bluuebunny/crossref_metadata_2025 huggingface dataset:
Letter To The Editor
Authors: Katz Samuel L.
Published: December 2021

For the Academys' Committee on Infectious Diseases, Dr. Katz writes as follows:

Dr. Lewak has underlined a troublesome confusion in names which has plagued physicians, patients, and parents. The single letter substitution which barely distinguishes rubella from rubeola is too subtle. The use of a national modifier ("German") which implies that rubella is merely another type of measles, is biologically, historically, and semantically unsound. Would that the confusion were limited to laymen alone! Many an obstetrician has telephoned or written to inquire about a pregnant woman with "measles," when his concern was obviously about rubella.
Psychiatry and the Army Brat, by Victor R. Gonzales, M.D. Springfield, Illinois: Charles C Thomas, 1970, 87 pp., $6.50
Authors: Biehusen Frederick C.
Published: December 2021

After reading this book the reviewer's mood changed from one of happy anticipation to one of complete disenchantment.

To help make his points the author, a psychiatrist who recently completed 2 years' service in the Medical Corps of the U.S. Army, selects isolated case histories with the result that one not familiar with service life gains the impression that the average military family has far more problems than its civilian counterpart.

Chapter Two entitled "Discipline: Authority Miscarried" is a case in point.
THE MANAGEMENT OF ELECTRICAL MOUTH BURNS IN CHILDREN
Authors: Gifford George H. , Marty Alan T. , MacCollum Donald W.
Published: December 2021

In spite of efforts to make electrical fittings safe, the incidence of electrical burns of the mouth at Children's Hospital Medical Center has increased. Mouthing a live female extension cord plug is the most common mechanism of injury. Bleeding occurred in 25% of the cases, some time between the first and twenty-first post burn day. Management has therefore included hospitalization during this vulnerable period. Late plastic surgical revision after scar maturation was necessary in 83% of the cases.
Prognosis of Acute Leukemia (Continued)
Authors: Sinks Lucius F.
Published: December 2021

I would like to communicate to Drs. Stein, et al.1,2 the experience of the Pediatric Department of Roswell Park Memorial Institute in order to illustrate the continued improvement in remission and survival rates that has occurred during tue last 7 years. I wish to avoid speculation3,4 as to future survival rates, but to establish firmly the facts that with the accumulation of data through cooperative studies, we have been able to improve upon survival figures. During the years 1963-1965, in the Department of Pediatrics at Roswell Park Memorial Institute, we entered 13 children with acute lymphobiastic leukemia on Acute Leukemia Group B protocol 6307.
Letters to the Editor
Authors: Kravath Richard E.
Published: December 2021

Dr. Harris brings up some important points and correctly is concerned about the clinical application of animal studies. The solution of sodium chloride that we used has an osmolality about 2.8 times higher than the sodium bicarbonate solution in common usage. This difference in concentration does not have a proportionate physiological effect since the shifts in body water produced by a given amount of solute are not linearly related to its osmolality. Four milliliters of a 2.5 M solution contains 10 mEq, while it takes 11.1 ml of a 0.9 M solution to contain the same amount.
THE ROLE OF THE PEDIATRICIAN IN RHEUMATIC FEVER CONTROL
Authors: M. E. A.
Published: December 2021

The following breakdown of the cost of a "strep only" throat culture came to my attention too late for inclusion in the above Commentary. This accounting was prepared by a university hospital laboratory director as justification for charging $7.50 for each such culture. The technique employed is the inoculation of a sheep blood agar plate plus two weak bacitracin disks for differentiation of group A from other hemolytic streptococci.

See Table in the PDF File

Obviously 40 minutes of personnel time (exclusive of professional supervision) is unreasonable. Granting that many other factors require consideration, ranging from the expense of a case of rheumatic fever on the one hand to the fact that the laboratory helps support other facets of hospital operation on the other, this cost is clearly prohibitive. Pediatricians and laboratory directors must find a better way.–
THE EFFECT OF FASTING ON DISACCHARIDASE ACTIVITY IN THE RAT SMALL INTESTINE
Authors: McNeill L. K. , Hamilton J. R.
Published: December 2021

We assessed intestinal structure, mucosal epithelial kinetics, and disaccharidase activities after fasting. Rats fasted for up to 120 hours were compared with control rats fed ad libitum. All rats had free access to water and all were prevented from ingesting their own stools. Body weight, small intestinal weight and mucosal protein, and maltase and sucrase activity of the total small intestine decreased in fasted rats. Lactase activity did not decrease. Specific activity of lactase actually increased in the jejunum. Assessed after a 96-hour fast, jejunal villi were shortened with less epithelial cells along their length and the rate of migration of those cells along the villi was diminished in the fasted rats compared with control rats.

We attribute the decreased total intestinal sucrase and maltase activities to a loss of total epithelial cell mass in the small bowel. An abnormality in the cells of the progenitor zone of the crypts is suggested by the decreased migration rate of mucosal epithelial cells in fasting rats. These factors do not explain our observations completely since lactase activity did not diminish. We postulate that the activity of the "acid" β-galactosidase located in the cytoplasm or lysosomes of the epithelial cells was stimulated by fasting.

Our observations are relevant to clinical pediatrics. Undernutrition and fasting my be associated with many childhood diseases and with treatment of disease. In assessing clinical data and advising treatment, the pediatrician should be aware of the potentially harmful effects of starvation on intestinal structure and function.
LITHIUM TOXICITY IN A NEWBORN
Authors: Woody James N. , London Will L. , Wilbanks George D.
Published: December 2021

The use of lithium salts in the treatment of affective neurosis has recently become popular. There have been no reports of neonatal lithium toxicity although it is embryopathic in other species. A newborn whose mother received lithium during the last month of pregnancy is presented. The infant manifested a 10-day course of cyanosis and lethargy with serum lithium levels in the adult toxic range. It is suggested lithium be used with caution during pregnancy.
INTRA-UTERINE UNDERNUTRITION AND BRAIN DEVELOPMENT
Authors: Chase H. Peter , Dabiere Carol S. , Welch N. Noreen , O'Brien Donough
Published: December 2021

The guinea pig, like the human, initiates the period of rapid brain growth in utero and thus provides a model for measuring the effects of maternal malnutrition on intra-uterine brain growth.

In these studies the newborn of undernourished guinea pig mothers showed significant reductions in body weight and brain weight, cellularity, protein, cholesterol, cerebroside, and sulfatide contents. The reductions in wet brain weight and protein content were significant for cerebellum but not for cerebrum.

Animals undernourished in utero and fed normally after birth showed normal whole brain weight, cerebroside and sulfatide contents, and normal cerebrum cellularity by adulthood. However, the type of cells increasing in the cerebrum during postnatal rehabilitation is unknown. Wet weight and cellularity were still diminished by 22% and 17%, respectively, in the adult cerebella. The results suggest that adequate postnatal nutrition will offset some, though not all of the brain biochemical changes resulting from fetal undernutrition.
BOOK OF ACCIDENTS
Authors: Cone Thomas E.
Published: December 2021

The little girl in the lesson below has half cut off her brother's hand by her carelessness in playing with a knife. The illustration combined with the lesson's pointed text is an excellent example of the tone of writing for children in the 1830's.1
ACUTE AND CHRONIC CHILDHOOD LEAD POISONING
Authors: Wehrle Paul F. , Yamazaki James N. , Brent Robert L. , Chisolm J. Julian , Doyle John L. , Fagan Emmett L. , Finberg Laurence , Nahmias Andre J. , Thompson G. D. Carlyle , Farr Lee E. , Horton Robert J. M. , Miller Robert W. , Coleman Allan B. , Alpert Joel J. , Breault Henri J. , Harris Virginia G. , Scherz Robert G. , Semsch Robert D. , Smith Hugo D.
Published: December 2021

Lead poisoning in childhood is a preventable disease. Virtually all cases occur in children who live in old, deteriorated houses which were built and painted years ago when the use of lead-based paints on housing surfaces was widespread. Eighty-five percent of recognized cases occur in children in the 1- to 3-year age range in which pica (the habit of eating non-food substances) is prevalent. Consequently, the disease results from the interaction between hazardous housing and the child with pica. Early diagnosis of plumbism on clinical grounds alone is exceedingly difficult, and often impossible. Furthermore, by the time the clinical diagnosis is obvious, permanent brain damage which cannot be modified by therapy may already have taken place. Although the true incidence of plumbism is not known, careful surveys have revealed that 10 to 25% of young children who live in deteriorated urban slum housing show evidence of increased absorption of lead and that 2 to 5% show evidence of poisoning. While recent therapeutic advances have reduced the mortality of acute lead encephalopathy, it is now apparent that at least one-third of the survivors of encephalopathy sustain permanent irreversible damage to the brain. Significant reduction in the risk of permanent brain damage, therefore, requires identification of the child with increased body lead burden prior to the onset of poisoning. Fundamentally, both the prevention of adverse health effects due to lead and the treatment of identified cases depend upon the elimination of the housing hazard which lies at the root of the problem.
One More Danger from Toys
Authors: RementeríA José Luis , Coleman Allan B.
Published: December 2021

Recently, in the press, there has been some publicity with regard to the various dangers found in toys. Several weeks ago, we had an incident on one of our pediatric wards which we thought could be informative to other physicians, nurses, and interested personnel.

An 11-month-old female infant was admitted to our pediatric ward due to a convulsive disorder and bronchitis. After 11 days of hospitalization, she was doing well and was about to be discharged.
Toe Tourniquet Syndrome
Authors: Quinn Norman James
Published: December 2021

Five infants seen in the general practice of pediatrics in a 3-year period are presented with an entity which might be called the toe tourniquet syndrome. Each infant who was wearing a leotard type of garment developed edema and inflammation of a toe distal to a constricting band of human hair or thread-like material. It is assumed that a combination of circumstances involving the design of the clothing and the variable response of the plantar reflex in this age group are factors in producing this potentially dangerous lesion.
Severe Rectal Bleeding from an Intramural Hematoma of the Sigmoid
Authors: Schiller Medad , Morse Thomas S. , Frye Thomas R.
Published: December 2021

A rare case of intramural hematoma of the sigmoid colon is presented. The etiology and presenting symptoms in this patient are unusual and were never previously recorded. The diagnostic radiological features are discussed. The nonoperative management in this case affirms the conservative approach to uncomplicated intramural hematomas in other parts of the gastrointestinal tract.
The Drug Users: The Psychopharmacology of Turning On, by A. E. Wilder Smith, D.Sc., Ph.D., Dr.es.Sc., F.R.I.C. Wheaton, Illinois: Harold Shaw Publishers, 1970, 294 pp., $5.95
Authors: Blaine Graham B.
Published: December 2021

This book, written by a professor of pharmacology at The University of Illinois Medical Center, ranges over a vast spectrum by using drugs as a taking off place. Cardinal Mindszenty's trial, astrology, extrasensory perception, REM sleep, and fundamentalist religion are all woven into Professor Smith's discussion of the place of drugs in our present youth culture.

The book starts with seven chapters devoted to a fairly detailed description of the pharmacological properties of certain drugs.
The Transmission of Passive Immunity from Mother to Young (North-Holland Research Monographs, Frontier of Biology Vol. 18), by F. W. Rogers Brambell. New York: American Elsevier Publishing Company, Inc., 1970, 385 pp., $20.75
Authors: Gitlin David
Published: December 2021

This is Professor Brambell's fulfillment of a long-cherished desire; he had wanted to write this monograph for many years, only to be diverted by committee and advisory obligations that are frequently required of a man of his stature. When, at last, he found a year's respite after full retirement from the Department of Zoology, University College of North Wales, and at a time when many might have let the dream remain just that, the book was born–and a fine book it is.
METHADONE AND CHILDREN
Authors: Blatman Saul
Published: December 2021

The increasing use of methadone maintenance (substitution) programs1-3 in the treatment of adult heroin addiction has created situations for children which require the attention of pediatricians. Methadone is an analgesic drug. In urban areas, thousands of heroin addicts are now receiving high dosage of methadone, usually 80 to 120 mg daily. This approach to heroin addiction has met with greater success than any other form of treatment. It is expected that increasing numbers of heroin addicts will be treated in the near future by this method throughout the United States and Canada.4

Pediatricians should focus on three aspects of the problem as follows:
Accidental Methadone Intoxication in a Child
Authors: Sey Mark J. , Rubenstein David , Smith David S.
Published: December 2021

A child with severe accidental methadone intoxication is presented. The symptoms are discussed with particular reference to respiratory depression. The phenomenon of transient pulmonary edema secondary to this intoxication is described, we believe, for the first time in a child.
Cardiac Arrhythmias from Chloral Hydrate
Authors: Silver Walter , Stier Moishe
Published: December 2021

The article in Pediatrics for January, 19711 points out that reports of significant cardiac arrhythmias caused by chloral hydrate are rare.

This drug has been used regularly as a hypnotic by our pediatric neurology department prior to electroencephalography, and no cardiac complications have ever been noted. In 12 consecutive children undergoing electroencephalography we studied electrocardiographic tracings taken before chioral hydrate was given and after the patient was asleep.

The doses of chloral hydrate used in our patients were somewhat higher than those recommended, but we never reached the value considered by the author as toxic.
Letters to the Editor
Authors: Filer L. J.
Published: December 2021

Doctor Filer comments as follows:

If we define nutritional iron deficiency on the basis of a hemoglobin level less than 10 gm per 100 ml, the incidence of this deficiency state among infants of middle-upper socioeconomic groups appears to range from 3 to 8%.1-3 In a nutritional survey of children 1 to 6 years of age composited to resemble the U.S., Owen and co-workers found the incidence of nutritional iron deficiency among infants 12 to 23 months of age to be 6%.4
Modern Perspectives in Child Psychiatry: Modern Perspectives in Psychiatry, No. 1, edited by John C. Howells. New York: Brunner/Mazel, 1971, 605 pp., $20.00
Authors: Aug Robert G.
Published: December 2021

Lamentably, this compendium of comprehensive, high-quality articles on a wide range of topics is a reprint of a book published in 1965. Not a second edition, but a literal reprint. Not only is the content of every article unchanged (including all the bibliographies), but even the paging is identical throughout.

Before elucidating further this unearthedtime-capsule phenomenon (and giving it some justification) let us enumerate the specific topics covered. The book is divided into two sections: Part One, entitled "Scientific Basis of Child Psychiatry," and Part Two, "Clinical Aspects of Child Psychiatry."
EXPIRATORY GRUNTING IN THE LATE CLAMPED NORMAL NEONATE
Authors: Yao A. C. , Lind J. , Vuorenkoski V.
Published: December 2021

Clinical observation on 57 normal term neonates was carried out in regard to respiratory frequency, pattern, and occurrence of expiratory grunting from birth through the first hours of life. In addition to the above observation, 29 infants had simultaneous graphic recordings of their respiratory cycles as sensed by a nasal thermistor and sounds over the tracheal region by a contact microphone. Fourteen infants had their breath and grunting sounds, when present, tape recorded from the moment of birth.

Expiratory grunting was observed in 13 of 33 infants whose umbilical cords were clamped late (3 to 5 minutes after birth); while no one demonstrated this sign among the 24 early clamped infants (cords clamped within 5 to 10 seconds of birth). Grunting, when present, started within the first half hour of life with peak frequency at 30 to 60 minutes and, in most, disappeared gradually by the end of the second to the fourth hour. It is suggested that in the presence of an overdistended circulatory system in the late clamped infants, expiratory grunting serves as a compensatory mechanism in some to better achieve respiratory adaptation at birth when conditions are less than optimal.
Ichthyosis and Methotrexate: Reply to Words of Caution
Authors: Esterly Nancy B.
Published: December 2021

The article by Drs. Jetton and Eby on ichthyosis and methotrexate therapy in the May issue of Pediatrics1 raised some issues which perhaps can be clarified. In treating our patient with nonbullous congenital ichthyosiform erythroderma (CIE)2 we embarked on a trial of methotrexate with trepidation, but did so because the little girl in question was a complete social outcast due to the severity of her disease. Despite higher than average intelligence, the local public school refused to accept her and no appropriate facility could be found for schooling.
Down's Syndrome and Institutionalization
Authors: Scheiner Albert P.
Published: December 2021

The book review by Hans Zellweger, M.D. in the December 1971 issue of Pediatrics of the New York Academy of Sciences' monograph on Down's Syndrome presents some very controversial issues in reference to the institutionalization of retarded children. Dr. Zellweger advocates that "parents have to be convinced that the separation is for the benefit of the affected child and not only for the rest of the family." I am afraid that I also would have to be convinced of the appropriateness of this course of action.
Teen-age Pregnancy: The Family Background
Authors: Shatkin Eugene P.
Published: December 2021

I read the statement of the Committee on Youth concerning teen-age pregnancy and the problem of abortion and I am concerned that they have overlooked or elected to omit comment on more basic problems preceding the pregnancy crisis of the unmarried teen-ager.

Teen-agers of both sexes need advocates and adequate counseling for resolving this crisis. More importantly, I feel, they need an aware primary physician who recognizes the pregnancy as only that part of a larger problem that shows.
Sickle States: Clinical Features in West Africans, by Roger A. Lewis, M.D. Accra: Ghana Universities Press, 1970, 138 pp., $8.50
Authors: Pearson Howard A.
Published: December 2021

In this interesting little book, the author describes the abnormal hemoglobin syndromes and G6PD deficiency disease in a central African nation (Ghana). In a series of short staccatto chapters he describes fundamental and practical aspects of disorders of what he calls, the "African red cell." His brief and often sketchy summaries of complex matters may be confusing for readers with little background in pediatric hematology. For example, in just over three pages of text in Chapter II the author describes the structure and ontogeny of the normal human hemoglobins (A1, A2, and F), the effects of thalassemia and other diseases on hemoglobin components, hemoglobin H and Barts, the biochemical basis of abnormal hemoglobin mutations, principles of hemoglobin electrophoresis, fingerprinting, and hemoglobin-oxygen interactions.
COMPARISON OF PLACENTAS FROM TWO SOCIOECONOMIC GROUPS. I. MORPHOMETRY
Authors: Laga Emil M. , Driscoll Shirley G. , Munro Hamish N.
Published: December 2021

Eighteen placentas from a middleclass North American urban population (Boston) and 20 placentas from a Central American urban population of low socioeconomic status (Guatemala) were examined by morphometric techniques including an image quantizer. Placental mass was 14% less in the Cuatemalan group. Total mass of peripheral villi was decreased 24% with a proportional reduction in trophoblast mass; on the other hand, the mass of the stem villi was only 5% less than in Boston. Villous and capillary surfaces of the peripheral villi were reduced 22% and 38% respectively in the Guatemalan group, while stem villous surfaces and capillary surfaces were actually increased 20% and 40% respectively. No significant differences were found in the cross-sectional areas of villi in the two populations. Because of this similarity of dimensions of average villi in the two groups, the reduction in villous mass and surface areas could only be attributed to a decreased number of villi in the Guatemalan group. Perivillous fibrin was unexpectedly prominent in the Guatemalan placentas and was often associated with mononuclear infiltration, suggesting parenchymal placental disease.
MENKES'S KINKY HAIR SYNDROME
Authors: Danks David M. , Campbell Peter E. , Stevens Brian J. , Mayne Valerie , Cartwright Elizabeth
Published: December 2021

Seven new cases of Menkes's kinky hair syndrome are described from five families. These patients were seen in a period of 3 years in Melbourne and the frequency of the disease is estimated to be 1 in 35,000 live births. Seven other affected males were present in these families and each pedigree was compatible with X-linked inherintance.

Hypothermia was noted to be an important clinical feature which has escaped previous attention. Widespread arterial tortuosity and variation in the lumen of arteries has been demonstrated by arteriography and by microscopic examination at necropsy. Fragmentation of the internal elastic lamina is seen in the arterial walls with thickening of the intima in the most severely affected vessels. This process can lead to complete obliteration of major arteries. Involvement of cerebral arteries is the probable cause of the gliosis and cystic degeneration seen in the brain. Metachromasia was observed in fibroblasts cultured from patients and from heterozygous females.

Low levels of serum copper and ceruloplasmin were found in all patients studied and a defect in the intestinal absorption of copper has been demonstrated. This appears to be the basic defect in the disease and copper deficiency provides an adequate explanation of all the features of the disease. Parenteral administration of copper may prove therapeutically effective.

These findings suggest many new lines of research on copper metabolism and trace metal deficiency.
NINE YEARS' EXPERIENCE WITH "TOTAL THERAPY" OF CHILDHOOD ACUTE LYMPHOCYTIC LEUKEMIA
Authors: Pinkel Donald , Simone Joseph , Hustu H. Omar , Aur Rhomes J. A.
Published: December 2021

Experience with combined chemotherapy and radiotherapy of acute lymphocytic leukemia (ALL) in children is reviewed. Multiple anti-metabolite chemotherapy is effective in prolonging duration of continuous hematological remission. Craniospinal irradiation or cranial irradiation combined with intrathecal methotrexate in adequate doses inhibits relapse in the central nervous system. The high frequency of lengthy continuous complete remission achieved with "total therapy" indicates that ALL in children cannot be considered an incurable disease. Palliation is no longer an acceptable approach to its initial treatment.
CHILDREN'S GAMES
Authors: Iona  , Opie Peter
Published: December 2021

In the past, traditional games were thought to be dying out, few people cared, and the games continued to flourish. In the present day we assume children to have lost the ability to entertain themselves, we become concerned, and are liable, by our concern, to make what is not true a reality. In the long run, nothing extinguishes self-organized play more effectively than does action to promote it. It is not only natural but beneficial that there should be a gulf between the generations in their choice of recreation. Those people are happiest who can most rely on their own resources; and it is to be wondered whether middle-class children in the United States will ever reach maturity ‘whose playtime has become almost as completely organized and supervised as their study’ (Carl Withers). If children's games are tamed and made part of school curricula, if wastelands are turned into playingfields for the benefit of those who conform and ape their elders, if children are given the idea that they cannot enjoy themselves without being provided with the ‘proper’ equipment, we need blame only ourselves when we produce a generation who have lost their dignity, who are ever dissatisfied, and who descend for their sport to the easy excitement of rioting, or pilfering, or vandalism. But to say that children should be allowed this last freedom, to play their own games in their own way, is scarcely to say more than John Locke said almost three centuries ago:

‘Children have as much a Mind to shew that they are free, that their own good Actions come from themselves, that they are absolute and independent, as any of the proudest of your grown Men.’
Drugs (e.g., Hexachiorophene), the FDA, and the AAP
Authors: Marks Ira
Published: December 2021

Although it is now six months since the Food and Drug Administration (FDA) originally approached the American Academy of Pediatrics regarding the potential dangers of hexachlorophene, the Academy (through its Committee on Fetus and Newborn) still seems to be basing its decision on three (unconfirmed) studies referred to in the FDA Bulletin of December 1971.

If the Academy is to become involved in the FDA decision (and I agree that it should) is it not mandatory that we set up specific criteria that must be met before we agree or disagree with any FDA announcement? Simply because the FDA does, must we feel obliged to make decisions on the basis of a few studies which have been repeated by no one? Apparently the Committee has felt so, since it made its recommendation after "reviewing all the available information," i.e., a few unconfirmed studies.
H. influenzae Meningitis: Ampicillin or Chloramphenicol Treatment?
Authors: Slungaard Rolv K.
Published: December 2021

The letter from Dr. Marder concerning the use of ampicillin for Hemophilus influenzae meningitis and the reply from the Committee on Infectious Diseases brought to mind a patient who recently was treated by us for that disease.

The child had been diagnosed as having meningitis and received penicillin elsewhere for two weeks with no good response. A lumbar puncture at the time she was seen by us revealed 1,100 cells, protein of 106 mg/100 ml and sugar of 40 mg/100 ml. Gram stain showed gram-negative rods which were identifled as H. influenzae.
Pediatric Sonoencephalography: The Practical Use of Ultrasonic Echoes in the Diagnosis of Childhood Intracranial Disorders, by A. Mostafawy, in cooperation with J. B. Nagle. Berlin, Heidelberg, New York: Springer-Verlag, 1971, 137 pp., $22.60
Authors: Erba G.
Published: December 2021

The growing number of clinicians interested in Sonoencephalography (SEG) will welcome this compact monograph dealing with "the practical use of ultrasonic echoes in the diagnosis of childhood intracranial disorders." Dr. Mostafawy's monograph represents a step forward over the existing publications on this subject because it strives to establish strict criteria of normality. Those akeady acquainted with A-Mode SEG, will find the first part of the book particularly informative where the findings of ventricular size in normal subjects at different ages are reported.
FETAL OXYGEN CONSUMPTION, CARBON DIOXIDE PRODUCTION, AND GLUCOSE UPTAKE IN A CHRONIC SHEEP PREPARATION
Authors: James Elizabeth J. , Raye John R. , Gresham Edwin L. , Makowski Edgar L. , Meschia Giacomo , Battaglia Frederick C.
Published: December 2021

Metabolic studies were carried out in 22 sheep fetuses free of operative stress. The studies included measurements of umbilical blood flow (175 ± 8 ml/min/kg), fetal oxygen consumption (5.99 ± 0.15 ml/min/kg), carbon dioxide production (5.65 ± 0.17 ml/min/kg), glucose uptake (3.06 ± 0.28 mg/min/kg), respiratory quotient (0.94 ± 0.01), and glucose/oxygen quotient·(0.41 ± 0.03).

The studies demonstrated that fetal glucose uptake could be correlated with the glucose concentration difference betsveen maternal arterial and fetal umbilical arterial blood, as well as with maternal arterial glucose concentration. Umbilical arterial glucose concentration was a function of maternal arterial concentration over the concentration range studied. The study demonstrates that the fetal respiratory quotient is significantly less than one. These data suggest that the accumulation of carbon in the fetus for growth represents approximately 40% of the carbon intake in the growing fetal lamb.
RECURRENT ABDOMINAL PAIN, HEADACHE AND LIMB PAINS IN CHILDREN AND ADOLESCENTS
Authors: Øster Jakob
Published: December 2021

The prevalence of recurrent abdominal pain, headache, and growing pains has been investigated in an eight-year long longitudinal study on the basis of a nonselected population of school children. The prevalence of these pains was 14.4%, 20.6%, and 15.5%, respectively.

Abdominal pain seems to reach a maximum at 9 years of age and headache about three years later. All three sorts of pain show a declining frequency toward adulthood. The ultimate prognosis appears to be dubious.

An inquiry into the families of children with and without recurrent pain shows that these pains are part of a reaction pattern in families with an exceptional pain proneness.
PEDIATRIC PERCEPTIONS: JUMPING THE GENERATION GAP WITH SIXTH, SEVENTH, AND EIGHTH GRADE BOYS
Authors: Wilson James R.
Published: December 2021

The generation gap is supposed to create a great chasm over which it is often quite impossible to communicate. Much of what seems wrong with the younger generation is credited to the unwillingness of the young to listen. For this dilemma I think I have found a cure.

It is just this: Skip a generation; let the grandfather figures do the communicating and carrying of messages. It works!

What a revelation it has been to find that with ease I can communicate effectively with sixth, seventh, and eighth grade boys. Our discussions last as long as 90 minutes. Their interest doesn't waiver; they look me straight in the eye; their questions are intelligent and pertinent. I doubt that this would happen as easily if I were 30 years younger than I am.

Apparently these boys view me as a friendly grandfather figure with whom it is safe and useful to discuss personal and scientific matters, even though I am a member of the establishment.

Here is how it goes: In our schools we show a film entitled "Human Growth." This film covers the essentials of human growth and development from the fertilized ovum to birth and on through adolescence.

After the showing of the film, which takes 15 to 20 minutes, the meeting is opened for questions.

The teacher introduces me. I amplify the teacher's introduction with a few remarks about as follows:

"Would any of you boys like to guess how old I am?" Some student politely underestimates my age.
Leukocyte β-Galactosidase Activity in GM1-Gangliosidosis
Authors: Young Elisabeth , Ellis R. B. , Patrick A. D.
Published: December 2021

The recent article by Singer et al. entitled "Leukocyte beta-Galactosidase Activity in the Diagnosis of Generalized GM1-Gangliosidosis," prompts us to report the results of two years of routine service assay of this enzyme in leukocytes using the alternative substrate, 4-methyl-umbelliferyl β-D-galactopyranoside.

The β-galactosidase assay medium contained McIlvaine phosphate-citric acid buffer, pH, 4.1 (40µl); 4-methylumbelliferyl β-D-galactopyranoside (1 mM in buffer, 150µl) and leukocyte extract in 0.2 MKCl (10µl). After incubation for 15 minutes at 30°C, the reaction was stopped by the addition of 0.25 M glycine-NaOH, pH, 10.4 (1 ml) and the fluorescence measured.
The Metabolic Basis of Inherited Disease, ed. 3, edited by John B. Stanbury, M.D., James B. Wygaarden, M.D. and Donald S. Fredrickson, M.D. New York: McGraw-Hill, 1972, 1778 pp., $45.00
Authors: Sidbury James B.
Published: December 2021

This is the second revision and updating of a book which from the first established a notable standard of excellence and remains without parallel in its area. To keep pace with the information explosion which has occurred in the areas encompassed by this volume the editors have effected major revisions of all chapters except one. New chapters have been added, notably that in cytogenetics. The extensive revision of the chapter on diabetes reflects the extensive new information on control mechanisms in this disease.
NEUROLOGICAL ASSESSMENT OF INFANTS OF DIABETIC MOTHERS IN THE FIRST WEEK OF LIFE
Authors: Priestley Betty L.
Published: December 2021

A method for neurological assessment of gestational age was shown to be reliable on control infants. This method was then used to investigate the neurological development of 55 infants of diabetic mothers (IDMs) during the first week after birth. Neurological maturation in the IDM is shown to be consistent with gestational age. Many of the IDMs showed neurological abnormalities resulting from hypotonia, which in turn correlated well with previous hypoglycemia. The individual tests used in the examination were assessed for reliability.
GROWTH HORMONE RESPONSE TO EXERCISE
Authors: Keenan Bruce S. , Killmer Lewis B. , Sode Jonas
Published: December 2021

Twenty-five healthy children who were not growth hormone-deficient were tested for growth hormone secretion using a standardized exercise protocol. Mean human growth hormone (HGH) values for the group were: resting, 5.7 ± 1.0 ng/ml (SEM); after 20 minutes exercise, 11.8 ± 1.5 ng/ml (SEM); and 40 minutes after beginning protocol, 10.5 ± 1.7 ng/ml (SEM). The mean maximal value for the test, 13.7 ± 1.7 ng/ml (SEM), compared favorably with other standard tests of HGH secretion.

Twenty (80%) had values greater than 6.0 ng/ml on the first test. Twenty-three (92%) had values greater than 6.0 ng/ml when the better of two tests was selected. None had values of 3.0 ng/ml or less.

It is suggested that this test is a reliable stimulus to GH secretion. It has three advantages: it can be done on only three blood samples, in the outpatient clinic, and without the administration of any drug.
A Handbook of Pre-natal Paediatrics for Obstetricians and Paediatricians, edited by Gifford F. Batstone, M.B., B.S., Alastair W. Blair, M.B., Ch.B., M.R.C.P.E., D.C.H., and Jack M. Slater, M.B., Ch.B., M.R.C.O.G. Philadelphia: J. B. Lippincott, 1971, 225 pp., $10.00
Authors: Hobbins John C.
Published: December 2021

The British authors have chosen to call this a "handbook." It may be a handbook in size but not in content. It contains more pertinent information relating to the expanding field of perinatology than most of the bulkier texts on my shelf. Although detail and filigree have been sacrificed, the book is far from dry.

In the early chapters the reader is given a concise account of fetal monitoring by interpretation of continuous fetal heart rate patterns and information obtained from scalp sampling.
PARENTAL MOSAICISM IN TRISOMY 18
Authors: Beratis Nicholas G. , Kardon Nataline B. , Hsu Lillian Y. F. , Grossman Dora , Hirschhorn Kurt
Published: December 2021

Five cases of trisomy 18 were diagnosed in our laboratory during the period of February to July 1970. The parents of these patients were investigated for their chromosomal constitution, thyroid autoantibody (TA) titer, and the presence of hepatitis-associated antigen (HAA). Definite trisomy 18 mosaicism was detected in one of the fathers, while in the leukocyte cultures of one of the mothers two out of 100 metaphases examined were found to have an extra No. 18 chromosome. No case with increased TA titer was found and all of the parents were HAA-negative. Elevated IgM levels were observed in two of the three patients studied. In one of them the IgA was also elevated. The findings of this study suggest that the parents of children with trisomy 18 should be investigated for their chromosomal constitution. This is particularly indicated if the mothers are young.
Vomiting In Utero: Another Case?
Authors: Millunchick Edward W.
Published: December 2021

An article in Pediatrics described vomiting of bile in utero as a sign of possible high intestinal obstruction. I would like to report a similar case.

Baby girl P, birth weight 2,510 gm, was the firstborn of twins delivered shortly after the membranes ruptured. Green amniotic fluid was noted. At birth the infant was slightly depressed. The vocal cords were visualized and some green material was suctioned from the larynx. The infant was then ventilated with bag and mask for a short period of time.
Letter to the Editor
Authors: Patel Rashmi , Groff Diller B.
Published: December 2021

Nowhere in the presentation of the case is there any implication that a tine test is "a diagnostic tool for venereal disease." We felt that the inclusion of the results of a test for one of the granulomatous diseases might be of interest to the readers.
Letters to the Editor
Authors: Schell Norman B.
Published: December 2021

The editorial, "A New Role for the School Physician," by Dr. John Menkes1 in the June issue of Pediatrics intrigued me. Its theme parallels that of my paper: "School Physicians: A Weakening Breed" which will appear in a forthcoming issue of the Journal of School Health.2

I fully agree on the need for retreading the present-day school physician who is woefully inept in many areas affecting school children. He is being gradually replaced by many non-medical disciplines within the schools who have greater expertise in the spheres of behavior, learning, special education, speech therapy, health education, physical conditioning, sports medicine, etc.
Letters to the Editor
Authors: Menkes John H.
Published: December 2021

Dr. Menkes commented as follows on the three letters printed above:

In their justifiably indignant letters both Dr. Frothingham and Dr. Brown indicate their ability and willingness to evaluate the child with a learning disorder, and to set up the school contacts necessary for an adequate follow-up. More power to them! I suspect, however, that many pediatricians do not share their interest in the problem of learning disorders.

I agree with Dr. Brown that school officials are most amenable to an exchange of information with pediatricians, but believe that the "reasonable effort" required to achieve all the contacts is very time-consuming, probably even more so in a large city than in a small community, where there is far more opportunity for physician-school meetings.
Clinical Evaluation of the VMA Test Strip
Authors: Helson Lawrence , Bethune Victor , Schwartz Morton K.
Published: December 2021

The VMA test strip, based upon detection of increased amounts of vanillylmandelic acid (VMA) and metanephrine in urine has had wide publicity as a reliable screening test for neuroblastoma. Its authors report that of a total of 20,000 tests administered, 50, or roughly one per 400 were false-positives. Of these false-positive tests, 15, or 30% were in children with other cancers. Urines from each of 24 children with neuroblastoma tested positive.1

We evaluated the test strip in an ambulatory group of 50 children with cancer, which included eight children with disseminated neuroblastoma and seven other children with histologically proven, treated, and clinically inactive neuroblastoma.
Letters to the Editor
Authors: Glaser Jerome
Published: December 2021

With reference to the discussion of otitis media by Phillips1 and by Bland2 in the August issue of Pediatrics, the report of Tonkin,3 a medical officer in the Department of Health of Auckland, New Zealand, gives strong support to Phillips' suggestion that allergy to cow's milk may be an important predisposing cause of otitis media in infancy. She studied 120 Maori infants all born during the same three-month period. All came from good homes, were well cared for and were not fed lying down.
Behavior Modification Of The Mentally Retarded, edited by Travis Thompson & John Grabowski. New York/London/Toronto: Oxford University Press, 1972, 297 pp., $7.50 cloth, $4.95 paper
Authors: MacCubrey Jean K.
Published: December 2021

The editors of this text admit that the title is probably a misnomer, and it is. This is not a book about all the possible applications of behavior modification principles to the training and education of the wide range of retarded individuals. Nor does it attempt to review systematically the important studies which have been done in recent years. Rather, it describes a number of applications of operant techniques in a particular state institution for the retarded.
THE ADOLESCENT PATIENT'S DECISION TO DIE
Authors: Schowalter John E. , Ferholt Julian B. , Mann Nancy M.
Published: December 2021

Those who are treating a severely ill patient who decides to die are faced with an agonizing dilemma. The problem is magnified when life can be sustained for a significant period if the patient accepts dependence on a drug, a procedure, or a machine. A patient may, however, refuse further transfusions, another course of a cytotoxic drug, further cancer surgery or radiation, an organ transplant, renal dialysis or an artificial organ on pacemaker. New techniques to prolong life make this problem increasingly common in situations where death is not imminent, but the quality of life is greatly impaired. In pediatrics the problem of a patient's decision to die is complicated even more by special developmental, ethical, legal, and family considerations. There has been little discussion in the medical literature of these issues, but recently there has been editorial recognition of the need for further debate on the issues of euthanasia and the child's right to die.1-3 The basic question to be faced is should a physician always oppose a patient's request to end his life and, if not, under what conditions should he respect or even support a patient in his decision to die? These are situations of conflict between our commitment to relieve suffering and our commitment to prolong life. Sometimes it is evident to everyone that death is imminent, the suffering severe, and that efforts to prolong life will only prolong suffering, while at other times it is clear that the wish to die is irrationally out of proportion to the suffering. There is also, however, a very difficult middle ground.
MANAGEMENT OF AN AUTISTIC CHILD UNDERGOING OPEN HEART SURGERY
Authors: Gabriel Hugh Paul , Gluck Regina
Published: December 2021

The hospital course of an autistic child who underwent open heart surgery is outlined. The management using morphine sulfate intravenously for acute control followed by a structured environment with minimal sedation later was extremely effective in controlling this child without the need for restraints. Drugs potentially dangerous to the cardiac status were thus avoided and the child did not suffer any apparent loss of forward gains made during his previous psychiatric treatment.
Gonorrheal Infection and Diagnostic Procedures: A Response to the Statement of the Committee on Youth
Authors: Ris Hania H.
Published: December 2021

The report of the Academy's Committee on Youth on "Venereal Disease and the Adolescent," in your September issue1 is most timely. I would like to comment on the diagnosis of gonorrhea. While the cervix is considered the best site for culture of N. gonorrhoeae, our recent study2 of 1,899 girls yielded positive cultures in 213; 94.2% of these were from the vagina, while subsequent cervical cultures revealed only an additional 13 (5.8%) positive cases. Lucas et al3 found only a similar minor difference, with 92.4% of cervical and 89.5% of vaginal cultures positive in the same patient.
Letters to the Editor
Authors: Fiengold L. Michael
Published: December 2021

The case reported by Drs. Keidel and Feingold of Wilson Mikity Disease in a full-term infant indeed had meconium aspiration as a component. However, the baby went on to have oxygen dependency for at least a month following birth. This of course differs entirely from the syndrome of meconium aspiration. Moreover, the case was reviewed by Dr. Arnold Rudolph and Dr. Victor Mikity who read the x-rays personally. There is no doubt that the case report is valid and can clearly be differentiated from the course of the two infants that Dr. Cohen reported.
An Improved Ear Syringe
Authors: Schmitt Barton
Published: December 2021

Most ear wax succumbs to the well-directed ear currette. When this technique fails because the cerumen is too soft or the ear canal too narrow, one must usually resort to irrigation. The following comments describe an efficient ear syringe that one can quickly assemble when none seems available.

The unit consists of a 10- to 12-cc plastic syringe plus a piece of small plastic tubing. The tubing can be made from any size scalp vein needle set by cutting off the needle about 3 inches from the female connector.
SMALL-GROUP CRITIQUE OF MANAGEMENT OF ACUTE PEDIATRIC PROBLEMS IN FAMILY PRACTICE
Authors: Ross Avron H. , Rodriguez Linda P.
Published: December 2021

This paper describes the conception, inception, and reception of an informal course of instruction for family practitioners referring patients to the Ambulatory Pediatric Service of a suburban Medical Center. The demonstrated need for such instruction and the success of the teaching method used may lead to its adoption elsewhere.
Pyloric Atresia: A Case Report
Authors: Saw Eng Chuan , Arbegast Neil R. , Comer Thomas P.
Published: December 2021

A case of pyloric atresia is reported. This brings the total to 30 such cases in the literature and makes this patient the 22nd survivor in the series. Pyloric atresia must be considered in the differential diagnosis of any high intestinal obstruction in the newborn with bile-free emesis. Early diagnosis and surgical intervention give the patient the best chance of survival.
EXAMINATION OF THE HYPOTHESIS OF A CRITICAL WEIGHT AT MENARCHE IN AMBULATORY AND BEDRIDDEN MENTALLY RETARDED GIRLS
Authors: Osler David C. , Crawford John D.
Published: December 2021

The ages, weights, and calculated total body water and body fat contents as menarche of 44 mentally retarded, institutionalized girls were examined to determine whether they were in accord with the hypothesis that menarche is dependent upon achievement of a critical weight or body water content. The findings in the 35 ambulatory children were in accord with the hypothesis, menarche being achieved later but at attainment of the same weight and body water content as in normal girls. The mean age at menarche of the nine bedridden retarded children was slightly less than that of their ambulatory counterparts and their weights and calculated body water and fat contents were substantially below those of normal girls at menarche.

It is suggested that the effect of being bedridden may be to lower the metabolic rate, thus hastening the time when it falls to the level of 28 calories/kg/24 hr, a characteristic parameter of normal girls at menarche.