course of oral cholestyramine therapy. Two of these infants had diarrhea in the form of profuse watery ileostomy discharge. It is suggested that the mode of action of this drug may be through binding of endotoxin and/or bile acids in the intestinal lumen, thus allowing time for recovery from injury of the intestinal mucosa.
A Method of Securing Orotracheal Tubes in Neonatal Respiratory Care
Authors: Cussel George , Levy Louis , Thompson Richard E.
Published: December 2021

Endotracheal tubes, employed in respirator therapy or CPAP, must remain in place despite frequent suctioning, manipulation of the baby by x-ray and blood-drawing technicians, and changes in the baby's position. After trying several methods, the following simple inexpensive method of securing endotracheal tubes is now used in our NICU.

Materials

Figure 1 pictures the materials that are used. The clamp is a Hollister plastic umbilical clamp with a central hole drilled to accommodate the endotracheal tube. The clamp's "safety lock"is beveled on both sides so the clamp can be opened and closed.
Recurrent Acute Intussusception
Authors: Kenigsberg Kenneth , Lee Jack C. , Stein Harry
Published: December 2021

1. A case of idiopathic recurrent acute intussusception in a 2-year-old male child is presented. The patient was successfully treated with elective ileocolectomy after four recurrences.

2. The incidence of recurrent acute intussusception in children is about 4% and in 20% a specific etiology is identifiable.

3. The treatment of recurrent acute intussusception is essentially the same as that of primary intussusception. However, after the second recurrence, resection of the involved intestinal segment is indicated, as this seems to be the only effective means of preventing further recurrence.
Interspersed Advertising: Invaded Reader Is Attacked—and Counter-Attacks
Authors: Szalay Glenn C.
Published: December 2021

In response to the "Invaded Reader," (Pediatrics, 52:618, 1973), may I congratulate those who made the decision to interpose advertising pages between the textual pages? However, you have not gone far enough! Those of us who tear journals apart for the purpose of filing articles, need complete separation of each article; this need is easily met by interposing pages of advertising.
Nasal Continuous Positive Airway Pressure: Further Details
Authors: Rosenfield Charles S.
Published: December 2021

The recent description by Dr. Kattwinkel et al. of the use of CPAP by the nasal route is quite interesting and encouraging with regard to the delivery of CPAP without intubation. Though the data look quite good, there is no mention of either the starting pressures used or the mean pressure required in the 22 cases reported. I can only presume that in addition to a PaO2 < 50 mm Hg with a FiO2 of 1.0 indicating failure of therapy, the CPAP was not greater than 12 cm of H2O.
The Pediatric Experience of an Experimental Prepaid Group Practice in a Medical School Setting
Authors: Kahn Lawrence , Perkoff Gerald T.
Published: December 2021

The Medical Care Group (MCG) of Washington University is an experimental prepaid group practice which operates as an integral part of a medical school. When the practice was begun, study (MCG) and control group (CG) families were enrolled and selected prospectively by random drawing. Medical care utilization by families in the prepaid group practice (MCG) then was compared with that of families cared for in the traditional fee-for-service system (CG).

The data presented here represent pediatric utilization for the first 25 months' experience. There were 592 pediatric person years of experience (PY) in MCG and 697 PY in CG. MCG enrollees made almost twice as many ambulatory visits as did CG, 3.45 versus 1.79 visits/PY. There were fewer hospital admissions and the average duration of stay was shorter for MCG than for CG. Thus, MCG used 53.4% fewer hospital days 10.8 per 100 PY compared to 23.2 for CG (p = < 0.01). This reduction resulted more from reduced nonsurgical than surgical utilization.

These data substantiate, in a prospectively controlled study of pediatric enrollees, the reduced hospital and increased ambulatory care utilization expected in a prepaid group practice and support the feasibility of conducting such a practice as an integral part of a medical school setting.